Relating Onset of Health Conditions to Changes in Tobacco/Nicotine Use — Analyses based on the U.S. PATH Study *

	Health condition considered initially	Reason for excluding conditions from analyses presented	Individuals excluded on the basis of health conditions present at Wave 1
1	COPD	Not clearly distinct from 2 or 3	–
2	Chronic bronchitis	Not clearly distinct from 1 or 3	–
3	Emphysema	Not clearly distinct from 1 or 2	–
4	Any major respiratory disease (i.e., conditions 1, 2 or 3)	Included	Any of 1, 2 or 3
5	Asthma	Included	5 only
6	Other lung/respiratory condition	Not clearly defined	–
7	Any respiratory condition (i.e. conditions 1, 2, 3, 5 or 6)	Included	Any of 1, 2, 3, 5 or 6
8	Congestive heart failure	Few changes	–
9	Stroke	Few changes	–
10	Heart attack	Few changes	–
11	Some other heart condition	Not clearly defined	–
12	Any cardiovascular condition (i.e. conditions 8, 9, 10 or 11)	Included	Any of 8, 9, 10 or 11
13	High blood pressure	Included	13 only
14	High cholesterol	Included	14 only
15	Diabetes (sugar or borderline)	Included	15 only
16	Cancer	Included	16 only
17	Tobacco-related cancer	Few changes	–
18	Any major smoking-related condition (i.e., conditions 4, 7 or 12)	Included	Any of 4, 7 or 12

Table 2.

Changes in tobacco/nicotine product use between Waves 1 and 4 in relation to onset of health condition in Waves 2 or 3^a.

Note that initiation and quitting of cigarettes is regardless of e-cigarette use, and that initiation of e-cigarettes is regardless of smoking habits.

Change in product use in relation to onset of health condition	OR for main analysis^b	OR excluding other tobacco/nicotine product users^c	OR controlling for three more variables^d
Initiation of smoking
Any major respiratory condition	1.11 (0.85–1.44)	0.91 (0.65–1.27)	1.01 (0.78–1.32)
Asthma	1.14 (0.84–1.56)	0.95 (0.63–1.43)	1.08 (0.79–1.48)
Any respiratory condition	1.05 (0.86–1.28)	0.82 (0.63–1.07)	0.98 (0.80–1.19)
Any cardiovascular condition	1.65 (1.31–2.08)	1.96 (1.49–2.59)	1.61 (1.27–2.04)
High blood pressure	1.34 (1.13–1.58)	1.23 (0.99–1.52)	1.28 (1.08–1.52)
High cholesterol	1.05 (0.89–1.23)	0.88 (0.71–1.08)	1.03 (0.87–1.22)
Diabetes	1.15 (0.95–1.38)	1.17 (0.93–1.47)	1.11 (0.92–1.33)
Cancer	1.41 (0.96–2.05)	1.55 (0.98–2.46)	1.34 (0.92–1.97)
Any major smoking-related condition	1.35 (1.12–1.62)	1.51 (1.20–1.89)	1.28 (1.06–1.54)
Quitting of smoking
Any major respiratory condition	0.97 (0.75–1.24)	1.86 (1.22–2.83)	1.07 (0.83–1.39)
Asthma	0.90 (0.64–1.27)	0.96 (0.50–1.82)	0.96 (0.68–1.36)
Any respiratory condition	1.06 (0.86–1.32)	1.47 (1.00–2.17)	1.16 (0.93–1.44)
Any cardiovascular condition	1.16 (0.87–1.54)	0.98 (0.56–1.74)	1.27 (0.95–1.69)
High blood pressure	1.09 (0.87–1.37)	1.84 (1.20–2.83)	1.16 (0.92–1.45)
High cholesterol	1.29 (1.02–1.62)	1.75 (1.17–2.62)	1.34 (1.06–1.70)
Diabetes	1.08 (0.82–1.42)	1.37 (0.86–2.18)	1.17 (0.89–1.54)
Cancer	0.77 (0.47–1.25)	1.38 (0.59–3.23)	0.81 (0.50–1.33)
Any major smoking-related condition	1.05 (0.84–1.30)	1.73 (1.18–2.56)	1.16 (0.93–1.44)
Initiation of e-cigarettes
Any major respiratory condition	2.86 (2.10–3.90)	3.36 (1.76–6.42)	2.02 (1.47–2.79)
Asthma	1.57 (1.05–2.35)	1.78 (0.75–4.22)	1.29 (0.85–1.95)
Any respiratory condition	2.08 (1.61–2.68)	1.41 (0.71–2.83)	1.67 (1.28–2.18)
Any cardiovascular condition	1.67 (1.16–2.42)	2.21 (1.08–4.55)	1.42 (0.98–2.08)
High blood pressure	1.55 (1.19–2.01)	1.38 (0.74–2.57)	1.28 (0.98–1.67)
High cholesterol	1.33 (1.01–1.75)	1.38 (0.76–2.49)	1.33 (1.00–1.77)
Diabetes	1.74 (1.31–2.32)	2.32 (1.37–3.92)	1.61 (1.20–2.16)
Cancer	2.51 (1.52–4.14)	3.67 (1.48–9.13)	2.14 (1.27–3.60)
Any major smoking-related condition	1.94 (1.48–2.55)	2.61 (1.50–4.51)	1.55 (1.17–2.06)

1 ^a Numbers of adults changing tobacco/nicotine habits between Waves 1 and 4 are shown in Supplementary File 1 for each combination of health condition and change for the main analysis. Numbers for the other analyses are shown in the detailed results (Supplementary File 2).

