Reasons for Electronic Nicotine Delivery System use and smoking abstinence at 6 months: a descriptive study of callers to employer and health plan-sponsored quitlines

Motivations for E-cigarette use and associations with vaping frequency and smoking abstinence among adults who smoke cigarettes in the United States

INTRODUCTION

In observational studies, vaping daily is positively associated with cigarette smoking abstinence, while non-daily vaping is associated with less smoking abstinence (versus no e-cigarette use). It remains unknown whether cigarette smokers who vape daily have different motivations for using e-cigarettes than those who vape non-daily.

METHODS

Using latent class analysis and 10 self-reported reasons for vaping, we identified sub-groups of participants based on vaping motivations among 1544 adult (≥18 y) dual users of e-cigarettes and cigarettes at wave 4 of the Population Assessment of Tobacco and Health (2016-2018). We examined the association of motivation sub-groups with vaping frequency at wave 4, and subsequent cigarette smoking abstinence at wave 5 (2018-2019). Additional analyses examined the association of vaping frequency with smoking abstinence before and after adjustment for motivation sub-groups.

RESULTS

Four distinct sub-groups of e-cigarette users emerged, including 54 % of participants who were "Vaping Enthusiasts", 20 % who vaped for "Convenience and Social Acceptability", 10 % classified as "Experimenters", and 16 % who vaped for "Quitting Smoking and Harm Reduction." The Convenience and Social Acceptability sub-group were less likely than "Vaping Enthusiasts" (AOR=0.29, 95 %CI[0.20-0.42]) and "Quitting Smoking and Harm Reduction" (AOR=0.41, 95 %CI[0.24-0.71]) classes to vape daily (versus non-daily). Sub-groups were not associated with smoking abstinence after one year. Adjustment for motivation sub-groups did not attenuate a positive association of daily vaping with smoking abstinence.

CONCLUSIONS

Cigarette smokers who vaped for convenience and social acceptability were less frequent e-cigarette users than those with other vaping motivations. Vaping motivations were not associated with subsequent smoking abstinence.

Treatment development, implementation, and participant baseline characteristics: A randomized pilot study of a tailored quitline intervention for individuals who smoke and vape

Background

Approximately 57,000 dual users of cigarettes and e-cigarettes call state tobacco quitlines in the U.S. each year.

Methods

This paper describes a behavioral intervention for dual users of cigarettes and e-cigarettes designed to increase cigarette abstinence. It also presents baseline data from a randomized pilot comparing the Enhanced E-cigarette Coaching (EEC) intervention with quitline treatment as usual (TAU). Oklahoma Tobacco Helpline callers were recruited at registration and randomized to EEC (n = 46) or TAU (n = 50). Treatment included 5 coaching calls and free nicotine replacement therapy (NRT). EEC treatment included enhanced e-cigarette assessment, education, a shared decision-making quit plan development approach, and tailored behavioral support.

Results

Participants averaged 40.6 years of age and 19.2 cigarettes per day; 85% smoked daily, 48% vaped daily, and 53% reported medium to high e-cigarette dependence. Most reported using e-cigarettes to quit (43%) or to cut down (26%) on smoking. Most had previously tried to quit smoking (91%) and had tried FDA-approved cessation medications (79%). Beliefs about vaping, NRT, and smoking included misinformation. After discussing the relative risks of NRT, vaping, and smoking, most EEC participants (89%) selected a quit plan that incorporated both NRT and vaping.

Conclusions

At baseline, most participants reported a history of failed quit attempts with NRT and were vaping to quit or cut down on smoking, but they may need more support to completely quit smoking. If the EEC improves smoking outcomes, it would provide needed guidance on behavioral support best practices for individuals who vape and want to quit smoking.

Do the associations between the use of electronic cigarettes and smoking reduction or cessation attempt persist after several years of use? Longitudinal analyses in smokers of the CONSTANCES cohort

INTRODUCTION

We examined whether duration of electronic cigarette (e-cigarette) use could be associated with smoking reduction or cessation attempt.

