A Longitudinal Analysis of Respiratory Illness and Tobacco Use Transitions

Published:October 08, 2022DOI:


      Among individuals with chronic respiratory conditions, transitions between patterns of tobacco product use are not well understood. This study examines how transitions, including quitting altogether, differ over time between those who do and do not have chronic respiratory conditions.


      Data from youth and adult participants of the longitudinal Population Assessment of Tobacco and Health Study (2013–2018) were analyzed. Youth aged 12–17 years were included if they had aged into the adult sample by Wave 4. Stratified polytomous regression models built under a first-order Markov assumption modeled the probability of transitioning between different states/patterns of tobacco product use (exclusive current E-cigarette use, exclusive current combustible tobacco product use, current dual use of combustible products and E-cigarettes, and no current tobacco product use) at each wave. Marginal transition probabilities were computed as a function of ever or past-year diagnosis of a respiratory condition (separately for asthma and a composite variable representing chronic bronchitis, emphysema, and/or chronic obstructive pulmonary disease). Analyses were conducted in 2020–2021.


      Most individuals, regardless of respiratory condition, maintained the same pattern of tobacco use between waves. Exclusive combustible tobacco product users, including those with or without a respiratory condition, were not likely to become exclusive E-cigarette users or to quit using tobacco entirely.


      Although combustible tobacco use negatively impacts the management and prognosis of respiratory illnesses, combustible tobacco users who were recently diagnosed with a chronic respiratory condition were not likely to quit using tobacco. Efforts to encourage and support cessation in this medically vulnerable population should be increased.
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        • Wills TA
        • Pagano I
        • Williams RJ
        • Tam EK.
        E-cigarette use and respiratory disorder in an adult sample.
        Drug Alcohol Depend. 2019; 194: 363-370
        • Osei AD
        • Mirbolouk M
        • Orimoloye OA
        • et al.
        The association between e-cigarette use and asthma among never combustible cigarette smokers: Behavioral Risk Factor Surveillance System (BRFSS) 2016 & 2017.
        BMC Pulm Med. 2019; 19: 180
        • Cho JH
        • Paik SY.
        Association between electronic cigarette use and asthma among high school students in South Korea.
        PLoS One. 2016; 11e0151022
        • Wills TA
        • Soneji SS
        • Choi K
        • Jaspers I
        • Tam EK.
        E-cigarette use and respiratory disorders: an integrative review of converging evidence from epidemiological and laboratory studies.
        Eur Respir J. 2021; 571901815
        • Xie W
        • Kathuria H
        • Galiatsatos P
        • et al.
        Association of electronic cigarette use with incident respiratory conditions among U.S. adults from 2013 to 2018.
        JAMA Netw Open. 2020; 3e2020816
        • Bhatta DN
        • Glantz SA.
        Association of e-cigarette use with respiratory disease among adults: a longitudinal analysis.
        Am J Prev Med. 2020; 58: 182-190
        • Bowler RP
        • Hansel NN
        • Jacobson S
        • et al.
        Electronic cigarette use in U.S. adults at risk for or with COPD: analysis from two observational cohorts.
        J Gen Intern Med. 2017; 32: 1315-1322
      1. U.S. Department of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2014. Accessed February 12, 2021.

        • Rabe KF
        • Hurd S
        • Anzueto A
        • et al.
        Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary.
        Am J Respir Crit Care Med. 2007; 176: 532-555
        • McLeish AC
        • Zvolensky MJ.
        Asthma and cigarette smoking: a review of the empirical literature.
        J Asthma. 2010; 47: 345-361
        • Gotts JE
        • Jordt SE
        • McConnell R
        • Tarran R.
        What are the respiratory effects of e-cigarettes?.
        BMJ (Clin Res Ed). 2019; 366: l5275
        • Huang J
        • Feng B
        • Weaver SR
        • Pechacek TF
        • Slovic P
        • Eriksen MP.
        Changing perceptions of harm of e-cigarette vs cigarette use among adults in 2 U.S. national surveys from 2012 to 2017.
        JAMA Netw Open. 2019; 2e191047
        • Mayer M
        • Reyes-Guzman C
        • Grana R
        • Choi K
        • Freedman ND.
        Demographic characteristics, cigarette smoking, and e-cigarette use among U.S. adults.
        JAMA Netw Open. 2020; 3e2020694
        • Rutten LJF
        • Blake KD
        • Agunwamba AA
        • et al.
        Use of e-cigarettes among current smokers: associations among reasons for use, quit intentions, and current tobacco use.
        Nicotine Tob Res. 2015; 17: 1228-1234
        • Coleman BN
        • Rostron B
        • Johnson SE
        • et al.
        Electronic cigarette use among U.S. adults in the Population Assessment of Tobacco and Health (PATH) Study, 2013–2014.
        Tob Control. 2017; 26: e117-e126
        • Berg CJ.
        Preferred flavors and reasons for e-cigarette use and discontinued use among never, current, and former smokers.
        Int J Public Health. 2016; 61: 225-236
        • Hyland A
        • Ambrose BK
        • Conway KP
        • et al.
        Design and methods of the Population Assessment of Tobacco and Health (PATH) Study.
        Tob Control. 2017; 26: 371-378
      2. American Lung Association. Trends in COPD (chronic bronchitis and emphysema): morbidity and mortality. Chicago, IL: American Lung Association; 2013. Published March 2013. Accessed February 12, 2021.

      3. Dennis ML, Feeney T, Stevens LH. Global Appraisal of Individual Needs-Short Screener (GAIN-SS): Administration and Scoring Manual for the GAIN-SS Version 2.0.1; 2006. Accessed February 12, 2021.

        • Särndal CE
        • Swensson B
        • Wretman J.
        Model Assisted Survey Sampling.
        Springer Science and Business Media, Berlin, DE2003
        • McCaul KD
        • Hockemeyer JR
        • Johnson RJ
        • Zetocha K
        • Quinlan K
        • Glasgow RE.
        Motivation to quit using cigarettes: a review.
        Addict Behav. 2006; 31: 42-56
        • Vangeli E
        • Stapleton J
        • Smit ES
        • Borland R
        • West R.
        Predictors of attempts to stop smoking and their success in adult general population samples: a systematic review.
        Addiction. 2011; 106: 2110-2121
        • van Eerd EA
        • van Rossem CR
        • Spigt MG
        • Wesseling G
        • van Schayck OC
        • Kotz D.
        Do we need tailored smoking cessation interventions for smokers with COPD? A comparative study of smokers with and without COPD regarding factors associated with tobacco smoking.
        Respiration. 2015; 90: 211-219
        • Jiménez-Ruiz CA
        • Masa F
        • Miravitlles M
        • et al.
        Smoking characteristics: differences in attitudes and dependence between healthy smokers and smokers with COPD.
        Chest. 2001; 119: 1365-1370
        • Shahab L
        • Jarvis MJ
        • Britton J
        • West R.
        Prevalence, diagnosis and relation to tobacco dependence of chronic obstructive pulmonary disease in a nationally representative population sample.
        Thorax. 2006; 61: 1043-1047
      4. U.S. Department of Health and Human Services. Smoking Cessation: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General; 2020. Accessed February 12, 2021.

      5. COVID-19: people at increased risk: people with certain medical conditions. Centers for Disease Control and Prevention. 2021. Updated May 13, 2021. Accessed July 23, 2021.

        • Goniewicz ML
        • Smith DM
        • Edwards KC
        • et al.
        Comparison of nicotine and toxicant exposure in users of electronic cigarettes and combustible cigarettes.
        JAMA Netw Open. 2018; 1e185937