Cigarette Smoking and Electronic Cigarettes Use: A Meta-Analysis

Prevalence of Electronic Cigarette Use Among Female Residents of Al-Ahsa, Kingdom of Saudi Arabia: A Cross-Sectional Study

Background Electronic cigarettes (e-cigarettes) have gained considerable popularity on a global scale, with an increasing prevalence among younger adults. The objective of this study was to investigate the prevalence, patterns, and determinants of e-cigarette use among women in Al-Ahsa, Saudi Arabia. Methodology A cross-sectional study was conducted between October 2023 and July 2024 involving 491 adult female participants. The data were collected using a structured questionnaire and subsequently analyzed using SPSS Version 26.0 (IBM Corp., Armonk, NY, USA). Descriptive and inferential statistics, including chi-square tests, were employed to assess relationships between e-cigarette use and various independent variables. Results The prevalence of e-cigarette use among participants was 17.5%. Significant factors associated with e-cigarette use included age (highest among women aged 21 to 30 years, p = 0.038), unemployment (p = 0.011), perceived poor health (p = 0.002), and having friends or family members who use e-cigarettes (p = 0.001). The primary reasons for using e-cigarettes were influence from friends (70.9%) and family members (54.7%), curiosity (33.7%), and appealing flavors (30.2%). A considerable proportion of users reported experiencing dependence and difficulty quitting. Conclusions The prevalence of e-cigarette use among female residents of Al-Ahsa is influenced by a complex interplay of social, demographic, and perceptual factors. The findings underscore the necessity for comprehensive interventions targeting social environments and educational initiatives and addressing misconceptions about the potential risks of e-cigarettes.

Sociodemographic factors, health behavior, parental or workplace smoking, and adult asthma risk in the United States

BACKGROUND

Although several studies have found a link between parental or workplace smoking and asthma risk, particularly in children and adolescents, only a few studies have found this link in adults.

OBJECTIVE

This study aimed to investigate the associations of sociodemographic factors, health behavior, and parental or workplace smoking with adult asthma risk in the United States (US).

METHODS

A secondary data analysis on 874 participants aged 25-45 was performed using data from the 2011-2014 National Survey of Midlife Development in the United States Refresher. Participants were divided into smokers and nonsmokers. Participants were further divided into groups A (a father or mother with a smoking history) and B (others in the house or colleagues in the workplace who had a smoking history).

RESULTS

Findings from the FREQ procedure revealed that sociodemographic (female, black, school or college education, unmarried/divorced, and employed) and lifestyle (no alcohol intake, physically inactive, and obese) and clinical (diabetes and joint disease) factors were significantly associated with one- or more-fold odds of asthma among adult smokers than nonsmokers. Adult smokers in group A, particularly females, those with a high school or college education, physically inactive, and overweight or obese, had a higher risk of asthma than those in group B.

CONCLUSION

Adult smokers' risk of developing asthma is increased in the US by having smoked with their parents, being a woman, being black, having a school or college education, being single or divorced, working, not drinking alcohol, being physically inactive, being obese, having diabetes, and having a joint disease.

Pulse wave velocity demonstrates increased aortic stiffness in newly diagnosed, antiretroviral naïve HIV infected adults: A case-control study

Increased aortic stiffness is an important predictor of cardiovascular disease (CVD). It remains controversial whether HIV infected persons have increased aortic stiffness at the time of HIV diagnosis. An explorative, case-control study was performed using carotid-femoral pulse wave velocity (PWV) in a newly diagnosed, antiretroviral treatment (ART)-naïve cohort with modest baseline cardiovascular risk. We recruited 85 newly diagnosed adults without known CVD from health care facilities in South Africa (43 female; mean age 33). Median CD4 count was 285, IQR 156-393 cells/µL. Twenty two HIV uninfected controls were recruited from the same facilities (8 female; mean age 33). PWV was measured using the Vicorder module (Skidmore Medical, United Kingdom) using a corrective factor of 0.8. The HIV infected group's mean PWV measured 11% higher than controls (5.88 vs 5.28 m/s; P = .02). Median aortic distensibility in HIV infected persons was 18% lower than controls (0.37 vs 0.45 mm Hg-1; P = .009). Multivariate analysis revealed that the difference in PWV between groups remained significant when corrected for age, sex, mean blood pressure and kidney function (mean difference 0.52 m/s; P = .01). Mean blood pressure, estimated glomerular filtration rate, HIV infection per se, age and male sex were important associations with increased PWV. Our study provides evidence for increased aortic stiffness in ART naïve adults already demonstrable at the time of HIV diagnosis. The cohort's young age and recent HIV diagnosis makes atherosclerosis a less likely explanation for the difference. Alternative, potentially reversible, explanations that require further research include vasomotor tone abnormalities and endothelial dysfunction.

Patterns of Non-Cigarette Tobacco and Nicotine Use Among Current Cigarette Smokers and Recent Quitters: Findings From the 2020 ITC Four Country Smoking and Vaping Survey

INTRODUCTION

This study explores patterns of use of non-cigarette tobacco and nicotine products among adult cigarette smokers and recent ex-smokers. Along with cigarette smoking status we explore differences as a function of countries with different product regulations, gender, and age.

METHODS

Data came from the ITC Four Country Smoking and Vaping Wave 3 Survey conducted between February-June 2020. The analytic sample consisted of 9112 current cigarette smokers (at least monthly) and 1184 recent ex-smokers (quit cigarettes ≤ 2 years) from Australia, Canada, England, and the United States. Respondents were asked about their cigarette smoking and current use of the following non-cigarette products: combustible tobacco (cigars, cigarillos, pipe, waterpipe); noncombustible tobacco (smokeless tobacco, and heated tobacco products [HTPs]); and non-tobacco nicotine products (nicotine vaping products [NVPs], nicotine replacement therapy [NRT], and nicotine pouches).