METHODS

5,409 current smokers at baseline enrolled in the French CONSTANCES cohort in 2015 or 2016 were included. Duration of e-cigarette use was categorized as follows: never; former user for more than one year; former user for less than one year; new user for less than one year; return to use for less than one year; regular use for one to two years; regular use for more than two years. Two outcomes were considered at one-year of follow-up: change in the number of cigarettes per day and cessation attempt.

RESULTS

Compared to never users, former users had an increase in the number of cigarettes per day at follow-up (B = 0.95[95%CI:0.57-1.33] and B = 1.03[95%CI:0.47-1.59] for former users of more than one year and less than one year, respectively). Compared to never users, all categories of current users had a decrease in the number of cigarettes per day (B = -3.31[95%CI:-4.07;-2.54] and B = -4.18[95%CI:-5.06;-3.29] for new users of less than one year and users of more than two years, respectively). Compared to never users, former users had a decreased likelihood of cessation attempt (OR = 0.80[95%CI:0.67-0.95] and OR = 0.77[95%CI:0.60-0.99] for former users of more than one year and less than one year, respectively). Compared to never users, all categories of current users had an increased likelihood of cessation attempt (OR = 3.12[95%CI:2.32;4.19] and OR = 3.36[95%CI:2.39;4.72] for new users of less than one year and users of more than two years, respectively).

CONCLUSIONS

E-cigarette use was associated with smoking reduction and cessation attempt for individuals who have used it for less than one year and additional benefits are expected to occur with a longer duration of use. Former users of e-cigarettes had poorer outcomes than those who have never used them.

Vaping and E-Cigarettes Within the Evolving Tobacco Quitline Landscape

This article summarizes the vaping research literature as it pertains to tobacco quitlines and describes vaping assessment, treatment, and evaluation quitline practices. It also presents 2014-2018 registration data (vaping in the past 30 days, number of use days, use for quitting smoking, and intentions to quit vaping) from 24 public quitlines (23 states and District of Columbia) and 110,295 enrollees to employer-sponsored quitlines. Trends in vaping rates over time, by state, and by age group are described. Approximately 57,000 adult public quitline enrollees in the U.S. reported vaping at registration in 2018 (14.7% of enrollees). Most quitline participants who vape also smoke cigarettes and contact the quitline for smoking cessation support. Rates of reporting vaping and no combustible or smokeless tobacco use in the past 30 days are 0.5% of all public quitline participants (<3% of public quitline vaping product users). Data are not systematically available regarding the number of quitline participants who are seeking help quitting vaping and only vape (do not use combustible or smokeless tobacco). Few quitline participants (<1%) are youth aged <18 years, but more than a third (35%) report vaping. This paper outlines research and evaluation priorities to inform the future quitline treatment landscape with respect to vaping. The quitline community is positioned to increase the likelihood that vaping has a positive impact for adults who smoke through harm reduction or supporting cessation and has opportunities to expand impacts on youth and young adult vaping prevention and cessation.

E-Cigarette Use and Adult Cigarette Smoking Cessation: A Meta-Analysis

Objectives. To determine the association between e-cigarette use and smoking cessation.Methods. We searched PubMed, Web of Science Core Collection, and EMBASE and computed the association of e-cigarette use with quitting cigarettes using random effects meta-analyses.Results. We identified 64 papers (55 observational studies and 9 randomized clinical trials [RCTs]). In observational studies of all adult smokers (odds ratio [OR] = 0.947; 95% confidence interval [CI] = 0.772, 1.160) and smokers motivated to quit smoking (OR = 0.851; 95% CI = 0.684, 1.057), e-cigarette consumer product use was not associated with quitting. Daily e-cigarette use was associated with more quitting (OR = 1.529; 95% CI = 1.158, 2.019) and less-than-daily use was associated with less quitting (OR = 0.514; 95% CI = 0.402, 0.665). The RCTs that compared quitting among smokers who were provided e-cigarettes to smokers with conventional therapy found e-cigarette use was associated with more quitting (relative risk = 1.555; 95% CI = 1.173, 2.061).Conclusions. As consumer products, in observational studies, e-cigarettes were not associated with increased smoking cessation in the adult population. In RCTs, provision of free e-cigarettes as a therapeutic intervention was associated with increased smoking cessation.Public Health Implications. E-cigarettes should not be approved as consumer products but may warrant consideration as a prescription therapy.