1 ^b Adjusted for sex and broad age groups

1 ^c Excluding users of traditional cigars, filtered cigars, pipes, hookahs, smokeless tobacco, snus, and dissolvable products

1 ^d Also adjusted for income, region and use of the products included in footnote b OR = odds ratio with 95% confidence interval.

Table 3.

Other changes in tobacco/nicotine habits between Waves 1 and 4 in relation to onset of health conditions in Waves 2 or 3 (main analyses)^a.

Health condition	ORs for change in tobacco/nicotine habits
Health condition	Re-initiating cigarettes	Initiating cigarettes in never e-cig users	Quitting cigarettes in never e-cig users	Re-initiating cigarettes in never e-cig users	Initiating e-cigarettes in never smokers	Smokers becoming dual users
Any major respiratory condition	1.22 (0.57–2.61)	1.08 (0.83–1.41)	0.97 (0.74–1.27)	1.14 (0.48–2.70)	3.36 (1.57–7.16)	1.49 (0.98–2.27)
Asthma	0.95 (0.41–2.30)	1.15 (0.84–1.57)	0.77 (0.52–1.14)	0.93 (0.36–2.38)	1.96 (0.79–4.83)	0.65 (0.32–1.33)
Any respiratory condition	0.98 (0.54–1.76)	1.03 (0.85–1.26)	1.06 (0.84–1.34)	0.89 (0.45–1.76)	1.99 (1.02–3.88)	1.53 (1.06–2.21)
Any cardiovascular condition	0.73 (0.35–1.51)	1.64 (1.30–2.07)	1.12 (0.82–1.52)	0.60 (0.25–1.41)	1.82 (0.77–4.32)	1.42 (0.83–2.42)
High blood pressure	1.17 (0.73–1.88)	1.32 (1.11–1.57)	0.97 (0.75–1.25)	0.99 (0.57–1.73)	1.33 (0.76–2.33)	0.91 (0.58–1.42)
High cholesterol	1.18 (0.76–1.84)	1.04 (0.88–1.23)	1.24 (0.96–1.59)	1.29 (0.80–2.09)	1.21 (0.65–2.25)	1.45 (0.94–2.23)
Diabetes	1.80 (1.09–2.98)	1.14 (0.95–1.38)	1.05 (0.78–1.41)	2.02 (1.18–3.46)	4.23 (2.45–7.29)	1.02 (0.60–1.75)
Cancer	0.81 (0.25–2.64)	1.39 (0.94–2.05)	0.66 (0.38–1.15)	0.86 (0.24–3.12)	2.36 (0.63–8.78)	0.57 (0.19–1.74)
Any major smoking-related condition	0.95 (0.52–1.74)	1.33 (1.11–1.61)	1.03 (0.81–1.31)	0.94 (0.48–1.84)	2.20 (1.17–4.14)	0.95 (0.62–1.46)

1 ^a Numbers of adults changing tobacco/nicotine habits between Waves 1 and 4 are shown in Supplementary File 1 for each combination of health condition and change

1 OR = odds ratio with 95% confidence interval.

Table 4.

Comparison of original results (adjusted for sex and age group) with those avoiding reverse causation (see footnote).

Results not shown for analysis or combined analysis where number of changes following onset of the condition is less than 2.