RESULTS

Overall, NVPs (13.7%) and NRT (10.9%) were the most reported nicotine products used, followed by cigars (5.3%), cigarillos (4.2%), and HTPs (3.5%). More than 21% current and recent ex-smokers of cigarettes reported using a non-tobacco nicotine product and noncombustible product, with respondents in England reporting the highest levels of use (>26%). Males, younger respondents, and current non-daily cigarette smokers were more likely to use non-cigarette nicotine products. Notably, 11.6% of ex-cigarette smokers were using other combustible tobacco.

CONCLUSION

Considerable percentages of current cigarette smokers and ex-smokers use non-cigarette nicotine products, and there are unexpectedly high levels of use of other combustible products by those recent ex-smokers of cigarettes which is concerning and has important implications for definitions of smoking cessation.

IMPLICATIONS

The tobacco product market has evolved to include new products which add to existing non-cigarette tobacco products creating a much more diverse nicotine market. This brief report provides a snapshot of use of various combustible and noncombustible nicotine-containing products among current cigarette smokers and recent ex-smokers in four western countries. Our results indicate that use of non-cigarette tobacco and nicotine products among these cigarette smokers and recent ex-smokers is not low, particularly among males, younger and non-daily cigarette smokers. Use of other combustible tobacco among respondents that recently quit cigarette smoking is concerning and has important implications for definitions of smoking cessation. Increased emphasis on researching non-cigarette nicotine product use is warranted in tobacco control generally and smoking cessation in particular.

Electronic cigarette use among 14- to 17-year-olds in Europe

BACKGROUND

Studies comparing adolescent e-cigarette use in different countries are scarce. We study students' e-cigarette and conventional cigarette ever-use, their social correlates and e-liquid use in seven EU countries.

METHODS

SILNE-R data (N=12 167, response rate 79.4%) of 14-17-year-olds from Amersfoort (NL), Coimbra (PT), Dublin (IR), Hanover (GE), Latina (IT), Namur (BE) and Tampere (FI) were used. E-cigarette and conventional cigarette ever-use, dual-use, type of e-liquid and social correlates were measured with a school survey and analyzed with cross-tabulations and multinomial logistic regression.

RESULTS

About 34% had tried e-cigarettes, but the variation was large between the cities (Latina 50%; Hanover 23%). Of e-cigarette ever-users, 37% had used nicotine e-liquid, 43% exclusively non-nicotine liquid and 20% did not know the content. Nicotine e-liquid was more prevalent among monthly e-cigarette users and weekly smoking e-cigarette users. The social correlates were mainly the same for exclusive e-cigarette ever-use, exclusive conventional cigarette ever-use and dual-use. Boys had greater odds for exclusive e-cigarette and dual-use compared to girls. Of social correlates, low academic achievement and parental smoking were positively associated with all categories of use, but parental education and immigrant background were not. The strongest association was found between peer smoking (most/all best friends smoke) and dual-use (OR 34.29).

CONCLUSIONS

Students' e-cigarette ever-use varies greatly between EU countries. E-cigarettes seem not to be a substitute for conventional cigarettes but more a complementary product. Tobacco control policies might also prevent e-cigarette use but specific regulations on e-cigarettes are needed to prevent nicotine addiction originating from them.

Use of Single, Dual, and Poly Tobacco Products in Korean Adolescents

This study aimed to examine the prevalence of single, dual, and poly use of conventional cigarettes, e-cigarettes, and heated tobacco products among Korean adolescent smokers and identify factors related to dual and poly tobacco product use. Data from 4028 current smokers in the 2019 Korea Youth Behavior Web-based Survey were included. Single users accounted for 53.1%, followed by dual users at 24.8% and poly users at 22.1%. The factors influencing dual and poly tobacco product use included male, living in a metropolitan area, risky alcohol drinking, sexual experience, number of cigarettes smoked, secondhand smoke exposure, and easy-to-buy tobacco products. The findings suggest restricting the use of new types of tobacco products in the high-risk group are required to prevent dual and poly use. Furthermore, it is necessary to provide support like education for new tobacco products and smoking cessation, programs for secondhand smoke prevention, or rigorous marketing regulations for adolescents.

Impact of Cigarette Smoking on the Risk of Osteoporosis in Inflammatory Bowel Diseases

Cigarette smoking constitutes one of the most important modifiable factors of osteoporosis, as well as contributes to an early death, tumors, and numerous chronic diseases. The group with an increased risk of a lower bone mineral density are patients suffering from inflammatory bowel diseases. In fact, tobacco smoke, which contains more than 7000 chemical compounds, affects bone mineral density (BMD) both directly and indirectly, as it has an impact on the RANK-RANKL-OPG pathway, intestinal microbiota composition, and calcium-phosphate balance. Constant cigarette use interferes with the production of protective mucus and inhibits the repair processes in the intestinal mucus. Nicotine as well as the other compounds of the cigarette smoke are important risk factors of the inflammatory bowel disease and osteoporosis. Additionally, cigarette smoking may decrease BMD in the IBD patients. Interestingly, it affects patients with Crohn's disease and ulcerative colitis in different ways-on the one hand it protects against ulcerative colitis, whereas on the other it increases the risk of Crohn's disease development. Nevertheless, all patients should be encouraged to cease smoking in order to decrease the risk of developing other disorders.

