Social norms for e-cigarettes and smoking: associations with initiation of e-cigarette use, intentions to quit smoking and quit attempts: findings from the EUREST-PLUS ITC Europe Surveys

Socio-ecological factors that influence youth vaping: perspectives from Western Australian school professionals, parents and young people

PURPOSE

To understand from the perspectives of school professionals, parents and young people the socio-ecological factors that may facilitate and prevent e-cigarette use among young people in Perth, Western Australia.

METHODS

Purposive sampling was used to recruit school professionals, parents and young people for one-on-one (n = 35) or joint (n = 3) interviews (in-person n = 11 or online n = 27). Data were analysed using thematic analysis and classified into four domains based on the socio-ecological model: i) individual, ii) interpersonal, iii) organizational/community and iv) societal/policy.

RESULTS

Factors that were found to support vaping among young people included sensation-seeking and risk-taking behaviour; a low-risk perception of vapes; attractive characteristics of vapes; ease of access; perception vaping is a social activity; and lack of knowledge about vaping among parents and school professionals. Vaping prevention messages originating from the familial, educational and community spheres are lacking but wanted by adults and young people.

CONCLUSIONS

The pervasiveness of the e-cigarette trade and persistent challenges related to surveillance and enforcement need to be addressed to reduce exposure and access to e-cigarettes. A mixture of "hard" and "soft" public policy tools involving key stakeholders in a range of settings is needed to prevent e-cigarette access and uptake by young people.

Association between prolonged dual use of cigarettes and E-cigarettes and psychosocial factors among U.S. Smokers: Secondary data analysis from the 2013 to 2019 PATH study

Objective

Dual use of combustible cigarettes and e-cigarettes is common among U.S. tobacco users, yet mis-perceptions about the harm of dual use persist, often oversimplifying its multifaceted exposure and health impacts. To address this gap, we evaluated the association of prolonged dual use (consecutive use for more than 1 year) with psychosocial factors, including perceptions of absolute and relative harm of e-cigarettes, social norms, and intentions to quit smoking, among U.S. adult smokers over time.

Methods

Using the data from Waves 1 to 5 (2013-2019) from the Population Assessment of Tobacco and Health (PATH) Study, we characterized dual use and prolonged dual use by sociodemographics and psychosocial factors among U.S. adult smokers. We examined the association between dual use, including prolonged dual use, and psychosocial factors over time using logistic regression.

Results

Dual use of smokers decreased from 19.8 % in 2013 to 16.4 % in 2019, and prolonged dual use among dual users decreased from 40.0 % in 2013 to 27.4 % in 2019. Prolonged dual users, independent of frequency of use, presented significantly higher cigarette dependence than temporary dual users. The perception of absolute e-cigarette harm (perceiving e-cigarettes as very or extremely harmful) was negatively associated with prolonged dual use. No significant association was found between prolonged dual use and perception of relative e-cigarette harm (perceiving e-cigarettes are less harmful than cigarettes) as well as with intentions to quit smoking and beliefs that most people disapprove of e-cigarette use.

Conclusion

Increased perceptions of absolute harm of e-cigarettes, rather than relative harm, appear to decrease prolonged dual use. Public health strategies should consider further emphasis in educating users of the absolute harm, as opposed to endorsing e-cigarette use as a harm reduction alternative, in their tobacco cessation efforts to further discourage dual use.

Interpersonal communication and perceived norms as social influence mechanisms of e-cigarette use among adults: a systematic review

Background: Given the increasing popularity of e-cigarette use among adults and the ongoing debate about the benefits and the potential adverse health risks associated with e-cigarette use, it is critical to identify the correlates of e-cigarette use. Prior research has found associations between interpersonal communication, perceived norms, and adults' e-cigarette use, but the evidence has yet to be summarized and synthesized.Objectives: This paper reviewed empirical studies examining the relationship between interpersonal communication, perceived norms, and e-cigarette use among adults.Methods: Following PRISMA guidelines, articles were searched on DOAJ, EMBASE, Europe PubMed Central, Google Scholar, PsychINFO, PubMed, Web of Science, and the reference list of the retrieved studies for studies that examined social influence on e-cigarette use. Three reviewers independently screened 1,713 non-duplicate papers and further screened the full text of 195 articles for inclusion.Results: Thirty studies (30), consisting of quantitative (n = 25) and qualitative (n = 5) data, were included in this review. The twenty-five (25) quantitative studies consisted of both cross-sectional (n = 20) and longitudinal (n = 5) studies. Interpersonal communication portraying e-cigarettes as beneficial or harmful was found to increase e-cigarette use and quit attempts, respectively. Across study designs, greater perceptions of others' e-cigarette use or approval were related to more frequent e-cigarette use.Conclusions: The findings highlight that e-cigarette-related interpersonal communication and perceived norms are associated with e-cigarette use. These factors may be useful targets in brief interventions. However, most of the included studies were cross-sectional, limiting the ability to establish clear cause-and-effect relationships; therefore, more longitudinal studies are needed.

