Awareness and use of heated tobacco products among adult smokers in six European countries: findings from the EUREST-PLUS ITC Europe Surveys

Abstract Background The study assessed awareness and use of heated tobacco products (HTPs) and factors that influenced these issues among cigarette smokers from six European countries in 2016 (Wave 1) and 2018 (Wave 2). Methods A survey was conducted among a nationally representative sample of cigarette smokers aged 18 years or older from Germany, Greece, Hungary, Poland, Romania and Spain in 2016 (N = 6011) and 2018 (N = 6027; 53% of smokers from the previous wave were retained, regardless of smoking status and dropouts were replaced by a replenishment sample of smokers). Data were collected through face-to-face interviews. Estimates were produced using weighted data. The study presents the cross-sectional results. Results Awareness of HTPs increased from 8% to 17% between the two waves. At Wave 1, 1.1% of the smokers declared having used HTPs at least once during their lifetime; and at Wave 2, this increased to 1.9% (around 1% or less in four countries, except for Greece and Romania where it was around 4%). Factors associated with HTPs use among those who had ever heard about these products at Wave 1 were country of residence, being a daily cigarette smoker and ever use of electronic cigarettes. At Wave 2, ever use of HTPs was significantly higher among those who had tried to quit smoking combustible cigarettes in the last 12 months, had tried electronic cigarettes during lifetime and perceived HTPs as less dangerous than combustible cigarettes; the country of residence was also associated with HTPs use. Conclusion This study offers insights into the behaviours and perceptions of European adult smokers regarding HTPs, an important emerging issue in the field of tobacco control.

Download Full-text

Knowledge and Beliefs Regarding Harm From Specific Tobacco Products: Findings From the H.I.N.T. Survey

American Journal of Health Promotion ◽

10.1177/08901171211026116 ◽

2021 ◽

pp. 089011712110261

Author(s):

Wenxue Lin ◽

Joshua E. Muscat

Keyword(s):

Electronic Cigarettes ◽

Multiple Linear Regression Model ◽

Cross Sectional ◽

Cigarette Smokers ◽

Tobacco Products ◽

Single Item ◽

Knowledge And Beliefs ◽

Nationally Representative ◽

National Trends ◽

Medical Recommendations

Purpose: Determine whether dual tobacco users have different levels of knowledge about nicotine addiction, perceived harm beliefs of low nicotine cigarettes (LNCs) and beliefs about electronic cigarettes (e-cigarettes) Design: Quantitative, Cross-sectional Setting: Health Information National Trends Survey 5 (Cycle 3, 2019) Participants: Nationally representative adult non-smokers (n=3113), exclusive cigarette smokers (n=302), and dual (cigarette and e-cigarette) users (n=77). Measures: The survey included single item measures on whether nicotine causes addiction and whether nicotine causes cancer. A five-point Likert scale assessed comparative harm of e-cigarettes and LNCs relative to conventional combustible cigarettes (1=much more harmful, 3=equally harmful…5 = much less harmful, or don’t know). Analysis: We used weighted multiple linear regression model to estimate means and 95% confidence intervals (CI) of e-cigarettes and LNCs beliefs by current tobacco user status. Results: Over 97% of dual users, 83% of non-smokers and 86% of exclusive cigarette smokers correctly identified that nicotine is addictive. The majority of subjects incorrectly identified nicotine as a cause of cancer, with dual users having the lowest proportion of incorrect responses (60%). Dual users rated e-cigarette harmfulness as less harmful than combustibles (mean=2.20; 95% CI=1.73, 2.66) while exclusive cigarette smokers and non-smokers rated them as similarly harmful. LNCs were considered equally harmful and addictive as conventional cigarettes. Conclusion: Dual users had a higher knowledge base of tobacco-related health effects. The effectiveness of policies or medical recommendations to encourage smokers to switch from cigarettes to LNCs or e-cigarettes will need to consider accurate and inaccurate misperceptions about the harm and addictiveness of nicotine. Improved public health messages about different tobacco products are needed.

Download Full-text

Perception of Harms and Benefits of Electronic Cigarettes Among Adult Malaysian Men: A Comparison by Electronic Cigarette Use and Smoking Status

Asia Pacific Journal of Public Health ◽

10.1177/1010539519860730 ◽

2019 ◽

Vol 31 (7_suppl) ◽

pp. 32S-43S ◽

Cited By ~ 3

Author(s):

Caryn Mei Hsien Chan ◽

Jamalludin Ab Rahman ◽

Guat Hiong Tee ◽

Lei Hum Wee ◽

Bee Kiau Ho ◽

...

