Applying Social Cognitive Theory to Identify Predictors of Electronic Nicotine Product Use Trajectories and Cessation
Open AccessElectronic nicotine products (ENPs) are considered less harmful than cigarettes and could contribute to harm reduction if they facilitate sustained smoking cessation. On the other hand, ENPs may impede harm reduction and smoking cessation efforts if they are concurrently used with cigarettes for an extended duration, lead to smoking relapse among former smokers, or contribute to cigarette smoking initiation among never smokers. Additionally, ENPs have independent health risks and their long-term effects are unknown.In this dissertation, Population Assessment of Tobacco and Health (PATH) study data was analyzed to identify trajectories of ENP and cigarette use among adult ENP users. Informed by Social Cognitive Theory (SCT), cognitive, behavioral, and socio-environmental predictors of: 1) ENP and cigarette trajectories; 2) ENP quit attempts and cessation; 3) combined ENP and cigarette smoking abstinence; and 4) exclusive ENP use, were examined among ENP users. Across wave 1 to wave 5, two trajectories of ENP use (declining, consistent) and four trajectories of cigarette use (abstinent, occasional, declining, consistent) were identified. The majority of ENP users (52.3%) belonged to the joint trajectory characterized by declining ENP use and consistent cigarette use. Tobacco and ENP use characteristics emerged as significant predictors of group membership. Higher nicotine dependence was associated with membership in more harmful trajectories. Daily ENP use was associated with membership in less harmful cigarette trajectories but the consistent (vs declining) ENP trajectory. Socio-demographic characteristics also differed across trajectories. Wave 3 predictors of wave 4 ENP quit attempts, cessation, combined ENP and smoking abstinence, and exclusive ENP use included several SCT-based factors. Cognitive factors included interest in quitting ENPs, self-efficacy to quit ENPs, and perceived risk of ENPs; behavioral factors included cigarette smoking status, and use of non-combustibles and marijuana. Socio-environmental factors were household ENP rules and exposure to ENP advertising. However, there were differences in the magnitude and direction of the relationships between these variables and each of the outcomes examined. Findings of this dissertation indicate that SCT offers a useful framework for guiding ENP cessation and harm reduction interventions. ENPs do not appear to be displacing cigarette smoking at the population level, which underscores the need to promote smoking cessation and abstinence among ENP users. Interventions also need to address co-occurring use of other tobacco products and marijuana. Different cognitive factors may need to be targeted based on intervention objectives (harm reduction vs harm prevention) and outcomes (quit attempts vs cessation) of interest. Promoting supportive physical and social environments, through household vaping restrictions and limiting exposure to ENP advertising may also facilitate ENP cessation and harm reduction.
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Krishnan_gwu_0075A_15848.pdf | 2022-10-04 | Open Access |
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