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Salari N, Rahimi S, Darvishi N, Abdolmaleki A, Mohammadi M. The global prevalence of E-cigarettes in youth: A comprehensive systematic review and meta-analysis. PUBLIC HEALTH IN PRACTICE 2024; 7:100506. [PMID: 38817636 PMCID: PMC11137589 DOI: 10.1016/j.puhip.2024.100506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/22/2024] [Accepted: 05/09/2024] [Indexed: 06/01/2024] Open
Abstract
Objectives Smoking, especially cigarettes, is known as one of the most common social and health problems among people. E-cigarettes are another form of tobacco that has been an ordinary daily occurrence.Study Design: systematic review and meta-analysis. Methods Systematic searching of databases was performed in Scopus, Web of Science, PubMed, Science Direct, MagIran, IranDoc, SID and Google search engine based on the PRISMA 2020 guideline. This search was conducted by the end of May 2021. Following full-text assessments, the related data were extracted from the papers. Newcastle-Ottawa scale was also used to evaluate the quality of methodology of the articles. Finally, study analysis was performed using Comprehensive Meta-Analysis software (version 2) based on the random effect model. Results Global prevalence of E-cigarette in younger individuals was 16.8 (95 % CI: 10.6-25.6) and 4.8 (95 % CI: 3-7.6) in the Ever and Current modes of E-cigarette, respectively. We also found that E-cigarettes were used more common in young boys than young girls in both Ever and Current modes. In young boys, the prevalence of E-cigarette were 18.8 (95 % CI: 8.4-36.8) and 4.9 (95 % CI: 3-8) in both modes of Ever and Current, respectively. In young girls, these factors were 9.9 (95 % CI: 5-18.6) and 1.6 (95 % CI: 1-3.1) in both modes of Ever and Current, respectively. Conclusions The global prevalence of e-cigarettes among young people, especially young boys, is increasing. Based on this, the prevention and management of the damage of this social phenomenon requires comprehensive global study, planning and policy.
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Affiliation(s)
- Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sahel Rahimi
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Niloofar Darvishi
- Department of Psychiatric Nursing, Faculty of Nursing School, Tehran Medical Sciences, Islamic Azad University Science and Research Branch, Tehran, Iran
| | - Amir Abdolmaleki
- Department of Operating Room, Nahavand School of Allied Medical Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Masoud Mohammadi
- Research Center for NonCommunicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran
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Wang J, Xie CC, Jia XX, Xu K, Gong ZY, Sun YQ, Gao JR, Ding Y, Huang ZY, Chen D. E-cigarette awareness and use, among adult residents in Shanghai, China. Tob Induc Dis 2023; 21:104. [PMID: 37581174 PMCID: PMC10401329 DOI: 10.18332/tid/169559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/06/2023] [Accepted: 07/13/2023] [Indexed: 08/16/2023] Open
Abstract
INTRODUCTION The widespread popularity of e-cigarettes is considered an important public health concern. However, only some studies have investigated the prevalence of e-cigarette use in Shanghai, China. Research on the perceived harmfulness of e-cigarettes and public support for e-cigarette regulations in China is limited. This study aimed to estimate e-cigarette awareness, prevalence, and associated factors among adults in Shanghai, China. METHODS This study used data from a representative survey conducted in Shanghai, China, in 2019. The survey was conducted at 64 surveillance points in Shanghai, China, using a multistage, stratified, cluster-randomized sampling design, recruiting community-based Chinese adults aged ≥15 years. Based on the principles outlined in the Global Adult Tobacco Survey (GATS) China Project, data were collected by conducting face-to-face interviews in households. Of the 3200 selected households, 3060 people completed the individual survey. The overall response rate was 97.4%. RESULTS In all, 72.3% of the respondents had heard of e-cigarettes. The respondents who had used e-cigarettes at some point in their life, used them in the last 12 months, and used them currently were 5.8%, 2.6%, and 1.3%, respectively. Among adult residents who had heard of e-cigarettes, 38.2% thought they were less harmful than traditional cigarettes. The respondents who perceived e-cigarettes as more harmful than traditional cigarettes were less likely to have ever used e-cigarettes (AOR=0.2; 95% CI: 0.1-0.5, p=0.0015) and more likely to support incorporating e-cigarettes into the regulation of smoking control (AOR=3.9; 95% CI: 1.8-8.6, p=0.0008). CONCLUSIONS Our findings reveal that the awareness about e-cigarettes was high, and the prevalence of e-cigarette use was similar to the findings from previous studies in China. The harmful perception of e-cigarettes warrants further attention from public health practitioners.