Support for e-cigarette policies among smokers in seven European countries: longitudinal findings from the 2016-18 EUREST-PLUS ITC Europe Surveys

BACKGROUND

The 2016 European Tobacco Products Directive (TPD) required Member States (MS) to implement new regulations for electronic cigarettes (ECs). We conducted a longitudinal study to assess changes over 2 years in smokers' support for EC policies and identify predictors of support in seven European countries after TPD implementation.

METHODS

Prospective cohort surveys were conducted among adult smokers in Germany, Greece, Hungary, Poland, Romania, Spain and England in 2016 (n = 9547; just after TPD) and 2018 (n = 10 287; 2 years after TPD). Multivariable logistic regression models employing generalized estimating equations assessed changes in support for four EC policies, and tested for country differences and strength of key predictors of support.

RESULTS

Banning EC use in smoke-free places was supported by 53.1% in 2016 and 54.6% in 2018 with a significant increase in Greece (51.7-66.0%) and a decrease in Spain (60.1-48.6%). Restricting EC/e-liquid nicotine content was supported by 52.2 and 47.4% in 2016 and 2018, respectively, with a significant decrease in England (54.2-46.5%) and Romania (52.5-41.0%). An EC promotion ban was supported by 41.1 and 40.2%. A flavour ban was supported by 33.3% and 32.3% with a significant increase in Hungary (34.3-43.3%). Support was generally higher in Poland, Hungary and Greece vs. England. Support was lower among dual and EC-only users, and low-income smokers.

CONCLUSIONS

Smokers in all countries strongly supported banning EC use in smoke-free places and restricting nicotine content after TPD implementation, with no clear trends for changes in policy support.

Genetic Vulnerability for Smoking and Cannabis Use: Associations With E-Cigarette and Water Pipe Use

INTRODUCTION

Cigarette smoking and cannabis use are heritable traits and share, at least in part, a common genetic substrate. In recent years, the prevalence of alternative methods of nicotine intakes, such as electronic cigarette (e-cigarette) and water pipe use, has risen substantially. We tested whether the genetic vulnerability underlying cigarettes smoking and cannabis use explained variability in e-cigarette and water pipe use phenotypes, as these vaping methods are alternatives for smoking tobacco cigarettes and joints.

METHODS

On the basis of the summary statistics of the International Cannabis Consortium and the Tobacco and Genetics Consortium, we generated polygenic risk scores (PRSs) for smoking and cannabis use traits, and used these to predict e-cigarette and water pipe use phenotypes in a sample of 5025 individuals from the Netherlands Twin Register.

RESULTS

PRSs for cigarettes per day were positively associated with lifetime e-cigarette use and early initiation of water pipe use, but only in ex-smokers (odds ratio = 1.43, R2 = 1.56%, p = .011) and never cigarette smokers (odds ratio = 1.35, R2 = 1.60%, p = .013) respectively.

CONCLUSIONS

Most associations of PRSs for cigarette smoking and cannabis use with e-cigarette and water pipe use were not significant, potentially due to a lack of power. The significant associations between genetic liability to smoking heaviness with e-cigarette and water pipe phenotypes are in line with studies indicating a common genetic background for substance-use phenotypes. These associations emerged only in nonsmokers, and future studies should investigate the nature of this observation.

IMPLICATIONS

Our study showed that genetic vulnerability to smoking heaviness is associated with lifetime e-cigarette use and age at initiation of water pipe use. This finding has implications for the current debate on whether alternative smoking methods, such as usage of vaping devices, predispose to smoking initiation and related behaviors.

Nicotine vaping products as a harm reduction tool among smokers: Review of evidence and implications for pharmacy practice

With the growing popularity and use of nicotine vaping products (NVPs, also known as e-cigarettes) as a way to quit smoking, pharmacy staff are frequently asked by smokers for advice about NVPs. In Australia, there are currently no clear guidelines or policy statements provided by any of the professional organisations for pharmacists on how they should handle customer enquiries about NVPs, or on extemporaneous compounding of prescriptions for nicotine solution for use in NVPs as a smoking cessation aid. This commentary summarises the current evidence surrounding the safety and efficacy of NVPs, the Australian regulatory landscape, and provides a guide for pharmacy staff to use in discussions with customers regarding NVPs. Evidence strongly points to NVPs being considerably less harmful than smoking tobacco cigarettes and that they can be effective for smoking cessation. The maximum benefit from using NVPs as a harm reduction tool, however, will only be realised if smokers completely stop smoking rather than using NVPs as a partial substitute, because even low level smoking still confers substantial health risk. Vaping products containing nicotine are illegal to sell in Australia but users can still legally access nicotine e-liquid through some limited pathways if they hold a valid prescription from a registered medical practitioner. It is important that pharmacy staff keep abreast of the current evidence surrounding these products and provide evidence-based advice to customers.

Awareness, current use of electronic cigarettes and associated smoking factors in Zhejiang Chinese adolescents

OBJECTIVES

The present study aims at examining the prevalence of awareness and current use of electronic cigarettes (e-cigarettes) among middle and high school students from Zhejiang, China. Smoking-related factors associated with e-cigarettes use will also be explored.

METHODS

This cross-sectional study was based on 2017 Zhejiang Youth Risk Behavior Survey. A total of 24,157 adolescents were recruited and relevant data of e-cigarettes and smoking-related factors were collected via a self-reported questionnaire. Logistic regression models were used to examine the association between e-cigarettes current use and the smoking-related factors. Odds ratios (ORs) and their 95% confidence intervals (CIs) were reported.