Keyword(s):

Electronic Cigarettes ◽

Smoking Status ◽

Cigarette Use ◽

Government Employees ◽

Cross Sectional ◽

Face To Face ◽

Nationally Representative ◽

Wage Earners ◽

Sectional Analysis ◽

The Relationship

Little is known about the perceptions of harm and benefit associated with the use of e-cigarettes in Malaysia. This was a cross-sectional analysis of a nationally representative sample comprising 1987 males (≥18 years of age). Current, former, and never users of conventional cigarettes and/or e-cigarettes participated in a questionnaire study conducted via face-to-face interviews. The relationship between participant characteristics and perceptions of harm and benefit of e-cigarettes were determined with multivariable logistic regression. There were 950 current, 377 former, and 660 never users of e-cigarettes. Government employees (odds ratio [OR] = 1.85, 95% confidence interval [CI] = 1.29-2.66, P = .001), private sector employees (OR = 1.67, 95% CI = 1.27-2.18, P = .001), and the self-employed people (OR = 1.68, 95% CI = 1.31-2.17, P = .001) were more likely to perceive e-cigarettes as more harmful than conventional cigarettes compared with respondents who were not wage earners. All current users in the form of e-cigarette users (OR = 7.87, 95% CI = 3.23-19.18), conventional cigarette smokers (OR = 1.80, 95% CI = 1.39-2.33), and dual users (OR = 8.59, 95% CI = 4.76-15.52) were more likely to perceive e-cigarettes as useful in quitting conventional cigarette smoking compared with former and never users. Our findings constitute an important snapshot into the perceptions of e-cigarette harms and benefits, which could inform targeted public health messaging strategies.

Download Full-text

Prevalence of Flavored e-Cigarette Use Among Subpopulations of Adults in the United States

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djaa118 ◽

2020 ◽

Author(s):

Adam M Leventhal ◽

Hongying Dai

Keyword(s):

Smoking Status ◽

Statistical Significance ◽

The United States ◽

Cigarette Use ◽

Cross Sectional ◽

Quit Smoking ◽

Prevalence Estimates ◽

Quitting Smoking ◽

Nationally Representative ◽

Never Smokers

Abstract Background Evidence of US adult flavored e-cigarette use prevalence stratified by age, smoking status, and purpose for vaping (ie, quitting smoking, to use when or where smoking is not allowed) can inform policies that reduce the tobacco-related cancer burden. Methods Current flavored e-cigarette use (use 1 or more nontobacco flavors) prevalence estimates were compared across subpopulation groups using 2-sided statistical significance tests in the July 2018 Current Population Survey Tobacco Use Supplement, a nationally representative cross-sectional adult survey (n = 46 759). Results Current flavored e-cigarette use was reported by 1.6% (95% confidence interval [CI] = 1.47% to 1.69%) of all respondents. Among current vapers, the percentage of those who used flavored e-cigarettes was higher for adults aged 18-24 years (89.6%), 25-34 years (86.7%), and 35-44 years (76.0%) than for adults aged 45 years and older (60.4%, Ps < .001); was higher in never smokers (89.8%) than current (72.9%), long-term former (73.9%), and recent former (80.4%) smokers (Ps ≤ .009); was higher in smokers who reportedly did (78.9%) vs did not (71.1%) use e-cigarettes to vape where or when smoking is not allowed (P = .005); and did not differ between smokers who reportedly did (75.0%) vs did not (73.9%) vape to quit smoking (P = .71). Individuals who vaped to quit smoking and currently used flavored e-cigarettes constituted 0.9% (95% CI = 0.82% to 0.99%) of all adults (weighted N = 2 251 000, 95% CI = 2 046 000 to 2 476 000) and 57.2% of current flavored e-cigarette users. Conclusions Flavored e-cigarette use prevalence was low among US adults overall but common for current vapers. Flavored e-cigarette use was disproportionately prevalent among never smokers and other subpopulations that might experience harm from vaping.

Download Full-text

Use and perceptions of electronic cigarette by the adult population in France in 2017

European Journal of Public Health ◽

10.1093/eurpub/ckz186.626 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

G Quatremère ◽

A Pasquereau ◽

R Guignard ◽

R Andler ◽

J B Richard ◽

...