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Affiliation(s)
- Jian Wang
- Shanghai Municipal Center for Health Promotion, Shanghai, China
- Shanghai Association of Tobacco Control, Shanghai, China
| | - Chen-Chen Xie
- Shanghai Municipal Center for Health Promotion, Shanghai, China
- Shanghai Association of Tobacco Control, Shanghai, China
| | - Xiao-Xian Jia
- Shanghai Municipal Center for Health Promotion, Shanghai, China
- Shanghai Association of Tobacco Control, Shanghai, China
| | - Kun Xu
- Shanghai Development Promotion Centre of Undertakings for the Aged, Shanghai, China
| | - Zheng-Yang Gong
- Shanghai Municipal Center for Health Promotion, Shanghai, China
- Shanghai Association of Tobacco Control, Shanghai, China
| | - Yuan-Qiao Sun
- Shanghai Municipal Center for Health Promotion, Shanghai, China
- Shanghai Association of Tobacco Control, Shanghai, China
| | - Jing-Rong Gao
- Shanghai Development Promotion Centre of Undertakings for the Aged, Shanghai, China
| | - Yuan Ding
- Shanghai Municipal Center for Health Promotion, Shanghai, China
| | | | - De Chen
- Shanghai Municipal Center for Health Promotion, Shanghai, China
- Shanghai Association of Tobacco Control, Shanghai, China
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Font-Mayolas S, Sullman MJM, Hughes JD, Gras ME, Lucena Jurado V, Calvo F. Cigarette, e-cigarette and waterpipe cognitions and use among university students in Guangzhou, China. Tob Induc Dis 2023; 21:30. [PMID: 36844384 PMCID: PMC9943935 DOI: 10.18332/tid/159171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/24/2022] [Accepted: 01/10/2023] [Indexed: 02/24/2023] Open
Abstract
INTRODUCTION There is currently little research on polytobacco use in China. The present study examined cognitions that predicted the use of cigarettes, e-cigarettes and waterpipes in a Chinese sample of students. METHODS A convenience sample of 281 university students, obtained using snowball sampling, completed an online survey during the 2019-2020 academic year in Guangzhou, China. RESULTS Men more strongly agreed, than women, with the possible advantages of using alternative nicotine and tobacco products, including: young people who smoke have more friends, smoking makes young people look cool, smoking makes young people feel more comfortable, smoking helps relieve stress, and it would be easy to quit. Factors significantly associated with regular cigarette use were the cognitions: 'I would smoke if my best friend offered', 'Young people who use these products have more friends', and 'It would be easy to quit these products' (global good classifications= 80.1%). In the case of waterpipes, agreement with the cognition: 'The product helps people relieve stress' was significantly associated with its use (global good classifications=80.1%). In the case of e-cigarettes, agreement with the cognitions: 'I would smoke if my best friend offered' and 'It would be easy to quit using these products' were significantly associated with the use of e-cigarettes (global good classifications=74.7%). CONCLUSIONS The results highlight the need to develop prevention programs that prepare young Chinese people to resist social pressure from friends to use tobacco products. There is also evidence of the need to facilitate and disseminate rigorous scientific information among young people about the possible negative health effects of alternative tobacco products. There were also gender differences in the use of these products and in the cognitions towards their use, so it is important to take the gender perspective into account in the analysis of the results and when writing future questionnaire items.