Longitudinal Analysis of Associations Between Reasons for Electronic Cigarette Use and Change in Smoking Status Among Adults in the Population Assessment of Tobacco and Health Study

INTRODUCTION

Electronic cigarette (ECIG) use and changes in cigarette smoking status may be influenced by self-reported reasons for using ECIGs.

METHODS

We analyzed adult current and former cigarette smokers who were also current or former ECIG users at wave 1 (n = 3044) using wave 1 and wave 2 Population Assessment of Tobacco and Health Study data (2013-2015). Prevalence of reporting 13 reasons for ECIG use at wave 1 was examined and weighted logistic regressions were conducted predicting smoking status changes from wave 1 to wave 2.

RESULTS

Reasons for ECIG use ranged from 18.1% (people in the media or public figures use them) to 82.5% (they might be less harmful to people around me than cigarettes). From wave 1 to wave 2, 27.2% of former smokers (n = 249) became current smokers and 11.6% of current smokers (n = 246) became former smokers. Among wave 1 former smokers, using ECIGs because of the availability of flavors (AOR = 0.57, 95% CI = 0.39-0.85) or because they don't smell (AOR = 0.64, 95% CI = 0.42-0.97) was associated with lower odds of relapse to smoking, but using ECIGs because using them helps people quit smoking (AOR = 1.55, 95% CI = 1.01-2.38) was associated with greater odds of relapse. Among wave 1 current smokers, using ECIGs because they can be used where smoking is not allowed (AOR = 0.56, 95% CI = 0.38-0.85) was associated with reduced odds of quitting cigarettes.

CONCLUSIONS

Some reasons for ECIG use are associated with changes in self-reported smoking status. Researchers should examine ECIG user characteristics when assessing associations between ECIG use and smoking status transitions.

IMPLICATIONS

Given that certain reasons for ECIG use, such as using ECIGs in locations are where smoking is not allowed, may inhibit smoking reduction, policies may be developed to prevent ECIG use in locations where smoking is banned. In addition, because certain reasons for ECIG use may aid in relapse prevention, such as availability of desired flavors, efforts should be made to identify ECIG device characteristics that are appealing to smokers but not youth or nontobacco users. These results provide support for future research on reasons for ECIG use to inform regulatory policies.

Technology-based contingency management and e-cigarettes during the initial weeks of a smoking quit attempt

Contingency management (CM) interventions are among the most effective behavioral interventions for smoking. This study assessed the effects of CM and electronic cigarettes (ECs) on smoking reductions and abstinence for durations of 30-36 days. Twelve participants were exposed to Baseline, EC alone, and EC + CM conditions. An internet-based platform was used to monitor smoking via breath carbon monoxide (CO) and deliver CM for smoking abstinence (CO ≤4 ppm). A Bluetooth-enabled EC monitored daily EC puffs. Abstinence rates were equivalent between EC (34.4%) and EC + CM (30.4%) conditions. Both conditions promoted smoking reductions. We observed an inverse correlation between smoking and EC puffs (r = -.62, p < .05). Results suggest the use of electronic cigarettes can promote smoking reductions and abstinence, and CM did not improve these outcomes. Larger magnitude consequences or tailoring EC characteristics (e.g., flavor) may have improved outcomes. Technology-based methods to collect intensive, longitudinal measures of smoking and electronic cigarette use may be useful to characterize their environmental determinants.

Electronic cigarette use and tobacco cessation in a state-based quitline

Introduction

Evidence is mixed on e-cigarette's effectiveness as a tobacco cessation aid. Research suggests that e-cigarette users face greater barriers to quitting tobacco.

Aim

To examine the association between e-cigarette use and tobacco cessation outcomes among quitline callers.

Methods

We examined 2,204 callers who enrolled and completed 7-month follow-up surveys between April 2014 and January 2017. We examined the association between any e-cigarette use and tobacco cessation. We also evaluated these relationships by e-cigarette use patterns between enrollment and 7-month follow-up: sustained, adopted, discontinued, and non-use. We used multivariable logistic regression to control for caller characteristics, tobacco history, and program utilization.