RESULTS

Overall, 70.61% of middle and high school students reported hearing of e-cigarettes, while only 2.15% reported using e-cigarettes in the past month. Among smoking-related factors, cigarette smoking (ever and current), use of other tobacco products, second hand smoke exposure and previous attempts to quit smoking were significantly associated with higher current e-cigarettes use in adolescents.

CONCLUSIONS

These results presented high awareness of e-cigarettes while relatively low use in Chinese adolescents. Smoking-related factors were significantly associated with increased e-cigarettes use.

E-cigarette use among medical students at Qassim University: Knowledge, perception, and prevalence

Background:

The popularity of e-cigarettes is increasing rapidly worldwide and advertisements for such products are becoming ubiquitous in the media. Health concerns and smoking cessation are the most commonly reported reasons for traditional tobacco smokers to shift to e-cigarettes. As a result, the global market for e-cigarettes is on the rise. However, they are still a potential cause for many diseases.

Methods:

This is a cross-sectional study carried out at Qassim University in Buraydah, Saudi Arabia. A prevalidated questionnaire was distributed to medical students in April 2018 to evaluate the experience, knowledge, and awareness of e-cigarettes among the participants.

Results:

About one in ten students confirmed having smoked an e-cigarette. There was no significant relationship between e-cigarette users and demographic factors, such as gender, academic level, or age. However, the study showed a significant association between e-cigarette smoking and having an e-cigarette smoker among family members or friends. Most students 71.9% were not sure whether e-cigarettes were approved by the Food and Drug Administration (FDA) for smoking cessation. Only 23.3% of those surveyed believed that e-cigarettes can help in smoking cessation, whereas only 11% said that they would recommend it for a patient. On the contrary, 49.6% agreed that e-cigarettes are addictive. In response to another question, 92% reported receiving no education in medical school about e-cigarettes.

Conclusion:

Our study showed that medical students lacked knowledge about e-cigarettes. Therefore, more studies are needed to raise awareness about e-cigarettes, especially since the habit of using e-cigarettes is invading our society.

Perceptions and use of e-cigarettes among young adults in Hong Kong

Background

Little is known about the risk and addiction perceptions of e-cigarettes among Asian populations. We examined e-cigarette perceptions among young adults in Hong Kong and the association between the perceptions and e-cigarette use patterns.

Methods

An online survey was administered to a convenience sample of Hong Kong residents aged 18–35 (N = 1186). Measures of e-cigarette perceptions included perceived harm and addictiveness of e-cigarettes, perceived harm of secondhand e-cigarette aerosol, and perceived popularity of e-cigarette use among peers. Separate multinomial logistic regression models were conducted to examine the associations between the four perceptions and former and current use of e-cigarettes relative to never use, controlling for demographics and current cigarette smoking status. Interactions of e-cigarette perceptions and current cigarette smoking were assessed in all models. Among current e-cigarette users, bivariate exact logistic regression models were used to examine the relationships between each of the perceptions and frequent e-cigarette use (≥3 days in past 30-day vs. 1–2 days). Among participants who had never used e-cigarettes, separate multivariable logistic regression models were conducted to examine the associations between e-cigarette perceptions and susceptibility to e-cigarette use.

Results

Overall, 97.2% of participants were aware of e-cigarettes, and 16.1% had tried e-cigarettes (11.3% former users; 4.8% current users). Young adults perceived e-cigarettes (and aerosol) as less harmful, less addictive, and less popular than cigarettes. Current cigarette smokers reported significantly lower perceived harmfulness and addictiveness of e-cigarettes, lower perceived harmfulness of e-cigarette aerosol, and higher perceived popularity than nonsmokers. The lower degree of harm and addiction perceptions, and higher levels of popularity perceptions were associated with greater odds of e-cigarette use, and these relationships were generally stronger among nonsmokers compared to current cigarette smokers. E-cigarette perceptions were not associated with frequent e-cigarette use. Perceiving e-cigarettes (and aerosol) as less harmful and less addictive were associated with greater susceptibility to e-cigarette use. Compared to nonsmokers, current smokers were more likely to report e-cigarette use and susceptibility.

Conclusions

Continued monitoring of e-cigarette use and perceptions is needed. Educational programs should emphasize the potential harmful and addictive properties of e-cigarettes and the risks of secondhand exposure to e-cigarette aerosol.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7464-z) contains supplementary material, which is available to authorized users.

Awareness and use of e-cigarettes among urban residents in China

INTRODUCTION

The long-term health effects of e-cigarettes are uncertain, and data on e-cigarette use among Chinese adults are limited. This study examined the prevalence and correlates of e-cigarette awareness and use among urban residents in China. Data came from the China City Adult Tobacco Survey (CCATS), a city-representative household survey conducted using electronic tablets during 2013–2014 in 14 major Chinese cities.

METHODS

CCATS used multistage geographically clustered samples with standardized survey protocols and questionnaire to ensure data comparability. Overall, 31151 adults completed the survey, with sample size varying from 1977 to 3838 across cities, and survey response rates ranging from 79.8% to 97.5%. Respondents were considered current e-cigarette users if they self-reported using e-cigarettes ‘daily’ or ‘less than daily’ at the time of the survey. Descriptive statistics and multivariate logistic regression were conducted. Assessed correlates included: age, education, quit attempts in past 12 months, cigarettes smoked per day, and monthly expenditures on cigarettes.