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Affiliation(s)
| | | | - Jiawei D. Hughes
- Department of Psychology, Drexel University, Philadelphia, United States
| | - Maria-Eugenia Gras
- Quality of Life Research Institute, Universitat de Girona, Girona, Spain
| | | | - Fran Calvo
- Quality of Life Research Institute, Universitat de Girona, Girona, Spain
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Tehrani H, Rajabi A, Ghelichi- Ghojogh M, Nejatian M, Jafari A. The prevalence of electronic cigarettes vaping globally: a systematic review and meta-analysis. Arch Public Health 2022; 80:240. [PMID: 36415010 PMCID: PMC9682677 DOI: 10.1186/s13690-022-00998-w] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 11/07/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The purpose of this systematic review study was to determine the national, regional, and global prevalence of electronic cigarettes (e-cigarettes) vaping. METHOD The articles were searched in July 2020 without a time limit in Web of Science (ISI), Scopus, PubMed, and Ovid-MEDLINE. At first, the titles and abstracts of the articles were reviewed, and if they were appropriate, they entered the second stage of screening. In the second stage, the whole articles were reviewed and articles that met the inclusion criteria were selected. In this study, search, selection of studies, qualitative evaluation, and data extraction were performed by two authors independently, and any disagreement between the two authors was reviewed and corrected by a third author. RESULTS In this study, the lifetime and current prevalence of e-cigarettes vaping globally were 23% and 11%, respectively. Lifetime and current prevalence of e-cigarettes vaping in women were 16% and 8%, respectively. Also, lifetime and current prevalence of e-cigarettes vaping in men were 22% and 12%, respectively. In this study, the current prevalence of e-cigarettes vaping in who had lifetime smoked conventional cigarette was 39%, and in current smokers was 43%. The lifetime prevalence of e-cigarettes vaping in the Continents of America, Europe, Asia, and Oceania were 24%, 26%, 16%, and 25%, respectively. The current prevalence of e-cigarettes vaping in the Continents of America, Europe, Asia, and Oceania were 10%, 14%, 11%, and 6%, respectively. CONCLUSIONS Based on the results of this study, it can be concluded that the popularity of e-cigarettes is increasing globally. Therefore, it is necessary for countries to have more control over the consumption and distribution of e-cigarettes, as well as to formulate the laws prohibiting about the e-cigarettes vaping in public places. There is also a need to design and conduct information campaigns to increase community awareness about e-cigarettes vaping.
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Affiliation(s)
- Hadi Tehrani
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Health Education and Health Promotion, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abdolhalim Rajabi
- Environmental Health Research Center, Department of Biostatistics and Epidemiology, Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran
| | | | - Mahbobeh Nejatian
- Social Determinants of Health Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Alireza Jafari
- Department of Health Education and Health Promotion, School of Health, Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
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Changing Behaviour: Blindness to Risk and a Critique of Tobacco Control Policy in China—A Qualitative Study. CHILDREN 2022; 9:children9091412. [PMID: 36138721 PMCID: PMC9497915 DOI: 10.3390/children9091412] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/10/2022] [Accepted: 09/15/2022] [Indexed: 11/30/2022]
Abstract
(1) Background: It is well recognised that a focus on changing behaviour remains a dominant and often appealing approach to develop health policies. This study provides a sociological insight into young adults’ knowledge of the health effects of smoking cigarettes. We also examine the challenges in tobacco control and criticize the implementation policies in Chinese context. (2) Methods: The study applies both a micro-sociological and a macro-sociological approach using semi-structured interviews and documents as the primary research methodology. Fieldwork was conducted from July to September 2016 and December 2016 to March 2017. The qualitative study involved 45 semi-structured interviews with young adults aged 16–24 years (15 females and 30 males) in Tianjin, China. A grounded theory approach was used for a thematic analysis. (3) Results: The participants knew cigarettes are harmful, although they lacked a comprehensive understanding of the health risks of smoking. Because the health consequences usually emerge after a long period of smoking, young smokers decide to take the health risk. All participants have a general understanding of China’s tobacco control policies and think that the implementation is ineffective. (4) Conclusions: Changing in smoking is a process embedded in complex social environments and cultures. Smoking behaviour is not only a personal choice, but also related to personal connections with peers and identity in Chinese society. The Chinese government has made significant achievements in tobacco control since joining the WHO framework convention on tobacco control in 2005. However, implementation needs to be stricter in order to achieve international levels of control, especially in taxes on tobacco product and the price of cigarettes. There is an urgent need for the regulation of e-cigarettes in China.
