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This cross-sectional study examined differences in self-rated general health between exclusive e-cigarette users and exclusive cigarette smokers, using data from the 2017\u20132019 Scottish Health Survey. A total of 2484 adults (aged 16 and above)\u00a0were included and categorized as exclusive e-cigarette users (<jats:italic>n<\/jats:italic>\u2009=\u2009565) or exclusive cigarette smokers (<jats:italic>n<\/jats:italic>\u2009=\u20091919). Self-rated health was assessed using a single-item measure with five response categories: \u201cvery bad,\u201d \u201cbad,\u201d \u201cfair,\u201d \u201cgood,\u201d and \u201cvery good\u201d. Generalized ordinal logistic regression models were used to estimate the association between nicotine product use and self-rated health, adjusting for age, sex, Scottish Index of Multiple Deprivation, marital status, ethnicity, alcohol consumption frequency, physical activity, presence of longstanding physical or mental health conditions, and age of smoking initiation. In the fully adjusted model, exclusive e-cigarette users had higher odds of reporting better self-rated health compared to exclusive cigarette smokers overall (OR\u2009=\u20091.26, 95% CI 1.05\u20131.51, <jats:italic>p<\/jats:italic>\u2009=\u20090.012). A graded relationship was also observed in the fully adjusted model, with progressively lower odds of reporting better self-rated health as smoking intensity increased, using exclusive e-cigarette users as the reference group. Heavy smokers (\u2265\u200920 cigarettes\/day) had the lowest odds of reporting better self-rated health (OR\u2009=\u20090.63, 95% CI 0.49\u20130.80, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), followed by moderate smokers (10 to\u2009&lt;\u200920 cigarettes\/day) (OR\u2009=\u20090.81, 95% CI 0.66\u20130.99, <jats:italic>p<\/jats:italic>\u2009=\u20090.047). In contrast, light smokers (&lt;\u200910 cigarettes\/day) showed no significant difference in self-rated health compared to exclusive e-cigarette users (OR\u2009=\u20090.94, 95% CI 0.75\u20131.18, <jats:italic>p<\/jats:italic>\u2009=\u20090.614). These findings indicate that exclusive e-cigarette use is associated with better self-rated health compared to exclusive cigarette smoking, particularly among moderate and heavy smokers. Additional analyses revealed no significant differences in self-rated health among exclusive e-cigarette users based on prior smoking history (OR\u2009=\u20090.94, 95% CI 0.43\u20132.08, <jats:italic>p<\/jats:italic>\u2009=\u20090.882) or among exclusive cigarette smokers based on prior e-cigarette use (OR\u2009=\u20090.87, 95% CI 0.69\u20131.09, <jats:italic>p<\/jats:italic>\u2009=\u20090.219). These findings suggest that prior use is unlikely to explain\u00a0the observed association between exclusive e-cigarette use and better self-rated health compared to exclusive cigarette smoking. Given the subjective nature of self-rated health, these findings should be interpreted with caution. Future longitudinal studies incorporating objective health measures are essential to assess the long-term impacts of e-cigarette use and inform evidence-based harm reduction policies.<\/jats:p>","DOI":"10.1007\/s11739-025-03873-y","type":"journal-article","created":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T15:19:55Z","timestamp":1738336795000},"page":"771-784","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Self-rated health differences between exclusive e-cigarette users and exclusive cigarette smokers: evidence from the 2017\u20132019 Scottish Health Survey"],"prefix":"10.1007","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2381-0984","authenticated-orcid":false,"given":"Yusuff Adebayo","family":"Adebisi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"III","given":"Don Eliseo","family":"Lucero-Prisno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isaac Olushola","family":"Ogunkola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,1,31]]},"reference":[{"issue":"4","key":"3873_CR1","doi-asserted-by":"publisher","first-page":"e38073","DOI":"10.7759\/cureus.38073","volume":"15","author":"MP Parmar","year":"2023","unstructured":"Parmar MP, Kaur M, Bhavanam S et al (2023) A systematic review of the effects of smoking on the cardiovascular system and general health. 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Yusuff Adebayo Adebisi received funding in the past through the Tobacco Harm Reduction Scholarship and the Kevin Molloy Fellowship, both awarded by Knowledge-Action-Change (KAC) UK, an independent public health organization. KAC receives funding from Global Action to End Smoking (GA), an independent U.S. nonprofit 501(c)(3) grantmaking organization that supports Health & Science Research, Cessation Education, and Agricultural Transformation initiatives. This research was conducted independently and is not linked to any prior funding sources.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This was a secondary analysis of publicly available, anonymized data. No ethical approval was sought.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"As this study involved secondary data analysis, no ethical approval or informed consent was required by the authors for this research, as it qualifies for exemption from human subjects research.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human and animal rights and Informed consent"}},{"value":"Patients and\/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Patient and public involvement"}}]}}