RESULTS

Overall, 46.7% of respondents were aware of e-cigarettes, 2.9% ever used, and 0.8% currently used. Most current e-cigarette users (93.0%) also currently smoked tobacco. Among male current tobacco smokers, adjusted odds ratio (AOR) of current e-cigarette use was higher among those aged 15–29 (AOR=2.5; 95% CI: 1.5–4.3) or 30–49 (AOR=1.9; 95% CI: 1.0–3.4) than those ≥50 years; those who attempted to quit in the past 12 months than those who did not (AOR=4.7; 95% CI: 2.2–10.1); those with a college degree (AOR=3.4; 95% CI: 1.9–6.2) or just finished high school (AOR=2.2; 95% CI: 1.2–4.2) than those who did not finish high school; and those who smoked ≥15 cigarettes per day (AOR=2.8; 95% CI: 1.4–5.6) than those who smoked fewer.

CONCLUSIONS

These findings reveal that during 2013–2014, many urban Chinese adults were aware of e-cigarettes, while use was relatively low and most current users also smoked tobacco. Continued monitoring of e-cigarettes could help inform public health policy, planning, and practice.

Sleep quality in cigarette smokers and nonsmokers: findings from the general population in central China

Background

Sleep problems are common in the general population. Cigarette smoking is common in the general population of China. Examinations of the prevalence of poor sleep quality among Chinese smokers and nonsmokers are still lacking. This study was designed to examine sleep quality and sleep disturbances among cigarette smokers and nonsmokers in the general population in central China.

Methods

In this population-based sampling project, we used a multi-stage sampling method to recruit survey participants from September 2012 to October 2012 in rural and urban areas of Hunan province, China. A total of 27,300 subjects were sampled from the general population and 26,282 completed the self-report of cigarette smoking characteristics. Cigarette smoker was defined as having smoked ≥100 cigarette in a lifetime and smoked during the last 28 days. Cigarette smoking characteristics were obtained from smokers, including cigarettes per day, years of smoking, quit attempts, and smoking cravings. The Pittsburgh Sleep Quality Index (PSQI) was applied to assess quality of sleep and sleep disturbances (PSQI score > 5).

Results

Significantly more smokers than nonsmokers demonstrated poor sleep quality and sleep disturbances. Among smokers, linear regression analyses showed that poor sleep was inversely associated with cigarettes per day, and positively associated with years of smoking, quit attempts, and smoking craving. Logistic regression analysis showed that quit attempts and smoking cravings were associated with higher odds of sleep disturbances.

Conclusions

Sleep disturbances were more prevalent among cigarette smokers than nonsmokers. Smokers also varied in sleep problems on the basis of the characteristics of their smoking. Smokers should be informed about the link between cigarette smoking and poor sleep quality, and should be advised that one of several important health benefits from smoking cessation could be the improvement of sleep quality. Sleep therapy should be recommended as an adjunctive treatment for smoking cessation.

Prevalence and sociodemographic disparities in ever E-cigarette use among adults in Los Angeles County

E-cigarette use has increased rapidly among U.S. adults. Few studies have examined the prevalence and risk factors of e-cigarette use among adults in the United States. We conducted descriptive analyses to identify characteristics of ever e-cigarette users among adults (18 years and older) living in Los Angeles (LA) County, the most populous county in the U.S., using data from the 2015 LA County Health Survey. We used logistic regression to examine independent factors associated with ever e-cigarette use. Age-adjusted prevalence of ever e-cigarette use was 8.4%. A significant interaction between conventional cigarette smoking status and gender was found (p < 0.05), and several factors were identified as associated with ever e-cigarette use in models stratified by gender. Various social and demographic factors are associated with ever e-cigarette use and should be incorporated into evidence-based interventions.

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In LA County, 11.6% of males and 5.7% of females reported ever using e-cigarettes.

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The prevalence of ever e-cigarette use was 18.5% among young adults (18–24 years).

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Factors associated with ever e-cigarette use varied by gender.

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Concurrent use of other substances was associated with ever e-cigarette use.

The impact of e-cigarette price changes on vaping and smoking behaviors

Background: Understanding the relations between e-cigarette prices and e-cigarette/cigarette use may shed light on the possible impact of e-cigarette regulations on public health. Objectives: This study aimed to assess potential impacts of e-cigarette price changes on vaping and smoking behaviors by smoking status (current, former, and never smokers) and e-cigarette type (pre-filled only vs. refillable). Methods: A total of 918 US-based adult e-cigarette users completed an online survey, designed to assess behavioral intention of e-cigarette/cigarette use in hypothetical situations with varying prices of e-cigarettes, in 2017. Results: With reduction in e-cigarette prices, more than 50% of current smokers reported they would reduce or quit smoking, but with greater increases in price, the rates of not only those who would quit (12.5-19.4%), but also those who would increase smoking rose (15.1-25.1%). Current smokers (vs. former/never) were more likely to increase e-cigarette use at reduced e-cigarette prices. Among current smokers, pre-filled users were less likely to quit smoking with reduced prices. At higher prices, pre-filled users were more likely to quit e-cigarettes (former smokers), but also more likely to start smoking (never smokers). Among former smokers, recent quitters were more likely to restart smoking with any e-cigarette price changes, and less likely to reduce or quit e-cigarettes with increased prices. Conclusions: Both smoking and e-cigarette use seem to be sensitive to e-cigarette price changes. Increases in e-cigarette price may have both positive and negative effects on smoking behavior, and e-cigarette price changes may disproportionately affect pre-filled users and recent quitters.