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Xiao L, Yin X, Di X, Nan Y, Lyu T, Wu Y, Li X. Awareness and prevalence of e-cigarette use among Chinese adults: policy implications. Tob Control 2022; 31:498-504. [PMID: 33608465 PMCID: PMC9234419 DOI: 10.1136/tobaccocontrol-2020-056114] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/22/2020] [Accepted: 10/28/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To assess the awareness and prevalence of electronic cigarettes (e-cigarettes) and associated factors among Chinese adults (15 years and older). METHOD This study examined data from Global Adults Tobacco Survey China Project, which was nationally representative and used stratified multiphase cluster randomised sampling design. Data were collected in 2018 through a household survey with in-person interviews using tablet computers. Complex sampling weighted analysis method was used. RESULTS 48.5% of Chinese adults had heard of e-cigarettes. The proportions of Chinese adults who had ever used, had used in the last 12 months, and currently used e-cigarettes were 5.0%, 2.2% and 0.9%, respectively; people in the 15-24 years group showed the highest rates of ever use, last 12-month use and current use at 7.6%, 4.4%, and 1.5%, respectively. Among males, higher e-cigarette use was associated with 15-24 years age group, college/university or above education, and daily use of combustible cigarettes. Among all e-cigarette users, 90.6% also used combustible cigarettes. The most common reason for e-cigarette use was smoking cessation (46.2%) while among ever smokers, 9.5% of ever e-cigarette users had quit smoking and 21.8% of never e-cigarette users had quit smoking (adjusted OR 0.454, 95% CI 0.290 to 0.712). CONCLUSION Prevalence of e-cigarettes among Chinese adults had increased since 2015, especially among young people aged 15-24. The high level of dual use and lower quit rate among e-cigarette users indicated e-cigarettes had not shown cessation utility at the population level in China. Regulation of e-cigarettes is needed to protect youth and minimise health risks.
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Affiliation(s)
- Lin Xiao
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, Beijing, China
| | - Xi Yin
- China office, World Health Organization, Geneve, GE, Switzerland
| | - Xinbo Di
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, Beijing, China
| | - Yi Nan
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, Beijing, China
| | - Tianchu Lyu
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, Beijing, China
| | - Yiqun Wu
- ThinkTank Research Center for Health Development, Beijing, Beijing, China
| | - Xinhua Li
- Chinese Center for Disease Control and Prevention, Beijing, Beijing, China
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Hairi FM, Goh KT, Driezen P, Nordin ASA, Yee A, Tajuddin NAA, Hasan SI, Danaee M, Kamaludin IS, Kaai SC, Yan M, Grey M, Quah ACK, Thompson ME, Fong GT. Reasons for using e-cigarettes and support for e-cigarette regulations: Findings from the 2020 ITC Malaysia Survey. Tob Induc Dis 2022; 20:33. [PMID: 35431720 PMCID: PMC8969647 DOI: 10.18332/tid/146364] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/02/2022] [Accepted: 02/02/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Malaysia has the largest e-cigarette (EC) market in Southeast Asia, and it has been estimated that 17% of adult daily cigarette smokers also used ECs on a daily basis in 2020. However, few studies have examined the reasons people use ECs in Malaysia. This cross-sectional study of adult cigarette smokers from Malaysia assessed reasons for EC use and their support for key proposed EC regulations. METHODS Data are from the 2020 International Tobacco Control (ITC) Malaysia Wave 1 Survey of adult (aged ≥18 years) smokers who reported that they used ECs at least monthly (N=459 out of 1047 smokers). Weighted analyses were conducted on EC users' reasons for using ECs and their support for various EC regulations. RESULTS Smokers who used ECs at least monthly were more likely to be male, aged 25-39 years, of Malay ethnicity, married, more highly educated, and living in Peninsular Malaysia. Smokers who used ECs daily reported using ECs to reduce the number of cigarettes smoked (91.3%), pleasant taste (90.1%), to quit smoking (87.9%), and enjoyment (87.5%). Smokers who used ECs less than daily reported using ECs for their pleasant taste (weekly 89.4%, monthly 87.5%), curiosity (weekly 79.5%, monthly 88.8%), being offered EC by someone (weekly 76.3%, monthly 81.6%), and to reduce the number of cigarettes smoked (weekly 76.2%, monthly 77.6%). Smokers who also used ECs were most likely to support EC regulations requiring a minimum purchasing age (88.3%) and limiting nicotine concentration (79.6%), and least likely to support regulations banning EC fruit and candy flavors (27.1%). CONCLUSIONS The most prevalent reasons for using ECs in Malaysia are comparable to those of other ITC countries, including Canada, US, England, and Australia. An understanding of use patterns of ECs, especially their interaction with cigarettes, are important in developing evidence-based regulations in Malaysia.