Results

Overall, 18% of callers reported using e-cigarettes at enrollment, follow-up, or both. Compared to non-users, e-cigarette users were more likely to be younger, non-Hispanic, and report a mental health condition. The adjusted odds of tobacco cessation were not statistically different for callers who used e-cigarettes compared to those who did not (adjusted odds ratios = 1.02, 95% confidence interval 0.79–1.32). Results were similar when examining cessation by patterns of e-cigarette use.

Conclusions

E-cigarette use was not associated with tobacco cessation. This suggests that e-cigarette use may neither facilitate nor deter tobacco cessation among quitline callers. Future research should continue exploring how e-cigarette use affects quitting.

Willingness-to-try various tobacco cessation methods among US adult cigarette smokers

INTRODUCTION

METHODS

RESULTS

CONCLUSIONS

Are electronic nicotine delivery systems helping cigarette smokers quit? Evidence from a prospective cohort study of U.S. adult smokers, 2015-2016

Background

The potential of electronic nicotine delivery systems (ENDS) to reduce the cardiovascular and other disease risks of smoking is of great interest. While many smokers report using ENDS for cessation, their impact under real-world use patterns and conditions on adult smokers’ quitting behavior is uncertain. The objective of this study was to generate more recent and comprehensive evidence on the effect of “real world” ENDS use on the population quit rates of adult smokers while taking account of frequency and duration of use, device type, e-liquid flavor, and reasons for use.

Methods and findings

We conducted a population-based, prospective cohort study of a random probability sample of 1284 U.S. adult smokers recruited in August/September 2015 and re-contacted one-year later (September 2016) from GfK’s KnowledgePanel, a national, probability-based web-panel designed to be representative of non-institutionalized U.S. adults. Among the 1081 baseline smokers who remained members of KnowledgePanel, 858 completed the follow-up survey. The primary outcome was smoking abstinence for at least 30 days prior to follow-up. Secondary outcomes were making a quit attempt during the 12-month study period and number of cigarettes smoked per day at follow-up. The adjusted odds of quitting smoking were lower for those that used ENDS at baseline (9.4%, 95% CI = 5.22%-16.38%; AOR = 0.30, 95% CI = 0.13–0.72) compared to smokers who did not use at ENDS (18.9%, 95% CI = 14.24%-24.68%). Smokers who used ENDS daily at some point during the study period were also less likely to quit smoking than nonusers (AOR = 0.17; 95% CI = 0.04–0.82). Limited ability to draw causal inferences from the observational design and a lack of biochemical verification of quitting smoking or ENDS use are limitations of this study.

Conclusions

We found no evidence that ENDS use, within context of the 2015–2016 US regulatory and tobacco/vaping market landscape, helped adult smokers quit at rates higher than smokers who did not use these products. Absent any meaningful changes, ENDS use among adult smokers is unlikely to be a sufficient solution to obtaining a meaningful increase in population quit rates. Additional research is needed to reconcile the divergent literature and monitor the impact of ENDS in an environment of rapidly evolving markets and regulatory policies.

Effects of exposure to anti-vaping public service announcements among current smokers and dual users of cigarettes and electronic nicotine delivery systems

INTRODUCTION

Anti-vaping public service announcements (PSAs) are intended to discourage vaping or use of electronic nicotine delivery systems (ENDS). However, vaping portrayals in PSAs may have unintended effects if they increase smoking or vaping urges. This study examined benefits and unintended effects of anti-vaping PSAs with vapor portrayals on smoking and vaping-related outcomes.

METHODS

Young adult smokers (N = 171) and dual users (N = 122) aged 21-30 years were randomly assigned to view: 1) anti-vaping PSAs with vapor; 2) anti-vaping PSAs without vapor; 3) physical activity PSAs; or 4) anti-smoking PSAs with smoking cues. Outcomes were changes in vaping and smoking urges before and after viewing PSAs, post-test vaping and smoking intentions in the next hour, and post-test intention to purchase ENDS and traditional cigarettes.