Health condition	Tobacco/nicotine habit change		Original results	Additional analysis C	Additional analysis D	Additional analyses C + D
Any major respiratory condition	Initiating smoking	OR	1.11 (0.85–1.44)	1.22 (0.78–1.89)	–	–
	Initiating smoking	n	286	113	80	193
	Quitting smoking	OR	0.97 (0.75–1.24)	0.75 (0.47–1.20)	1.78 (1.12–2.83)	1.16 (0.84–1.61)
	Quitting smoking	n	459	218	181	399
	Initiating e-cigarettes	OR	2.86 (2.10–3.90)	3.92 (2.39–6.45)	1.74 (0.48–6.32)	3.53 (2.22–5.61)
	Initiating e-cigarettes	n	656	321	255	576
Any respiratory condition	Initiating smoking	OR	1.05 (0.86–1.28)	1.15 (0.82–1.60)	1.01 (0.32–3.20)	1.14 (0.83–1.57)
	Initiating smoking	n	553	237	163	400
	Quitting smoking	OR	1.06 (0.86–1.32)	0.83 (0.57–1.23)	1.56 (1.01–2.42)	1.09 (0.82–1.46)
	Quitting smoking	n	639	310	234	544
	Initiating e-cigarettes	OR	2.08 (1.61–2.68)	2.64 (1.73–4.05)	2.18 (0.96–4.99)	2.54 (1.74–3.70)
	Initiating e-cigarettes	n	1092	543	437	980
Any cardio-vascular condition	Initiating smoking	OR	1.65 (1.31–2.08)	2.29 (1.63–3.22)	0.93 (0.16–5.57)	2.22 (1.59–3.10)
	Initiating smoking	n	279	117	66	183
	Quitting smoking	OR	1.16 (0.87–1.54)	0.97 (0.57–1.64)	1.22 (0.63–2.35)	1.06 (0.70–1.60)
	Quitting smoking	n	331	150	123	273
	Initiating e-cigarettes	OR	1.67 (1.16–2.42)	1.83 (0.95–3.53)	1.26 (0.28–5.75)	1.72 (0.94–3.15)
	Initiating e-cigarettes	n	587	287	248	535
Any major smoking-related condition	Initiating smoking	OR	1.35 (1.12–1.62)	2.03 (1.55–2.65)	0.95 (0.24–3.87)	1.98 (1.52–2.57)
	Initiating smoking	n	521	219	139	358
	Quitting smoking	OR	1.05 (0.84–1.30)	0.79 (0.53–1.19)	1.61 (1.05–2.49)	1.10 (0.82–1.48)
	Quitting smoking	n	606	286	227	513
	Initiating e-cigarettes	OR	1.94 (1.48–2.55)	2.22 (1.39–3.55)	0.93 (0.26–3.42)	2.01 (1.29–3.12)
	Initiating e-cigarettes	n	1048	526	412	938

1 Additional analysis C is restricted to those with unchanged tobacco/nicotine habits at Waves 1 and 2, and relates changes in tobacco/nicotine use between Waves 1/2 and Wave 4 according to whether onset of the condition occurred in Wave 2. Additional analysis D is restricted to those with unchanged tobacco/nicotine habits at Waves 1, 2 and 3, and relates changes in tobacco/nicotine use between Waves 1/2/3 and Wave 4 according to whether onset of the condition occurred in Wave 3.

1 OR = odds ratio with 95% confidence interval.

1 n = number of changes.

Table 5.

Change in amount smoked (cigs/day) between Waves 1 and 4 in relation to onset of health conditions in Waves 2 or 3.

Health condition	Change (95% CI)^a with 95% confidence interval and coded probability values^b
Health condition	Additional analysis E in continuing smokers at Waves 1 and 4	Additional analysis F in smokers at Wave 1 (allowing for quitting only)^c	Additional analysis G in the whole Wave 1 population (allowing for quitting and relapse)^c
Any major respiratory condition	−0.29 (−1.18 to +0.60)	−0.77 (−1.69 to +0.14)	−0.36 (−0.71 to −0.02) *
Asthma	−0.13 (−1.38 to +1.11)	+0.08 (−1.19 to +1.34)	−0.05 (−0.51 to +0.41)
Any respiratory condition	+0.06 (−0.71 to +0.84)	−0.43 (−1.21 to +0.36)	−0.23 (−0.51 to +0.04)
Any cardiovascular condition	−2.24 (−3.31 to −1.16) ***	−2.32 (−3.40 to −1.23) ***	−0.39 (−0.73 to −0.05) *
High blood pressure	−1.08 (−1.94 to −0.22) *	−1.03 (−1.88 to −0.17) *	−0.13 (−0.39 to +0.14)
High cholesterol	−0.48 (−1.35 to +0.39)	−0.64 (−1.52 to +0.24)	−0.11 (−0.37 to +0.15)
Diabetes	−0.43 (−1.43 to +0.56)	−0.21 (−1.22 to +0.79)	−0.07 (−0.37 to +0.23)
Cancer	+0.12 (−1.63 to +1.88)	+0.37 (−1.43 to +2.18)	+0.00 (−0.61 to +0.61)
Any major smoking-related condition	−0.36 (−1.16 to +0.44)	−1.18 (−1.99 to −0.36) **	−0.21 (−0.47 to +0.06)

1 ^a All analyses are adjusted for age and sex and take person-level weights into account.

1 ^b *** p < 0.001, ** p < 0.01, * p < 0.05

1 ^c While Additional analysis E is restricted to those smoking a positive number of cigs/day at Waves 1 and 4, Additional analysis F also includes those not smoking cigarettes at Wave 4, while Additional analysis G also includes those not smoking cigarettes at Waves 1 or 4.

Articles in this issue

DOI: https://doi.org/10.2478/cttr-2023-0001 | Journal eISSN: 2719-9509 (formerly 1612-9237)

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Language: English, French, German

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Submitted on: Oct 6, 2022

Accepted on: Jan 10, 2023

Published on: Mar 13, 2023

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Volume 32 (2023): Issue 1 (March 2023)