E-cigarette advertising exposure in e-cigarette naïve adolescents and subsequent e-cigarette use: A longitudinal cohort study

OBJECTIVE

Electronic (E-) cigarettes are one of the most popular tobacco products used by adolescents today. This study examined whether exposure to advertisements in (1) social networking sites (Facebook, Twitter, YouTube, Pinterest/Google Plus), (2) traditional media (television/radio, magazines, billboards), or (3) retail stores (convenience stores, mall kiosks, tobacco shops) was associated with subsequent e-cigarette use in a longitudinal cohort of adolescents.

METHODS

Data were drawn from longitudinal surveys conducted in fall 2013 (wave 1) and spring 2014 (wave 2) of a school-based cohort attending 3 high schools and 2 middle schools in Connecticut. Adolescents were asked about tobacco use behaviors and where they had recently seen e-cigarette advertising at wave 1. We used logistic regression to determine whether advertising exposure at wave 1 increased the odds of e-cigarette use by wave 2, controlling for demographics and cigarette smoking status at wave 1.

RESULTS

Among those who have never used e-cigarettes in wave 1 (n = 1742), 9.6% reported e-cigarette use at wave 2. Multivariate logistic regression demonstrated that exposure to e-cigarette advertising on Facebook (OR 2.12 = p < 0.02) at wave 1, but not other venues, significantly increased the odds of subsequent e-cigarette use wave 2. Age, white race, and cigarette smoking at wave 1 also was associated with e-cigarette use at wave 2.

CONCLUSION

This study provides one of the first longitudinal examinations demonstrating that exposure to e-cigarette advertising on social networking sites among youth who had never used e-cigarettes increases the likelihood of subsequent e-cigarette use.

Prevalence of electronic nicotine delivery systems (ENDS) use among youth globally: a systematic review and meta-analysis of country level data

OBJECTIVE

To describe the prevalence and change in prevalence of electronic nicotine delivery systems (ENDS) use in youth by country and combustible smoking status.

METHODS

Databases and the grey literature were systematically searched to December 2015. Studies describing the prevalence of ENDS use in the general population aged ≤20 years in a defined geographical region were included. Where multiple estimates were available within countries, prevalence estimates of ENDS use were pooled for each country separately.

RESULTS

Data from 27 publications (36 surveys) from 13 countries were included. The prevalence of ENDS ever use in 2013-2015 among youth were highest in Poland (62.1%; 95%CI: 59.9-64.2%), and lowest in Italy (5.9%; 95%CI: 3.3-9.2%). Among non-smoking youth, the prevalence of ENDS ever use in 2013-2015 varied, ranging from 4.2% (95%CI: 3.8-4.6%) in the US to 14.0% in New Zealand (95%CI: 12.7-15.4%). The prevalence of ENDS ever use among current tobacco smoking youth was the highest in Canada (71.9%, 95%CI: 70.9-72.8%) and lowest in Italy (29.9%, 95%CI: 18.5-42.5%). Between 2008 and 2015, ENDS ever use among youth increased in Poland, Korea, New Zealand and the US; decreased in Italy and Canada; and remained stable in the UK.

CONCLUSIONS

There is considerable heterogeneity in ENDS use among youth globally across countries and also between current smokers and non-smokers. Implications for public health: Population-level survey data on ENDS use is needed to inform public health policy and messaging globally.

E-cigarette and waterpipe use in two adolescent cohorts: cross-sectional and longitudinal associations with conventional cigarette smoking

Alternative tobacco products are increasing in popularity. An important question is whether their use is associated with or even leads to conventional smoking, but large-scale (European) studies are scarce. In two cohorts of Dutch adolescents (Cohort I n = 6819, mean age = 13.8 SD = 1.1, 48.2% female; Cohort II n = 2758, mean age = 17.3 SD = 1.8, 61.3% female), we investigated use of electronic (e)-cigarettes with nicotine, e-cigarettes without nicotine and waterpipe. Generalized estimating equation modelling was conducted with ever conventional smoking as the dependent variable (0 = no, 1 = yes) and ever alternative tobacco use as the independent variable, correcting for clustering within schools, age, sex and education in both cohorts. In a subsample (n = 2100), the association between alternative tobacco use at baseline and conventional smoking 6 months later was tested, taking into account smoking propensity (based on personality, susceptibility to peer pressure and smoking intentions). Ever use prevalence was 13.7% for e-cigarettes with nicotine, 29.4% for e-cigarettes without nicotine and 22.1% for waterpipe in Cohort I and 12.3, 27.6 and 45.3% respectively in Cohort II. Ever smokers had tried alternative tobacco products more often than never smokers. Among never-smoking adolescents at baseline, alternative tobacco use predicted ever smoking 6 months later (e-cigarettes with nicotine OR 11.90 95% CI 3.36-42.11; e-cigarettes without nicotine OR 5.36 95% CI 2.73-10.52; waterpipe OR 5.36 95% CI 2.78-10.31). This association was strongest for adolescents with a low baseline risk of smoking. Experimenting with alternative tobacco products is common among Dutch youth. Alternative tobacco use predicts (future) smoking, especially among adolescents with a low smoking propensity.

Electronic Cigarette Use in Students and Its Relation with Tobacco-Smoking: A Cross-Sectional Analysis of the i-Share Study

While young adults often try e-cigarettes, little is known about its use and the reasons for experimentation, particularly in relation with tobacco-smoking. In 2016, data were collected from 2720 French-speaking students participating in a web-based study on students' health: the internet-based Students Health Research Enterprise (i-Share) project. Univariate analyses and multivariable logistic regressions were performed to study the relationship between e-cigarette use and smoking status. Two out of five students declared having tried e-cigarettes and 3.6% were current users. Former smokers were more likely than current smokers to use e-cigarettes currently. Among those who had never smoked, 13.5% had tried e-cigarettes. Very few (0.3%) were current users, alternating e-liquids with and without nicotine. The three main reasons for trying e-cigarettes were curiosity, offer to try by someone, and attractiveness of e-liquid flavors. Among current smokers, previous attempts to quit smoking and a strong desire to stop tobacco were reported more in e-cigarette current users than in former users. In this large sample of French students, findings were consistent with the possibility that e-cigarettes might be used as smoking cessation or reduction aids by some young adults whereas other young never-smokers could be exposed to nicotine.