RESULTS

Smokers only: Exposure to anti-vaping PSAs with vapor (vs. physical activity) was associated with lower intention to vape and to purchase ENDS (ps < 0.001) and lower intention to smoke and purchase cigarettes (ps < 0.05). Exposure to anti-vaping PSAs with vapor (vs. PSAs without vapor and vs. anti-smoking PSAs with smoking cues) was associated with lower intention to vape in the next hour (ps < 0.05). Exposure to anti-vaping PSAs without vapor (vs. physical activity) was associated with lower change in vaping urge (p < 0.05) and intention to purchase ENDS (p < 0.001). Dual users: Exposure to anti-vaping PSAs without vapor (vs. anti-smoking PSAs) was associated with lower intention to purchase ENDS (p < 0.05).

CONCLUSION

Viewing anti-vaping PSAs with vapor was not associated with unintended effects and may have benefits on reducing smoking and vaping-related outcomes.

User-identified electronic cigarette behavioral strategies and device characteristics for cigarette smoking reduction

BACKGROUND

There is limited evidence on how cigarette smokers use electronic cigarettes (ECIGs) for smoking cessation and reduction. This study used concept mapping, a participatory mixed-methods research approach, to identify ECIG use behaviors and device characteristics perceived to be associated with cigarette smoking cessation or reduction.

METHODS

Current ECIG users aged 18-64 were recruited from seven cities selected randomly from U.S. census tract regions. Participants were invited to complete concept mapping tasks: brainstorming, sorting and rating (n=72). During brainstorming, participants generated statements in response to a focus prompt ("A SPECIFIC WAY I HAVE USED electronic cigarettes to reduce my cigarette smoking or a SPECIFIC WAY electronic cigarettes help me reduce my cigarette smoking is…") and then sorted and rated the statements. Multidimensional scaling and hierarchical cluster analyses were used to generate a cluster map that was interpreted by the research team.

RESULTS

Eight thematic clusters were identified: Convenience, Perceived Health Effects, Ease of Use, Versatility and Variety, Advantages of ECIGs over Cigarettes, Cigarette Substitutability, Reducing Harms to Self and Others, and Social Benefits. Participants generated several statements that related to specific behavioral strategies used when using ECIGs for smoking reduction/complete switching behaviors such as making rapid transitions from smoking to ECIG use or using certain ECIG liquids or devices. Former smokers rated the Perceived Health Effects cluster and several behavioral strategy statements higher than current smokers.

CONCLUSIONS

These results help to identify ECIG use behaviors and characteristics perceived by ECIG users to aid in cigarette smoking cessation or reduction.

How do we determine the impact of e-cigarettes on cigarette smoking cessation or reduction? Review and recommendations for answering the research question with scientific rigor

AIMS

To propose a hierarchy of methodological criteria to consider when determining whether a study provides sufficient information to answer the question of whether e-cigarettes can facilitate cigarette smoking cessation or reduction.

DESIGN

A PubMed search to 1 February 2017 was conducted of all studies related to e-cigarettes and smoking cessation or reduction.

SETTINGS

Australia, Europe, Iran, Korea, New Zealand and the United States.

PARTICIPANTS AND STUDIES

91 articles.

MEASUREMENTS

Coders organized studies according to six proposed methodological criteria: (1) examines outcome of interest (cigarette abstinence or reduction), (2) assesses e-cigarette use for cessation as exposure of interest, (3) employs appropriate control/comparison groups, (4) ensures that measurement of exposure precedes the outcome, (5) evaluates dose and duration of the exposure and (6) evaluates the type and quality of the e-cigarette used.

FINDINGS

Twenty-four papers did not examine the outcomes of interest. Forty did not assess the specific reason for e-cigarette use as an exposure of interest. Twenty papers did not employ prospective study designs with appropriate comparison groups. The few observational studies meeting some of the criteria (duration, type, use for cessation) triangulated with findings from three randomized trials to suggest that e-cigarettes can help adult smokers quit or reduce cigarette smoking.

CONCLUSIONS

Only a small proportion of studies seeking to address the effect of e-cigarettes on smoking cessation or reduction meet a set of proposed quality standards. Those that do are consistent with randomized controlled trial evidence in suggesting that e-cigarettes can help with smoking cessation or reduction.

E-cigarette use among treatment-seeking smokers: Moderation of abstinence by use frequency

INTRODUCTION

Emerging literature suggests that frequency of use of electronic cigarettes (e-cigarettes) may be an important moderating variable in the relationship between e-cigarette use and smoking cessation. However, few studies have focused specifically on treatment-seekers, a group that may differ in important ways from smokers in the general population. This study looks at the relationship between e-cigarette use frequency and abstinence among a sample of treatment-seeking tobacco users.

