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Harlow AF, Fetterman JL, Ross CS, Robertson RM, Bhatnagar A, Benjamin EJ, Stokes AC. Association of device type, flavours and vaping behaviour with tobacco product transitions among adult electronic cigarette users in the USA. Tob Control 2022; 31:e10-e17. [PMID: 33479031 PMCID: PMC8292448 DOI: 10.1136/tobaccocontrol-2020-055999] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/23/2020] [Accepted: 12/11/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Few studies assess whether electronic cigarette (e-cigarette) device characteristics or flavours impact longitudinal patterns of cigarette and e-cigarette use. DESIGN We examined data from waves 2-4 of the Population Assessment of Tobacco and Health Study (2014-2018). Among adult (≥18 years) current e-cigarette users at wave 2 who were current smokers (dual users; n=1759) and former smokers (exclusive e-cigarette users; n=470), we classified participants into four use patterns at wave 3 (~12 months later) and wave 4 (~24 months later): (1) dual use of e-cigarettes and cigarettes; (2) exclusive cigarette smoking; (3) exclusive e-cigarette use; (4) non-use of both products. We used multinomial logistic regression to assess correlates of changing use patterns at 24 months, relative to no change, adjusting for sociodemographic factors. RESULTS At 24 months, 26.5% of baseline exclusive e-cigarette users, and 9% of baseline dual users, abstained from both vaping and smoking. Participants who vaped non-tobacco flavours (vs tobacco flavours), and used refillable tank or modifiable devices (vs disposable, cartridges and other devices) were less likely to transition to non-use of both products and to exclusive cigarette smoking. Baseline daily vaping (vs non-daily) was positively associated with exclusive e-cigarette use at 24 months for baseline daily cigarette smokers, but negatively associated with exclusive e-cigarette use and non-use of both products at 24 months for baseline non-daily smokers. CONCLUSIONS Non-tobacco flavours, daily vaping and modifiable e-cigarette devices may help some smokers abstain from cigarette smoking via transitioning to exclusive e-cigarette use, but are also associated with ongoing exclusive e-cigarette use.
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Affiliation(s)
- Alyssa F Harlow
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Jessica L Fetterman
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Craig S Ross
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Rose Marie Robertson
- Tobacco Regulation and Addiction Center, American Heart Association, Dallas, Texas, USA
| | - Aruni Bhatnagar
- Department of Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Emelia J Benjamin
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Andrew C Stokes
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
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Vardavas CI. European Tobacco Products Directive (TPD): current impact and future steps. Tob Control 2022; 31:198-201. [PMID: 35241588 DOI: 10.1136/tobaccocontrol-2021-056548] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/19/2022] [Indexed: 11/03/2022]
Abstract
Efforts to reduce the toll of tobacco-related morbidity and mortality in the European Union are spearheaded by the Tobacco Products Directive (TPD), a legal act implemented during 2016-2021, with the overall aim to reduce tobacco consumption by 2% in Europe. Within this time frame, several core tobacco control measures were implemented, the impact of which is outlined within this manuscript. Key successful legislative actions implemented in this time frame led to greater availability of information and further regulation of additives, the banning of mentholated cigarettes, enhanced pictorial package warnings and a regulatory framework for e-cigarettes. While repeated cross-sectional data indicated a 12.5% relative reduction in smoking prevalence after implementation of the TPD, the differential regulation of cigarettes and roll-your-own tobacco compared with other products, such as cigarillos, e-cigarettes and heated tobacco products, may have also led to product displacement. Moreover, as the TPD could not keep up with the ever-changing nicotine product landscape, further adaptations may be needed.
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Girvalaki C, Filippidis FT, Kyriakos CN, Driezen P, Herbeć A, Mons U, Papadakis S, Mechili EA, Katsaounou PA, Przewoźniak K, Fernández E, Trofor AC, Demjén T, Fong GT, Vardavas CI. Perceptions, Predictors of and Motivation for Quitting among Smokers from Six European Countries from 2016 to 2018: Findings from EUREST-PLUS ITC Europe Surveys. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6263. [PMID: 32872132 PMCID: PMC7504326 DOI: 10.3390/ijerph17176263] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 12/23/2022]
Abstract
The European Tobacco Products Directive (TPD) was introduced in 2016 in an effort to decrease prevalence of smoking and increase cessation in the European Union (EU). This study aimed to explore quitting behaviours, motivation, reasons and perceptions about quitting, as well as predictors (reported before the TPD implementation) associated with post-TPD quit status. A cohort study was conducted involving adult smokers from six EU countries (n = 3195). Data collection occurred pre-(Wave 1; 2016) and post-(Wave 2; 2018) TPD implementation. Bivariate and logistic regression analyses of weighted data were conducted. Within this cohort sample, 415 (13.0%) respondents reported quitting at Wave 2. Predictors of quitting were moderate or high education, fewer cigarettes smoked per day at baseline, a past quit attempt, lower level of perceived addiction, plans for quitting and the presence of a smoking-related comorbidity. Health concerns, price of cigarettes and being a good example for children were among the most important reasons that predicted being a quitter at Wave 2. Our findings show that the factors influencing decisions about quitting may be shared among European countries. European policy and the revised version of TPD could emphasise these factors through health warnings and/or campaigns and other policies.