Keyword(s):

Social Inequalities ◽

Electronic Cigarettes ◽

Smoking Status ◽

Adult Population ◽

Descriptive Analysis ◽

Health Agency ◽

Electronic Cigarette ◽

Cross Sectional ◽

Quit Smoking ◽

Former Smokers

Abstract Background E-cigarette (EC) use is controversial because its benefit-risk ratio is still unclear. Since its introduction on the French market at the beginning of the 2010’s, French health authorities have published cautious recommendations. The study aims at describing uses and perceptions about EC among the adult population. Methods Santé Publique France’s Health Barometer, the French national public health agency, is a cross-sectional random survey conducted annually by phone, on a representative sample of the population aged 18-75 y/o in Mainland France. Descriptive analysis and logistic regressions were performed to analyze data collected from the 25,319 respondents of the 2017 edition. Results In 2017 in Mainland France, 3.8% of the population used an EC, 2.7% on a daily basis. Among EC daily users, 60.4% were men, 57.9% had a bachelor degree or higher qualifications. Less than 1% of EC users were never-smokers, 50.3% were daily or occasional smokers, 49.5% were former smokers. The number of daily ex-smokers who did quit smoking ( > = 6 months) and believed that vaping has helped them to, was estimated to be 700,000 since EC has been available in France. EC was perceived as equally or more harmful than regular cigarette by half of the population (51.5%), a proportion that has increased since 2014 (43.4%). Daily smokers perceived EC as more harmful, while being an EC user from high socioeconomic status was associated with the perception that EC is less harmful. The bans on EC in places where smoking is prohibited and on sales of EC to minors (<18 y/o) were appreciated by 66.9% and 77.5%, respectively. Conclusions These results show that in France, EC is strongly related to current or past smoking habits. A significant number of ex-smokers believe that EC has helped them quit smoking. Sociodemographic differences in the perception of EC harmfulness suggest social inequalities in access to information. Key messages Electronic cigarette users in France are few and most of them are smokers or former smokers. The perception of electronic cigarettes harmfulness depends on sociodemographic and smoking status.

Download Full-text

The Role of Novel (Tobacco) Products on Tobacco Control in Italy

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18041895 ◽

2021 ◽

Vol 18 (4) ◽

pp. 1895 ◽

Cited By ~ 1

Author(s):

Silvano Gallus ◽

Elisa Borroni ◽

Anna Odone ◽

Piet A. van den Brandt ◽

Giuseppe Gorini ◽

...

Keyword(s):

Smoking Prevalence ◽

Electronic Cigarettes ◽

Electronic Cigarette ◽

Italian Population ◽

Cross Sectional ◽

Tobacco Products ◽

Quit Smoking ◽

First Time ◽

Novel Products

In Italy, electronic cigarettes have spread since 2010 and heated tobacco products (HTP) since 2016. We investigated their public health consequences on conventional cigarette smoking, taking advantage of a series of cross-sectional studies annually conducted between 2001 and 2019 in Italy. Every year, the sample, including around 3000 individuals, was representative of the general Italian population aged ≥15 years. In Italy, smoking prevalence steadily declined from 29.1% in 2001 to 20.6% in 2013, then increased to 22.0% in 2019. In 2017–2019, current electronic cigarette users were 2.1% and in 2019 current HTP users were 1.1%. Among 498 ever electronic cigarette users, 23.2% started or re-started smoking and 15.7% quit smoking after electronic cigarette use; of 49 ever HTP users, 19.1% started or re-started smoking combusted cigarettes and 14.6% quit smoking after HTP use. The availability of novel products in Italy resulted in a halt of the decreasing trend in smoking prevalence. For the first time, we observed an increase of Italians inhaling nicotine, concurrently with the spread of novel (tobacco) products. More importantly, the use of novel products appears to increase—rather than decrease—the likelihood of smoking conventional cigarettes. Considering this evidence, we see no argument to justify the huge fiscal and regulatory benefits these products continue to have, at least in Italy.

Download Full-text

E-cigarettes from the perspective of teenagers – results of focus studies

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1006 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

K Pluta ◽

Ł Balwicki

Keyword(s):

Young People ◽

Preventive Measures ◽

Electronic Cigarettes ◽

Smoking Status ◽

Risky Behaviors ◽

Tobacco Prevention ◽

Tobacco Products ◽

Traditional Tobacco ◽

The Impact ◽

Natural Way

Abstract Research shows that over 80% of smokers start their habit under the age of 18. A few years ago young people undertook risky behaviors related to nicotine initiation mainly by smoking cigarettes. Today, next to traditional tobacco products, electronic cigarettes are becoming more and more popular. Due to the prevalence of new forms of nicotine addiction, modification of anti-tobacco prevention programs is required. The purpose of the research was exploration - learning the opinions and attitudes of young people towards e-cigarettes. The qualitative study was conducted using the FGI method (focus group interview). The meetings were modereted by specially trained psychologists. 48 students participated in the meetings of six focus groups, divided by gender and smoking status (smokers/non-smokers). The participants are young people aged 15-19, attending high schools in Warsaw, Kielce and Lublin. In conversations, young people emphasized the impact of e-cigarettes in smoking initiation - it usually occurs at the age of 12-14. E-cigarettes are perceived as cigarettes “for younger”, non-addictive, less serious, providing more entertainment. 'Cloud chasing' is particularly popular. They perform social functions - they are helpful in establishing relationships. Teenagers do not see the harmfulness of e-cigarettes. Participants mentioned their advantages over traditional tobacco products - they can be smoked everywhere and do not leave an unpleasant smell. Some of the respondents admit to the simultaneous use of electronic and traditional cigarettes. Moreover, many parents allow children to smoke electronic cigarettes. Vaping have become a natural way to relaxation and socialization for adolescents. E-cigarettes do not have such a negative connotation as traditional tobacco products. Young people do not see them as harmful, which is a challenge for effective preventive measures. Key messages Adolescents do not see e-cigarettes as harmful, which is a challenge for effective preventive measures. Vaping have become more and more popular - it's natural way to relaxation and socialization for young people.