METHODS

Seven-month follow-up survey data from N=2760 treatment-seeking tobacco users who utilized statewide tobacco quitlines in three states were used to assess the relationship between 30-day point prevalence abstinence and e-cigarette use frequency at follow-up. E-cigarette use was examined in two ways. First, we looked at any use in the past 30days versus no use. Additionally, past 30-day e-cigarette use frequency was categorized into four groups: 0days, 1-5days - infrequent, 6-29days - intermediate, 30days - daily. Logistic regression models were constructed predicting 30-day point prevalence tobacco abstinence.

RESULTS

Both infrequent (AOR=0.35; CI=0.20-0.59) and intermediate (AOR=0.50; CI=0.32-0.80) past 30-day e-cigarette use were associated with lower rates of tobacco abstinence versus no past 30-day use. However, daily e-cigarette users (AOR=1.16; CI=0.71-1.70) had similar 30-day abstinence when compared to non-users.

CONCLUSIONS

Results from this study of treatment-seekers support findings from studies of general population tobacco users that suggest frequency of e-cigarette use is an important moderating variable in the relationship between e-cigarette use and tobacco cessation. Future studies should employ more refined measures of e-cigarette use.

Prevalence of population smoking cessation by electronic cigarette use status in a national sample of recent smokers

INTRODUCTION

Amid decreasing rates of cigarette smoking and a rise in e-cigarette use, there is a need to understand population patterns of use to inform tobacco control efforts and evaluate whether e-cigarettes may play a role in tobacco harm reduction.

METHODS

This study merged data from the 2014 and 2015 National Health Interview Survey (NHIS) and restricted the sample to recent smokers [i.e., current smokers and former smokers who quit in 2010 or later (n=15,532)]. Log-binomial regression estimated adjusted prevalence ratios (aPR) for being quit by e-cigarette use status (i.e., daily, some day, former trier, never). All analyses controlled for factors traditionally correlated with smoking cessation.

RESULTS

A quarter of the sample (25.2%) were former smokers. The prevalence of being quit was significantly higher among daily e-cigarette users compared to those who had never used e-cigarettes [52.2% vs. 28.2%, aPR: 3.15 (2.66, 3.73)]. Those who used e-cigarettes on some days were least likely to be former smokers (12.1%). These relationships held even after accounting for making a quit attempt and use of other tobacco products.

CONCLUSIONS

Among those with a recent history of smoking, daily e-cigarette use was the strongest correlate of being quit at the time of the survey, suggesting that some smokers may have quit with frequent e-cigarette use or are using the products regularly to prevent smoking relapse. However, the low prevalence of cessation among infrequent e-cigarette users highlights the need to better understand this subgroup, including the individual factors and/or product characteristics that may inhibit cessation.

Internalized smoking stigma in relation to quit intentions, quit attempts, and current e-cigarette use

BACKGROUND

Reducing the social acceptability of smoking is associated with lowered smoking prevalence. However, denormalization strategies can also contribute to the stigmatization that some smokers may feel about their smoking. Smoking stigma may be more acute if smokers are also members of other stigmatized groups, such as racial/ethnic minorities. This study examined correlates of smoking self- and felt-stigma and discrimination, among current smokers.

METHODS

Participants were recruited in the United States via a national commercial consumer panel to complete a cross-sectional, Web-based survey. Participants were 1528 current cigarette smokers aged 14 and older. Measures included the Internalized Stigma of Smoking Inventory (ISSI), Heaviness of Smoking Index, quit intentions, past-year quit attempts, and current use of electronic cigarettes (e-cigarettes).

RESULTS

Self-stigma was significantly associated with higher intent to quit in the next 6 months (odds ratio [OR] = 2.47, P < .01) and in the next 30 days (OR = 4.21, P < .01), relative to no intention to quit, as well as having made 1 or 2 quit attempts in the past year (OR = 1.60, P < .01) or 3 or more quit attempts (OR = 1.74, P < .01) and associated with daily e-cigarette use (OR = 1.73, P < .05). Felt-stigma was positively associated with intent to quit in the next 30 days (OR = 1.54, P < .01), having made 3 or more quit attempts in the past year (OR = 1.35, P < .01), and both daily (OR = 2.05, P < .05) and some-day (OR = 1.30, P < .05) e-cigarette use. Discrimination was associated only with increased odds of daily e-cigarette use (OR = 1.83, P < .05).