Differences in Normative Beliefs and Tobacco Product Use by Age Among Adults Who Smoke: Cross-Sectional Analysis of a Nationally Representative Sample

BACKGROUND

The prevalence of combusted cigarette (CC) smoking among older adults is stagnant, with 0 declines attributable to e-cigarette (EC) use. Given that normative beliefs are associated with quitting and switching to ECs, we assessed cross-sectional associations between age, CC, and EC descriptive and injunctive norms and potential interactions with tobacco use behavior.

METHODS

Data are from people with current, established (≥100 lifetime CCs) CC use (n = 8072) at Wave 5 (2018-2019) of the adult Population Assessment of Tobacco and Health Study. We used adjusted multivariable logistic regressions to model social norms as a function of age (18-24, 25-34, 35-44, 45-54, 55-64, ≥65 years). We also dichotomized age (≥55 vs 18-54) to investigate interactions between age and social norms on past 12-month CC quit attempts and past-month EC use.

RESULTS

Older age was positively associated with pro- and anti-CC norms and anti-EC norms. Significant interactive effects revealed that being advised to quit smoking by a healthcare provider was more strongly associated with CC quit attempts among adults ≥55 years (adjusted odds ratio [aOR] [95% CI]: 2.12 [1.66, 2.71]) than adults <55 years (aOR: 1.63 [1.34, 2.00]). Reporting people close to you use ECs was also more strongly associated with EC use among adults ≥55 years (aOR: 4.37 [3.35, 5.69]) than among adults <55 years (aOR: 3.43 [2.89, 4.08]).

CONCLUSIONS

This study identified modifiable risk factors for tobacco use that may be particularly beneficial for older adults. Behavioral and communication interventions that target normative beliefs may maximize smoking cessation, or harm reduction when cessation is not possible.

Impact of e-cigarette retail displays on attitudes to smoking and vaping in children: an online experimental study

OBJECTIVES

To estimate the impact of electronic cigarette (e-cigarette) retail display exposure on attitudes to smoking and vaping (susceptibility to tobacco smoking and using e-cigarettes, and perceptions of the harms of smoking and e-cigarette use).

DESIGN

Between-subjects randomised experiment using a 2 (e-cigarette retail display visibility: high vs low)×2 (proportion of e-cigarette images: 75% vs 25%) factorial design.

SETTING

Online via the Qualtrics survey platform.

PARTICIPANTS

UK children aged 13-17 years (n=1034), recruited through a research agency.

INTERVENTION

Participants viewed 12 images of retail displays that contained e-cigarette display images or unrelated product images. E-cigarette display images were either high or low visibility, based on a conspicuousness score. Participants were randomised to one of four groups, with e-cigarette display visibility and proportion of e-cigarette images, compared with images of unrelated products, manipulated: (1) 75% e-cigarettes, high visibility; (2) 25% e-cigarettes, high visibility; (3) 75% e-cigarettes, low visibility; (4) 25% e-cigarettes, low visibility.

MAIN OUTCOME MEASURES

The primary outcome was susceptibility to smoking (among never smokers only). Secondary outcomes were susceptibility to using e-cigarettes (among never vapers only), and perceptions of smoking and e-cigarette harm (all participants).

RESULTS

Neither e-cigarette retail display visibility, nor the proportion of e-cigarette images displayed, appeared to influence susceptibility to smoking (visibility: OR=0.84, 95% CI 0.62 to 1.13, p=0.24; proportion: OR=1.34, 95% CI 1.00 to 1.82, p=0.054 (reference: low visibility, not susceptible)).Planned subgroup analyses indicated that exposure to a higher proportion of e-cigarette images increased susceptibility to smoking among children who visited retail stores more regularly (n=524, OR=1.59, 95% CI 1.04 to 2.43, p=0.034), and those who passed the attention check (n=880, OR=1.43, 95% CI 1.03 to 1.98, p=0.031).In addition, neither e-cigarette retail display visibility nor the proportion of e-cigarette images displayed, appeared to influence susceptibility to using e-cigarettes (visibility: OR=1.07, 95% CI 0.80 to 1.43, p=0.65; proportion: OR=1.22, 95% CI 0.91 to 1.64, p=0.18).Greater visibility of e-cigarette retail displays reduced perceived harm of smoking (mean difference (MD)=-0.19, 95% CI -0.34 to -0.04, p=0.016). There was no evidence that the proportion of e-cigarette images displayed had an effect (MD=-0.07, 95% CI -0.22 to 0.09, p=0.40).Perceived harm of e-cigarette use did not appear to be affected by e-cigarette retail display visibility (MD=-0.12, 95% CI -0.28 to 0.05, p=0.16) or by the proportion of e-cigarette images displayed (MD=-0.10, 95% CI -0.26 to 0.07, p=0.24).

CONCLUSIONS

There is no evidence in the full sample to suggest that children's susceptibility to smoking is increased by exposure to higher visibility e-cigarette retail displays, or to a higher proportion of e-cigarette images. However, for regular store visitors or those paying more attention, viewing a higher proportion of e-cigarette images increased susceptibility to smoking. In addition, viewing higher visibility e-cigarette images reduced perceived harm of smoking. A review of the current regulatory discrepancy between tobacco and e-cigarette point-of-sale marketing is warranted.