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Affiliation(s)
- Farizah Mohd Hairi
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur, Malaysia
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kok Tiong Goh
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Amer Siddiq Amer Nordin
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur, Malaysia
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Anne Yee
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur, Malaysia
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nur Amani Ahmad Tajuddin
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur, Malaysia
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Siti Idayu Hasan
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur, Malaysia
| | - Mahmoud Danaee
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur, Malaysia
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ina Sharyn Kamaludin
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur, Malaysia
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Susan C. Kaai
- Department of Psychology, University of Waterloo, Waterloo, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Mi Yan
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Matthew Grey
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Anne C. K. Quah
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Mary E. Thompson
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Canada
| | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo, Waterloo, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
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Lin HX, Zhang Y, Chen MJ, Zheng YT, Yun QP, Zhang LC, Zhang WT, Zhu BC, Liu Z. The characteristics and patterns of e-cigarette use and its
association with cigarette cessation intention in a Chinese
smoking population: A mediation analysis. Tob Induc Dis 2022; 20:16. [PMID: 35221859 PMCID: PMC8832540 DOI: 10.18332/tid/144251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/25/2021] [Accepted: 11/25/2021] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION The use of e-cigarettes has become more common in China, but the research on e-cigarettes in China, while growing, is still limited. This study examined the characteristics and patterns of e-cigarette use, and analyzed the possible mediators between cigarette cessation intention and e-cigarette use in a Chinese smoking population. METHODS This was a cross-sectional study conducted in mainland China. By convenience sampling method, the participants were recruited from 85 major commercial streets of several large cities in China. The study interviewers completed face-to-face interviews and uploaded the completed questionnaires into the online survey platform. The participants were contacted for clarification if any problems were detected. Logistic regression yielded adjusted odds ratios (ORs) for ever use of e-cigarettes. We further conducted a mediation analysis to estimate the effect of possible mediators. RESULTS From July to August 2020, a total of 738 smokers were invited to participate in this study; 613 smokers were identified as eligible and 609 smokers were included in this analysis. Of them, 24 (3.94%) participants were currently using e-cigarettes, and 165 (27.09%) participants have ever used e-cigarettes. The participants with younger age were more likely to have ever used e-cigarettes, ranging from 37.5% in the 18–29 years age group to 6.5% in the 60–69 years age group. After controlling for demographic characteristics and nicotine dependence, the ever use of e-cigarettes was significantly associated with younger age, higher education level, higher monthly income, previous smoking cessation attempts and quitting intention. With the mediation analysis, the education level is confirmed as a mediating factor, and approximately 42.86% of the effects were mediated through the channel of higher socioeconomic status. CONCLUSIONS This is the first study to examine the possible mediators between cigarette cessation intention and e-cigarette use in a Chinese smoking population. The findings revealed that high socioeconomic status, particularly higher education level, was a major mediating factor.
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Affiliation(s)
- Hao-Xiang Lin
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Yan Zhang
- China Journal of Traditional Chinese Medicine and Pharmacy, Beijing, China
| | - Mei-Jun Chen
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Yun-Ting Zheng
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Qing-Ping Yun
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Lan-Chao Zhang
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Wan-Tong Zhang
- Institute of Clinical Pharmacology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Bao-Chen Zhu
- Department of Pharmacology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Zhao Liu
- Tobacco Medicine and Tobacco Cessation Center, China-Japan Friendship Hospital, Beijing, China
