Cumulative Exposure to E-Cigarette Coupons and Changes in E-Cigarette Use Among U.S. Adults

• Published in: American journal of preventive medicine 2024-01, Vol.66 (1), p.55-63
• Main Authors: Duan, Zongshuan, Hamilton-Moseley, Kristen R., McNeel, Timothy S., Berg, Carla J., Choi, Kelvin
• Format: Article
• Language: English
• Subjects: Adult; Cigarette Smoking - epidemiology; Electronic Nicotine Delivery Systems; Health Behavior; Humans; Tobacco Products; Vaping - epidemiology
• ISSN: 0749-3797; 1873-2607; 1873-2607
• DOI: 10.1016/j.amepre.2023.09.001

Coupons are an effective, frequently used tobacco marketing strategy. This study examined prospective associations between cumulative exposure to e-cigarette coupons and changes in e-cigarette use among U.S. adults. Data were from a representative U.S. adult cohort (n=19,824) in the Population Assessment of Tobacco and Health Study (waves [W] 2, 3, 4, and 5), collected from October 2014 to November 2019. Analysis was conducted in 2022. Four logistic regression models examined associations of a number of waves for which participants received e-cigarette coupons during W2–W4 with changes in e-cigarette use: W2 never use to W5 current use (initiation); W2 current nondaily use to W5 daily use (progression); W2 current use to W5 former use (cessation), and W2 former use to W5 current use (return-to-use). Overall, 66.1% of U.S. adults never used e-cigarettes, 10.6% currently used e-cigarettes, and 23.4% formerly used e-cigarettes at W2. The average number of waves for which participants received e-cigarette coupons during W2–W4 was 0.13: 0.10 among W2 individuals who never used e-cigarettes, 0.30 among individuals who currently used e-cigarettes on a nondaily basis, 0.50 among individuals who currently used e-cigarettes, and 0.17 among individuals who formerly used e-cigarettes. Receiving coupons at increased waves was associated with (1) greater odds of initiation (AOR=1.58, 95% CI=1.26–1.97); (2) lower odds of cessation (AOR=0.78, 95% CI=0.67–0.91); and (3) increased odds of return-to-use (AOR=1.39, 95% CI=1.14–1.69). Findings did not differ by W2 cigarette smoking status. E-cigarette coupons may encourage and sustain e-cigarette use. Policies restricting e-cigarette coupons may curb e-cigarette use.