Racial Disparities in E-Cigarette Use among Conventionally Smoking Cancer Survivors in the United States, 2014-2018

Introduction Electronic cigarettes (e-cigarettes) have become increasingly popular in the United States, including among cancer survivors, and the majority of users also endorse conventional cigarette usage. There has been little research on racial disparities of e-cigarette usage among this population. Methods Using data from the National Health Interview Survey (2014-2018), trends in e-cigarette usage by smoking status was estimated among cancer survivors reporting a history of conventional cigarette use. Multivariable logistic regression analyses defined adjusted odds of e-cigarette usage including an interaction term between race*smoking status to assess whether the association between race and e-cigarette usage depended on smoking status. Results Among 8,199 cancer survivors with history of conventional e-cigarette usage, 1,422 (17.3%) also reported using of e-cigarettes. The majority (71.3%) of e-cigarette users were current (versus former) conventional cigarette smoking individuals. White race was associated with higher odds of e-cigarette usage (AOR 2.17, 95% CI 2.00-2.33, p < 0.001), however there was a statistically significant race*smoking status interaction term (p < 0.001) such that this association was only seen among current conventional smoking patients (AOR 1.96, 95% 1.67-2.70, p < 0.001; 50.6% vs. 33.7%). Conclusions Among the oncology population, the majority of e-cigarette users also endorsed active conventional cigarette smoking. In particular, dual usage was highest among White cancer survivors suggesting that e-cigarettes may not be an efficacious tool for smoking cessation among this population. Our findings can can help inform targeted screening and counseling efforts among cancer survivors.