The Prevalence and Characteristics of E-Cigarette Users in the U.S

Studies have examined the characteristics of individuals who use e-cigarettes, including sociodemographic and smoking characteristics, and the relationship of e-cigarette use to tobacco control policies. While most studies consider a subset of these characteristics with weak measures of regular e-cigarette use, this study uses a large, recent U.S. survey to simultaneously consider the association of each of these factors with different use measures. Data from the May 2014 Tobacco Use Supplement-Current Population Survey is supplemented with information on tobacco control policies. The prevalence of ever, current (at least 1 of the last 30 days), and regular (at least 20 of the last 30 days) e-cigarette use were 7.7%, 2.1% and 0.9%, implying that 27.0% of ever users were current users of which 45.3% were regular users. E-cigarette use varied by socio-demographic characteristics and by smoking status, and depended on the measure of use adopted. However, regardless of measures, e-cigarette use was higher among those smokers who smoked more cigarettes. The association with policies was generally weak, but we found more regular use by smokers in low tax and low tobacco control spending states. The results indicate that the user characteristics differ depending on the e-cigarette use measure. The measure of use should be carefully considered in analyzing how e-cigarette use affects cigarette use.

Prevalence and correlates of electronic cigarette use among Canadian students: cross-sectional findings from the 2014/15 Canadian Student Tobacco, Alcohol and Drugs Survey

BACKGROUND

Over the past decade, youth tobacco use has declined, and electronic cigarettes (e-cigarettes) have entered the market. The aims of this study were to describe the prevalence of e-cigarette use among youth in Canada, by province, across sociodemographic variables and smoking-related correlates; and to examine associations among e-cigarette use, sociodemographic variables and smoking-related correlates, with adjustment for other factors.

METHODS

The 2014/15 Canadian Student Tobacco, Alcohol and Drugs Survey, a biennial, school-based survey, was administered to students in grades 6-12 in all Canadian provinces. Logistic regression models were fitted to estimate odds of ever and past 30-day e-cigarette use by sociodemographic variables and smoking-related correlates.

RESULTS

A total of 336 schools from 128 school boards (47% of eligible schools approached) and 42 094 students (66% of eligible students approached) participated in the survey. In Canada, 17.7% (95% confidence interval [CI] 16.4%-18.9%) of students in grades 6-12 reported ever using e-cigarettes, and 5.7% (95% CI 5.2%-6.3%) reported past 30-day use. Substantial variation was observed across provinces. Female students had decreased odds of past 30-day use relative to male students (odds ratio [OR] 0.71, 95% CI 0.59-0.86), whereas current smokers (OR 10.0, 95% CI 6.66-15.02) and experimental smokers (OR 3.61, 95% CI 2.40-5.42) had increased odds relative to never smokers. Students who perceived that access was easy also had increased odds of using e-cigarettes relative to students who perceived that access was difficult (OR 3.86, 95% CI 2.96-5.03). Students who believed that regular use entailed slight risk (OR 0.68, 95% CI 0.52-0.88) and those who did not know risk levels (OR 0.31, 95% CI 0.21-0.46) had decreased odds compared with those perceiving no risk.

INTERPRETATION

Our data confirm that many youth used e-cigarettes in the 30 days preceding the survey, although rates were substantially higher among current and experimental smokers than among students who had never tried smoking.

Elucidating challenges that electronic cigarettes pose to tobacco control in Asia: a population-based national survey in Taiwan

OBJECTIVES

This study investigated the prevalence and correlates of electronic cigarettes (e-cigarettes) use in Taiwan.

DESIGN AND SETTING

We studied a nationally representative random sample in the 2015 Taiwan Adult Smoking Behavior Survey.

PARTICIPANTS

This study included 26 021 participants aged 15 years or older (51% women, 79% non-smokers, 16% aged 15-24 years), after excluding 31 persons (0.1%) who had missing information on e-cigarette use.

PRIMARY OUTCOME MEASURES

The prevalence of ever having used e-cigarettes was calculated in the overall sample and by smoking status (current, former and never) or age (15-24, 25-44 and ≥45 years). We performed multivariable log-binomial regression to assess correlates of ever having used e-cigarettes among all participants and separately for subgroups by smoking status and age.

RESULTS

Approximately 3% of all participants had ever used e-cigarettes. The prevalence of ever having used e-cigarettes was high in current smokers (14%) and people aged 18-24 years (7%). E-cigarette use was particularly common in people aged 15-24 years who were current (49-52%) or former (22-39%) smokers. Ever having used e-cigarettes was positively associated with tobacco smoking (adjusted prevalence ratio (aPR): 21.5, 95% CI 15.4 to 29.8, current smokers; aPR: 8.3, 95% CI 15.2 to 13.1, former smokers), younger age and high socioeconomic status. Age remained a significant factor of ever having used e-cigarettes across smoking status groups. Among non-smokers, men had a 2.4-fold (95% CI 1.5 to 3.8) greater prevalence of e-cigarette use than women.