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Zhao D, Abdullah AS, Wen T, Chen X, Xiao X, Pan Z, He J, Urmi DS, Hao W, Lin H, Zheng P. Perceptions of e-cigarettes among smokers and non-smokers in households with children in rural China: A cross-sectional study. Tob Induc Dis 2021; 19:25. [PMID: 33850512 PMCID: PMC8033598 DOI: 10.18332/tid/133264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/10/2021] [Accepted: 02/11/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The perceived health benefits and effectiveness of electronic cigarettes (e-cigarettes) in quitting smoking may affect e-cigarette usage, however, research on the use of e-cigarettes among the Chinese, especially among the rural Chinse, is scarce. This study examined factors associated with perceptions of e-cigarette related harms, benefits, and addictiveness, among smoker and non-smoker households with children in rural China, to support the design of population-based interventions targeting rural Chinese households. METHODS In a cross-sectional study design, using a structured questionnaire, we collected data from the household members of children in two selected rural communities in China. Descriptive analyses were used to characterize respondents; χ2 test and Fisher’s exact probability test were used to compare the perceptions of e-cigarettes between different sociodemographic groups. Logistic regression was used to determine predictors for e-cigarette harms, benefits, and addictiveness, adjusting for demographic and other characteristics. RESULTS The overall participation rate was 81% (1211/1498). Of the participants, 668 (55%) were smokers and 543 (45%) were non-smokers; 53% knew about e-cigarettes. Participants from rural Dali (77% vs 59%), those who were ethnic minority (76% vs 59%), those who perceived increased COPD risks from smoking (mean score 4.37 vs 4.18) and concerned about harmful effects of secondhand smoke (SHS) exposure to children (mean score 4.48 vs 4.30) and adults (mean score 4.06 vs 3.87) were more likely to believe that e-cigarettes were less harmful (p<0.05). Participants with more knowledge about the harm of smoking were more likely to believe that e-cigarettes were helpful in quitting smoking (p<0.05). Of those participants who knew about e-cigarettes, females (19%) were significantly more likely to believe that e-cigarettes are addictive than males (10%). In the logistic regression analyses, believing e-cigarettes are helpful to quit smoking was the only variable associated with holding a higher knowledge about smoking and SHS exposure (OR=0.608; 95% CI: 0.450–0.820). CONCLUSIONS Our results showed that more than half of the rural household members who have a child at home were aware of e-cigarettes. Knowledge about health impacts of SHS exposure and perceptions about the benefits, harms and addictiveness of e-cigarette use varied among the participants, with a significant proportion of participants having wrong information. Public health campaigns to disseminate evidence-based information of e-cigarette benefits and harms are warranted. As knowledge about the harmfulness of smoking and SHS exposure was associated with perceived e-cigarette benefits, particular focus should be given to increasing knowledge about the health hazards related to smoking and SHS exposure.
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Affiliation(s)
- Duan Zhao
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Abu S Abdullah
- Global Health Research Center, Duke Kunshan University, Kunshan, China.,Duke Global Health Institute, Duke University, Durham, United States.,Boston Medical Center, Boston University School of Medicine, Boston, United States
| | - Tong Wen
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Xiaoxiao Chen
- Taizhou City Centers for Disease Control and Prevention, Taizhou, China
| | - Xia Xiao
- School of Public Health, Kunming Medical University, Kunming, China
| | - Zixian Pan
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Jingyi He
- Department of Preventive Medicine, School of Public Health, Fudan University, Shanghai, China
| | - Dilshat S Urmi
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Wei Hao
- Taizhou City Centers for Disease Control and Prevention, Taizhou, China
| | - Haijiang Lin
- Taizhou City Centers for Disease Control and Prevention, Taizhou, China
| | - Pinpin Zheng
- Department of Preventive Medicine, School of Public Health, Fudan University, Shanghai, China
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Briggs K, Bell C, Breik O. What should every dental health professional know about electronic cigarettes? Aust Dent J 2021; 66:224-233. [PMID: 33428774 DOI: 10.1111/adj.12818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 01/02/2023]
Abstract
Electronic cigarettes (E-cigarettes) have become increasingly popular around the world. Currently, dental professionals' knowledge and attitudes are varied with many clinicians unclear regarding the impact of E-cigarette products on the oral and general health of their patients. With developing social and health-related challenges, advice of dental and medical associations and other regulatory bodies on E-cigarette use is changing. Growing evidence demonstrating the risks of E-cigarette usage has prompted a review of legislation in the United Kingdom (UK), United States of America (USA), Australia and Canada to include the sale and availability of E-cigarettes, particularly those containing nicotine. Further consideration within the scientific and public health community is being given to assessing demographic usage patterns particularly uptake by non-smokers and adolescents, efficacy as a cessation tool, the impact of vapour on bystanders and direct injuries via explosions as well as emerging lung injuries. This article aims to provide a summary of the most up to date evidence relating to E-cigarette use, the latest position of dental associations and the oral health implications of E-cigarettes compared to conventional smoking. The article also aims to collate this information in order to provide dental clinicians with guidance on how to advise patients, specifically in answering common questions posed regarding E-cigarette use.