TRIAL REGISTRATION NUMBER

ISRCTN18215632.

E-cigarette attitudes and use in a sample of Australians aged 15–30 years

OBJECTIVE

The aim of this study was to explore e-cigarette exposure and patterns of vaping in a sample of Australians aged 15-30 years to provide insight into potential means of minimising young people's harm from e-cigarettes.

METHODS

A national sample of 1,006 Australians aged 15-30 years completed an online survey. Demographics, use of tobacco and vaping products, motivations for use, how e-cigarettes are obtained, where they are used, intentions to use among nonusers, exposure to others' vaping behaviours, exposure to e-cigarette advertising, perceptions of harms associated with e-cigarettes, and minors' perceptions of ease of access were assessed.

RESULTS

Almost half of respondents reported being either current users (14%) or having tried/used e-cigarettes in the past (33%). Factors positively associated with ever use were being a past or present user of tobacco cigarettes and number of friends who vape. Stronger perceptions of addictiveness were inversely associated with use.

CONCLUSIONS

Despite current restrictions on e-cigarette availability and promotion, the results suggest many young people in Australia may be exposed to e-cigarettes in multiple ways.

IMPLICATIONS FOR PUBLIC HEALTH

Additional efforts appear to be needed to control e-cigarette availability and promotion to prevent young people's exposure to vaping.

Do Social Norms for Cigarette Smoking and Nicotine Vaping Product Use Predict Trying Nicotine Vaping Products and Attempts to Quit Cigarette Smoking Amongst Adult Smokers? Findings From the 2016-2020 International Tobacco Control Four Country Smoking and Vaping Surveys

INTRODUCTION

To examine whether perceived injunctive and descriptive social norms towards cigarette and nicotine vaping product (NVP) use predicted subsequent trying NVPs and attempts to quit cigarette smoking amongst current smokers and whether associations varied across countries.

AIMS AND METHODS

Three waves of longitudinal cohort data from the International Tobacco Control Four Country Smoking and Vaping Survey were collected between 2016 and 2020 from 2290 adult smokers in Canada, Australia, England, and the United States who had never used NVPs at baseline (either wave 1 or wave 2) and followed up at the subsequent wave (wave 2 or wave 3, respectively) were analyzed using Generalized Estimating Equations.

RESULTS

Of the injunctive and descriptive norm measures for smoking and NVP use, NVP initiation was only independently predicted by the injunctive interpersonal norm for NVP use, with perceived approval of NVP use by important others predicting higher odds of trying NVPs (AOR = 1.65, 95% CI = 1.20 to 2.27). This predictive effect was independent of baseline quit intention with no country variations found. By contrast, making cigarette smoking quit attempts were independently predicted by both injunctive and descriptive interpersonal norms with perceived disapproval of smoking by important others (AOR = 1.65, 95% CI = 1.38 to 1.99) and close friends using NVPs (AOR = 1.37, 95% CI = 1.04 to 1.79), both associated with higher odds of smoking quit attempts.

CONCLUSIONS

Adult smokers who perceive NVP use as normative, either because such behavior is socially approved or common within their close social networks, appear more inclined to try NVPs or make smoking quit attempts than smokers who do not.

IMPLICATIONS

Social norms can shape a person's behavior and result in behavior change. This study shows that initiation of NVP use behavior among smokers can be reliably predicted by their perception of whether NVP use is acceptable to those important to them within their close social networks. Similarly, any attempts to stop cigarette smoking can be predicted by their perception of how acceptable cigarette smoking is among those who are important to them and whether any of their close friends use NVPs. Changing social norms towards cigarette smoking and NVP use could therefore be incorporated into smoking cessation interventions to help smokers to quit and/or switch to NVP use.

Smoking cessation behaviors and reasons for use of electronic cigarettes and heated tobacco products among Romanian adults

We report cessation behaviors, reasons for use of electronic cigarettes (EC) and heated tobacco products (HTP) and association of their use with quit attempts and smoking intensity using Romania Global Adult Tobacco Survey 2018. Weighted estimates of EC and HTP by cigarette smoking (CS) status were assessed. Quit attempts, intention to quit, reasons for lack of intention to quit among current CS, and reasons for current use of EC and HTP were estimated. The association of 'ever use' of EC and HTP with cigarette smoking intensity and quit attempts was explored using binary logistic regression. Of the total 4571 surveyed, 1243 (27.3%) were current CS, 300 (24.4%) made quit attempts in the past 12 months. Only 38 (12.5%) and 26 (8.6%) had used EC and HTP as an aid to quit. Among current CS, 512 (41.2%) had no intention to quit. Reasons for this were, 'enjoy smoking' (86.1%), 'reduce stress' (65.9%), and 'staying alert' (46.3%). Awareness and use of EC and HTP were significantly higher among current CS. 'Dual use' of EC and HTP with CS was manifolds higher than stand-alone use. Reasons for current use of EC and HTP were 'enjoyment', and 'use in places where smoking was prohibited'.