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Affiliation(s)
- Charis Girvalaki
- Medical School, University of Crete, Heraklion, 71003 Crete, Greece; (C.N.K.); (S.P.); (E.A.M.); (C.I.V.)
- European Network for Smoking and Tobacco Prevention, 1050 Brussels, Belgium
| | - Filippos T. Filippidis
- Department of Primary Care and Public Health, Imperial College, London W6 8RP, UK;
- Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, 10561 Athens, Greece;
| | - Christina N. Kyriakos
- Medical School, University of Crete, Heraklion, 71003 Crete, Greece; (C.N.K.); (S.P.); (E.A.M.); (C.I.V.)
- European Network for Smoking and Tobacco Prevention, 1050 Brussels, Belgium
| | - Pete Driezen
- Department of Psychology and School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada;
| | - Aleksandra Herbeć
- Health Promotion Foundation, 00 764 Warsaw, Poland; (A.H.); (K.P.); (G.T.F.)
- Centre for Behaviour Change, Clinical, Educational and Health Psychology, University College London, London WC1E 6BT, UK
| | - Ute Mons
- Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany;
- Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50923 Cologne, Germany
| | - Sophia Papadakis
- Medical School, University of Crete, Heraklion, 71003 Crete, Greece; (C.N.K.); (S.P.); (E.A.M.); (C.I.V.)
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, and Faculty of Medicine, University of Ottawa, Ottawa, ON K1Y 4W7, Canada
| | - Enkeleint A. Mechili
- Medical School, University of Crete, Heraklion, 71003 Crete, Greece; (C.N.K.); (S.P.); (E.A.M.); (C.I.V.)
- European Network for Smoking and Tobacco Prevention, 1050 Brussels, Belgium
- Department of Health Care, Faculty of Public Health, University of Vlora, 9401 Vlora, Albania
| | - Paraskevi A. Katsaounou
- Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, 10561 Athens, Greece;
- First ICU Evaggelismos Hospital Athens, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | - Krzysztof Przewoźniak
- Health Promotion Foundation, 00 764 Warsaw, Poland; (A.H.); (K.P.); (G.T.F.)
- Maria Skłodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
- Collegium Civitas, 00-901 Warsaw, Poland
| | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), 08908 L’Hospitalet de Llobregat, Barcelona, Catalonia, Spain;
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), 08908 L’Hospitalet de Llobregat, Catalonia, Spain
- School of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, 08908 L’Hospitalet de Llobregat, Catalonia, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBER of Respiratory Diseases, CIBERES), 28029 Madrid, Spain
| | - Antigona C. Trofor
- University of Medicine and Pharmacy ‘Grigore T. Popa’ Iasi, 700115 Iasi, Romania;
- Aer Pur Romania, 052034 Bucharest, Romania
| | - Tibor Demjén
- Smoking or Health Hungarian Foundation, 1044 Budapest, Hungary;
| | - Geoffrey T. Fong
- Health Promotion Foundation, 00 764 Warsaw, Poland; (A.H.); (K.P.); (G.T.F.)
- Ontario Institute for Cancer Research, Toronto, ON M5G 0A3, Canada
| | - Constantine I. Vardavas
- Medical School, University of Crete, Heraklion, 71003 Crete, Greece; (C.N.K.); (S.P.); (E.A.M.); (C.I.V.)
- European Network for Smoking and Tobacco Prevention, 1050 Brussels, Belgium
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Vardavas CI, Kyriakos CN, McNeill A, Fong GT. Evaluating the impact of the Tobacco Products Directive within the context of the FCTC in Europe-findings from the EUREST-PLUS ITC Europe Surveys: introductory Commentary. Eur J Public Health 2020; 30:iii1-iii3. [PMID: 32918823 PMCID: PMC7526776 DOI: 10.1093/eurpub/ckaa110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Constantine I Vardavas
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
- School of Medicine, University of Crete, Heraklion, Greece
| | - Christina N Kyriakos
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
- School of Medicine, University of Crete, Heraklion, Greece
| | - Ann McNeill
- Department of Addictions, King’s College London, London, UK
| | - Geoffrey T Fong
- Department of Psychology and School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
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