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Affiliation(s)
- K Briggs
- General Dentist, Private Practice, Brisbane, Australia
| | - C Bell
- Associate Specialist Oral and Maxillofacial Surgery, Bristol University Hospitals Trust, Bristol, United Kingdom
| | - O Breik
- Oral and Maxillofacial Surgeon, Royal Brisbane and Women's Hospital, Brisbane, Australia
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Jafari A, Rajabi A, Gholian-Aval M, Peyman N, Mahdizadeh M, Tehrani H. National, regional, and global prevalence of cigarette smoking among women/females in the general population: a systematic review and meta-analysis. Environ Health Prev Med 2021; 26:5. [PMID: 33419408 PMCID: PMC7796590 DOI: 10.1186/s12199-020-00924-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/20/2020] [Indexed: 02/07/2023] Open
Abstract
Background This systematic and meta-analysis review aimed to provide an updated estimate of the prevalence of ever and current cigarette smoking in women, in geographic areas worldwide, and demonstrate a trend of the prevalence of smoking over time by using a cumulative meta-analysis. Methods Following PRISMA guidelines, we conducted a systematic review and meta-analysis of studies published on the prevalence of ever and current cigarette smoking in women. We searched PubMed, Web of Science (ISI), Scopus, and Ovid from January 2010 to April 2020. The reference lists of the studies included in this review were also screened. Data were reviewed and extracted independently by two authors. A random effects model was used to estimate the pooled prevalence of ever and current cigarette smoking in women. Sources of heterogeneity among the studies were determined using subgroup analysis and meta-regression. Results The pooled prevalence of ever and current cigarette smoking in women was 28% and 17%, respectively. The pooled prevalence of ever cigarette smoking in adolescent girls/students of the school, adult women, pregnant women, and women with the disease was 23%, 27%, 32%, and 38%, respectively. The pooled prevalence of ever cigarette smoking in the continents of Oceania, Asia, Europe, America, and Africa was 36%, 14%, 38%, 31%, and 32%, respectively. Conclusions The prevalence of cigarette smoking among women is very high, which is significant in all subgroups of adolescents, adults, and pregnant women. Therefore, it is necessary to design and implement appropriate educational programs for them, especially in schools, to reduce the side effects and prevalence of smoking among women. Supplementary Information The online version contains supplementary material available at 10.1186/s12199-020-00924-y.
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Affiliation(s)
- Alireza Jafari
- Department of Health Education and Health Promotion, Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abdolhalim Rajabi
- Biostatistics and Epidemiology Department, Faculty of Health, Environmental Health Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mahdi Gholian-Aval
- Department of Health Education and Health Promotion, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nooshin Peyman
- Department of Health Education and Health Promotion, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehrsadat Mahdizadeh
- Department of Health Education and Health Promotion, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hadi Tehrani
- Department of Health Education and Health Promotion, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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Duan Z, Wang Y, Huang J, Redmon PB, Eriksen MP. Reasons why Chinese smokers prefer not to use electronic cigarettes. Tob Induc Dis 2020; 18:104. [PMID: 33328836 PMCID: PMC7735022 DOI: 10.18332/tid/130477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/01/2020] [Accepted: 11/14/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION China is the world’s largest e-cigarette manufacturer. It also has the world’s largest smoking population. Although smoking is strongly associated with e-cigarette use, the prevalence of e-cigarette use is low among Chinese smokers compared with smokers in countries such as the US and UK. This study aims to explore the reasons why Chinese smokers prefer not to use e-cigarettes. METHODS Cross-sectional data from the Tobacco Questions for Surveys (TQS) conducted in four large Chinese cities (Chengdu, Wuhan, Xiamen, and Xi’an) in 2017–2018 were analyzed. A multi-stage cluster sampling approach was applied to select a representative sample of adults for each city. Weighted percentages and 95% confidence intervals (CIs) were estimated for self-reported reasons why smokers in China had never tried e-cigarettes, in total and by demographic characteristics. Multivariate logistic regression models were used to examine the adjusted associations between the top reasons why smokers never tried e-cigarettes and demographic and socioeconomic characteristics. RESULTS The top three reasons that Chinese adult smokers reported for never having tried e-cigarettes were: ‘I do not want to quit smoking’ (35.35%), ‘I do not think they would help me quit or cut down’ (24.31%), and ‘I am not addicted to smoking and don't need help to quit’ (14.93%). Other prominent reasons included: ‘I am concerned they are not safe enough’, and ‘I do not want to substitute one addiction for another’. Generally, there were no statistically significant associations between reasons why smokers never tried e-cigarettes and demographic and socioeconomic characteristics. CONCLUSIONS Our results suggest that many Chinese smokers associate e-cigarette use with smoking cessation. Continued monitoring of smokers’ views, beliefs, and risk perceptions regarding e-cigarettes is warranted. Health education campaigns communicating the risks of e-cigarettes are also needed.