CONCLUSIONS

Smokers who reported greater feelings of stigmatization about their smoking were more likely to report having made recent quit attempts, report a stronger intention quit smoking in the future, and report use of e-cigarettes, suggesting that feelings of self-and felt-stigmatization are related to greater motivation to stop smoking.

The Relation between Frequency of E-Cigarette Use and Frequency and Intensity of Cigarette Smoking among South Korean Adolescents

INTRODUCTION

The prevalence of adolescent electronic cigarette (e-cigarette) use has increased in most countries. This study aims to determine the relation between the frequency of e-cigarette use and the frequency and intensity of cigarette smoking. Additionally, the study evaluates the association between the reasons for e-cigarette use and the frequency of its use.

MATERIALS AND METHODS

Using the 2015 Korean Youth Risk Behavior Web-Based Survey, we included 6655 adolescents with an experience of e-cigarette use who were middle and high school students aged 13-18 years. We compared smoking experience, the frequency and intensity of cigarette smoking, and the relation between the reasons for e-cigarette uses and the frequency of e-cigarette use.

RESULTS

The prevalence of e-cigarette ever and current (past 30 days) users were 10.1% and 3.9%, respectively. Of the ever users, approximately 60% used e-cigarettes not within 1 month. On the other hand, 8.1% used e-cigarettes daily. The frequent and intensive cigarette smoking was associated with frequent e-cigarette uses. The percentage of frequent e-cigarette users (≥10 days/month) was 3.5% in adolescents who did not smoke within a month, but 28.7% among daily smokers. Additionally, it was 9.1% in smokers who smoked less than 1 cigarette/month, but 55.1% in smokers who smoked ≥20 cigarettes/day. The most common reason for e-cigarette use was curiosity (22.9%), followed by the belief that they are less harmful than conventional cigarettes (18.9%), the desire to quit smoking (13.1%), and the capacity for indoor use (10.7%). Curiosity was the most common reason among less frequent e-cigarette users; however, the desire to quit smoking and the capacity for indoor use were the most common reasons among more frequent users.

CONCLUSIONS

Results showed a positive relation between frequency or intensity of conventional cigarette smoking and the frequency of e-cigarette use among Korean adolescents, and frequency of e-cigarette use differed according to the reason for the use of e-cigarettes.

Overview of Electronic Nicotine Delivery Systems: A Systematic Review

CONTEXT

Rapid developments in e-cigarettes, or electronic nicotine delivery systems (ENDS), and the evolution of the overall tobacco product marketplace warrant frequent evaluation of the published literature. The purpose of this article is to report updated findings from a comprehensive review of the published scientific literature on ENDS.

EVIDENCE ACQUISITION

The authors conducted a systematic review of published empirical research literature on ENDS through May 31, 2016, using a detailed search strategy in the PubMed electronic database, expert review, and additional targeted searches. Included studies presented empirical findings and were coded to at least one of nine topics: (1) Product Features; (2) Health Effects; (3) Consumer Perceptions; (4) Patterns of Use; (5) Potential to Induce Dependence; (6) Smoking Cessation; (7) Marketing and Communication; (8) Sales; and (9) Policies; reviews and commentaries were excluded. Data from included studies were extracted by multiple coders (October 2015 to August 2016) into a standardized form and synthesized qualitatively by topic.

EVIDENCE SYNTHESIS

There were 687 articles included in this systematic review. The majority of studies assessed patterns of ENDS use and consumer perceptions of ENDS, followed by studies examining health effects of vaping and product features.

CONCLUSIONS

Studies indicate that ENDS are increasing in use, particularly among current smokers, pose substantially less harm to smokers than cigarettes, are being used to reduce/quit smoking, and are widely available. More longitudinal studies and controlled trials are needed to evaluate the impact of ENDS on population-level tobacco use and determine the health effects of longer-term vaping.