CONCLUSIONS

E-cigarette use was uncommon in the general population in Taiwan, but prevalence was high among smokers and young people. This study highlights challenges that e-cigarettes pose to tobacco control, which warrant high priority action by policymakers and public health professionals. E-cigarette regulations should focus on young people.

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.

The Application of a Decision-Theoretic Model to Estimate the Public Health Impact of Vaporized Nicotine Product Initiation in the United States

INTRODUCTION

The public health impact of vaporized nicotine products (VNPs) such as e-cigarettes is unknown at this time. VNP uptake may encourage or deflect progression to cigarette smoking in those who would not have otherwise smoked, thereby undermining or accelerating reductions in smoking prevalence seen in recent years.

METHODS

The public health impact of VNP use are modeled in terms of how it alters smoking patterns among those who would have otherwise smoked cigarettes and among those who would not have otherwise smoked cigarettes in the absence of VNPs. The model incorporates transitions from trial to established VNP use, transitions to exclusive VNP and dual use, and the effects of cessation at later ages. Public health impact on deaths and life years lost is estimated for a recent birth cohort incorporating evidence-informed parameter estimates.

RESULTS

Based on current use patterns and conservative assumptions, we project a reduction of 21% in smoking-attributable deaths and of 20% in life years lost as a result of VNP use by the 1997 US birth cohort compared to a scenario without VNPs. In sensitivity analysis, health gains from VNP use are especially sensitive to VNP risks and VNP use rates among those likely to smoke cigarettes.

CONCLUSIONS

Under most plausible scenarios, VNP use generally has a positive public health impact. However, very high VNP use rates could result in net harms. More accurate projections of VNP impacts will require better longitudinal measures of transitions into and out of VNP, cigarette and dual use.

IMPLICATIONS

Previous models of VNP use do not incorporate whether youth and young adults initiating VNP would have been likely to have been a smoker in the absence of VNPs. This study provides a decision-theoretic model of VNP use in a young cohort that incorporates tendencies toward smoking and shows that, under most plausible scenarios, VNP use yields public health gains. The model makes explicit the type of surveillance information needed to better estimate the effect of new products and thereby inform public policy.

Adolescent Awareness and Use of Electronic Cigarettes: A Review of Emerging Trends and Findings

Adult electronic cigarette (e-cigarette) use is increasing globally, and early studies have suggested that similar trends may be observed among the adolescent population, albeit at lower levels. The current literature review presents data collected since 2014 from 21 cross-sectional studies and one cohort study that were all published in English. In particular, it focuses on awareness, ever use, past 30-day use, and regular use of e-cigarettes. The article suggests that adolescents are nearing complete awareness of e-cigarettes. Furthermore, in relation to ever use and past 30-day use, higher prevalence rates continue to be reported across time, especially in the United States. Nonetheless, reported regular use of e-cigarettes remains much lower than past 30-day use, although conclusions are limited due to inconsistencies with measurement and consequent lack of cross-cultural applicability. The majority of studies do not report whether adolescents use non-nicotine e-cigarettes. There is a current absence of longitudinal studies that explore any association between e-cigarettes and tobacco use and little qualitative data that may illuminate how and why adolescents use e-cigarettes. Through addressing these methodological limitations, future research will be able to inform health care and policy more effectively.

Changes in Electronic Cigarette Use from 2013 to 2015 and Reasons for Use among Finnish Adolescents

Electronic cigarettes are quite a new potential source of nicotine addiction among youth. More research is needed, particularly on e-liquid use and socioeconomic factors as potential determinants. We studied changes from 2013 to 2015 in adolescent e-cigarette awareness and ever-use, types of e-liquids, and determinants in Finland. In 2015, we studied weekly use and reasons for ever-use. Data were from two national surveys of 12–18-year-old Finns (2013, n = 3535, response rate 38%; 2015, n = 6698, 41%). Descriptive statistics and logistic regression analysis were used. Awareness and ever-use of e-cigarettes increased significantly from 2013 to 2015 in all age and gender groups. Ever-use increased from 17.4% to 25%, with half having tried nicotine e-liquids. In 2015, weekly use was rare (1.5%). Daily cigarette smoking was the strongest determinant (OR 51.75; 95% CI 38.18–70.14) for e-cigarette ever-use, as for e-cigarette weekly use, but smoking experimentation and ever-use of snus (Swedish type moist snuff) and waterpipes alongside parental smoking and poor academic achievement also increased the odds for ever-use. The most common reason behind e-cigarette ever-use was the desire to try something new. To conclude, adolescent e-cigarette ever-use is increasing, and also among never-smokers. Tobacco-related factors are stronger determinants for e-cigarette use than socioeconomic factors.

Opinions and practices regarding electronic cigarette use among Romanian high school students

OBJECTIVE

The study assessed awareness, opinions, practices regarding electronic cigarettes (e-cigarettes) and factors associated with their use among Romanian high school students.

METHODS

A cross-sectional study was conducted in 2013 in two major Romanian cities, distributing anonymous questionnaires to 342 high school students aged 16-18.

RESULTS

52.3% of the smokers, 29.2% of the ex-smokers and 7% of the never-smokers had tried e-cigarettes at least once in their life; 7.8% of the smokers and 4.6% of the ex-smokers had used e-cigarettes in the last month. Among smokers, e-cigarette use was associated with lower participation in school health education regarding e-cigarettes and with having parents using e-cigarettes.. Among ex-smokers and never-smokers, e-cigarette use was associated with intention to use e-cigarettes in the next year and with having friends who use e-cigarettes.

CONCLUSION

Health education programmes and regulatory interventions addressing e-cigarettes are needed in Romania. More research is necessary on how to develop effective public health messages.