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Affiliation(s)
- Zongshuan Duan
- School of Public Health, Georgia State University, Atlanta, United States
| | - Yu Wang
- School of Public Health, Georgia State University, Atlanta, United States
| | - Jidong Huang
- School of Public Health, Georgia State University, Atlanta, United States
| | - Pamela B Redmon
- Emory Global Health Institute, Emory University, Atlanta, United States
| | - Michael P Eriksen
- School of Public Health, Georgia State University, Atlanta, United States
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Use of Electronic Nicotine Delivery Systems (ENDS) in China: Evidence from Citywide Representative Surveys from Five Chinese Cities in 2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072541. [PMID: 32276336 PMCID: PMC7177332 DOI: 10.3390/ijerph17072541] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/03/2020] [Accepted: 04/05/2020] [Indexed: 12/16/2022]
Abstract
China is the largest cigarette consuming country in the world. The emergence of electronic nicotine delivery systems (ENDS) in China may have important implications for the Chinese tobacco market. Unfortunately, research on ENDS in China, while growing, is still limited. This study was designed to examine the awareness and use of ENDS among adult urban residents in China. Data from five citywide representative surveys conducted in 2017–2018 were used. Percentages of residents who had ever heard of, ever used, or used ENDS in the past 30 days among all residents and smokers were estimated, in total and by demographic characteristics. Multiple logistic regression models were used to estimate the adjusted associations between awareness and use of ENDS and individual-level demographic characteristics and socioeconomic status (SES). Overall, 51.3% had ever heard, 4.8% ever used, and 0.9% used ENDS in the past 30 days. Men, young adults, those with high levels of education, and current smokers were more likely to be aware of and use ENDS. Among smokers, 67.8% had ever heard, 17.1% ever used, and 3.9% used ENDS in the past 30 days, respectively. Young adult smokers and smokers with high levels of education were more likely to be aware of and use ENDS. Our study results on ENDS awareness and use patterns and associated factors in China provide important evidence to inform research and policies related to ENDS manufacture, marketing, and sales in China.
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Lewek P, Woźniak B, Maludzińska P, Smigielski J, Kardas P. E-cigarette use and its predictors: Results from an online cross-sectional survey in Poland. Tob Induc Dis 2019; 17:79. [PMID: 31772557 PMCID: PMC6856825 DOI: 10.18332/tid/113093] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 10/05/2019] [Accepted: 10/15/2019] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Since the invention of electronic cigarettes (ECs) in 2003, their use has spread worldwide; however, little is known about the profiles of EC users. Understanding the motivators for using ECs enables more accurate prediction of their use and more effective direction of pro-health activities. Our objective was to identify the factors that may influence the decision to use ECs and their possible adverse effects according to the experiences of EC users. METHODS A cross-sectional online survey was administered between 1 July 2016 and 1 January 2017 among 1288 Polish-speaking users of social networks and EC forums. To explore associations between current EC use and other factors, multivariate binary logistic regression analyses were performed. RESULTS The final analysis included 1142 survey participants: mean age 25.9 years (± 11.1), 85.6% were male, 50.3% had secondary education, 98.2% were Polish citizens, and 81.0% were current EC users. Male gender, lower education, aged ≤40 years, former cigarette smoking, previous attempts to quit smoking, perception of lack of harmful effects of ECs, perception of ECs as being tastier and cheaper than cigarettes, awareness of the advantages of ECs and their use as a smoking cessation aid were all statistically significant factors increasing the risk of EC use. The majority of study participants claimed that ECs are less addictive or not addictive compared to cigarettes (62.6%) and less harmful or not harmful (89.5%) compared to cigarettes. The most common reported side effects of ECs were dryness in the mouth (8.3%), itching in the throat (4.5%) and nausea (1.9%). CONCLUSIONS Males aged ≤40 years with a lower level education were more likely to use ECs in the studied Polish population. The perception that ECs are less harmful than regular cigarettes is a factor increasing the odds of EC use; however, although ECs have few adverse effects, they nevertheless exist.
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Affiliation(s)
- Pawel Lewek
- Department of Family Medicine, Medical University of Lodz, Lodz, Poland
| | | | | | - Janusz Smigielski
- Social and Technical Department, State Higher Vocational School, Konin, Poland
| | - Przemyslaw Kardas
- Department of Family Medicine, Medical University of Lodz, Lodz, Poland
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