BACKGROUND: E-cigarettes are increasingly used as smoking cessation aids, yet population-level evidence on whether health status improves with time since smoking cessation among exclusive e-cigarette users remains limited. This study examined the association between time since cigarette smoking cessation and self-rated health among current e-cigarette users who were former smokers in Scotland and further explored whether duration of current e-cigarette use was associated with self-rated health within this group.

METHODS: A pooled cross-sectional analysis was conducted using seven waves of the Scottish Health Survey (2017-2024, excluding 2020). The analytic sample comprised 5,064 adults: 3,722 current cigarette smokers who were not currently vaping (reference group) and 1,342 current e-cigarette users who were former smokers, categorised by time since cessation (< 1 year, 1 to < 5 years, and ≥ 5 years). The outcome was self-rated health, measured on a five-category ordinal scale from very good to very bad. Associations were estimated using survey design-adjusted ordered logistic regression, adjusted for age, sex, ethnicity, area deprivation, limiting long-standing illness, and survey year. A secondary analysis restricted to current e-cigarette users who were former smokers examined time since cessation alone and, in a supplementary joint model, additionally included duration of current e-cigarette use (< 1 year, 1 to < 3 years, and ≥ 3 years).

RESULTS: In the fully adjusted main model, current e-cigarette users who had quit smoking 1 to < 5 years earlier (OR 0.81, 95% CI 0.68-0.96; p = 0.016) and ≥ 5 years earlier (OR 0.75, 95% CI 0.64-0.89; p = 0.001) had significantly lower odds of reporting worse self-rated health compared with current smokers. In the secondary analysis restricted to current e-cigarette users who were former smokers, there was no evidence that self-rated health differed by time since smoking cessation, using those who had quit < 1 year earlier as the reference group (1 to < 5 years vs. <1 year: OR 0.94, 95% CI 0.69-1.29; ≥5 years vs. <1 year: OR 0.94, 95% CI 0.68-1.30). After adding duration of current e-cigarette use in the exploratory supplementary joint model restricted to current e-cigarette users who were former smokers, time since smoking cessation remained non-significant. However, vaping for ≥ 3 years, compared with < 1 year, was associated with lower odds of worse self-rated health (OR 0.60, 95% CI 0.38-0.93; p = 0.022).

CONCLUSIONS: Exclusive e-cigarette users who were former smokers reported better self-rated health than current smokers, but self-rated health did not vary clearly by time since smoking cessation within the e-cigarette-user group. Longer vaping duration showed an exploratory association with better perceived health. Longitudinal studies are needed to clarify whether these patterns reflect changes after smoking cessation, selection effects, or both.