Changes in population estimates for electronic nicotine delivery systems (ENDS) have not been investigated in people with schizophrenia-spectrum disorders (SSDs). We assess the prevalence of daily use of ENDS, cigarettes or dual use, and changes in daily use among individuals with SSDs compared with the general population.
Respondents are from the Population Assessment of Tobacco and Health Study, 2016–2023 (age 18+ years) reporting (yes/no) daily combustible cigarette, daily ENDS or daily dual use at each wave (n=33 689 (517 SSD) in 2016–2017). Weighted generalised linear regression models were used to assess changes in odds of use for each product by self-reported SSD diagnosis.
In 2023, people with SSDs reported significantly higher rates of daily cigarette smoking (31.5%, 95% CI 28.6% to 34.4%), ENDS use (6.6%, 95% CI 5.2% to 8.0%) and dual use (1.8%, 95% CI 0.9% to 2.7%), relative to the general population (cigarettes: 10.0% (95% CI 9.7% to 10.2%); ENDS: 3.2% (95% CI 3.1% to 3.4%); dual use: 0.4% (95% CI 0.3% to 0.4%)). From 2016–2023, odds of daily cigarette smoking decreased comparably in people with and without SSDs, but remained significantly higher among people with SSDs over time. Additionally, there was an increase in the odds of ENDS use among people with (OR 1.26, 95% CI 1.11 to 1.43) and without SSDs (OR 1.07, 95% CI 1.05 to 1.10), that was comparable after adjusting for age. Odds of all three daily nicotine use patterns, as well as ENDS and cigarette dependence, were higher in people with SSDs over time.
Despite comparable declines in daily smoking and increases in daily vaping, rates of smoking, ENDS use and dual use were persistently higher among people with SSDs, demonstrating continued nicotine/tobacco health disparities.