Download Full-text

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

Nicotine & Tobacco Research ◽

10.1093/ntr/ntab040 ◽

2021 ◽

Author(s):

Lin Li ◽

Ron Borland ◽

K Michael Cummings ◽

Shannon Gravely ◽

Anne C K Quah ◽

...

Keyword(s):

Smoking Cessation ◽

Cigarette Smoking ◽

Smoking Status ◽

Tobacco Product ◽

Cigarette Tobacco ◽

Cigarette Smokers ◽

Tobacco Products ◽

Patterns Of Use ◽

Levels Of Use ◽

Current Cigarette

Abstract 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 US. Respondents were asked about their cigarette smoking and current use of the following non-cigarette products: combustible tobacco (cigars, cigarillos, pipe, waterpipe); non-combustible 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 non-combustible 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 non-combustible 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.

Download Full-text

The Frequency of Use and Harm Perception of Heated Tobacco Products (HTPs): The 2019 Cross-Sectional Survey among Medical Students from Poland

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18073381 ◽

2021 ◽

Vol 18 (7) ◽

pp. 3381

Author(s):

Paulina Majek ◽

Mateusz Jankowski ◽

Bartłomiej Nowak ◽

Maksymilian Macherski ◽

Maciej Nowak ◽

...

Keyword(s):

Medical Students ◽

Confidence Interval ◽

Odds Ratio ◽

Response Rate ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Cigarette Smokers ◽

Tobacco Products ◽

Frequency Of Use ◽

Medical University

Heated tobacco products (HTPs) are devices for generating a nicotine aerosol by heating the tobacco sticks. This study aimed to assess (1) the prevalence of HTP and tobacco cigarette usage among medical students, (2) to characterize smoking habits and (3) to assess students’ awareness and opinions about HTPs. A cross-sectional survey on the frequency and attitudes toward cigarettes, e-cigarettes and HTP use was performed between 2019–2020 at the Medical University of Silesia in Katowice (Poland). The data were obtained from 1344 students aged 21.8 ± 1.9 years (response rate: 66.9%). Current traditional tobacco use was 13.2%, e-cigarettes use 3.5%, and HTP use 2.8% of students. Duration of use was shorter among HTPs users comparing to cigarette smokers (p < 0.001) although the number of tobacco sticks used daily was similar (p = 0.1). Almost 30% of respondents have ever tried HTPs. HTPs were considered safe by 5.3% of respondents (43.2% of HTP users vs. 3.9% of non-HTP users, p < 0.001). HTP users were more likely to report that heating tobacco is not addictive (odds ratio (OR) = 8.9, 95% confidence interval (CI): 1.8–45.8) and disagreed with a public ban on HTP use (OR = 4.9, 95%CI: 2.5–9.8). Among students, HTP use was less popular than cigarette smoking, but awareness of their presence is widespread.

Download Full-text

The impact of pictorial warning attached on cigarette packet to the attitude of smoking habit

Z H Sikder Women’s Medical College Journal ◽

10.47648/zhswmcj.2020.v0201.05 ◽

2020 ◽

Vol 2 (Number 1) ◽

pp. 20-23

Author(s):

Dr. Kamrun Nahar ◽

Prof. Dr. Belal Ahmed ◽

Prof. Dr. Md. Khorshed Alam

Keyword(s):

Smoking Habit ◽

Sampling Technique ◽

Age Group ◽

Cross Sectional ◽

Face To Face ◽

Quit Smoking ◽

Warning Message ◽

Attitude And Practice ◽

The Impact ◽

Structured Questionnaire

This was a cross sectional descriptive study conducted to assess the effect pictorial warning message on cigarette packets to the attitude and practice of smokers using a semi-structured questionnaire employing purposive sampling technique with a sample size of 214 by face to face interview carried out in different cities, towns, and villages of Bangladesh from August 2016 to February 2017. Almost 97.6% were male and Most of the respondents (40.9%) belonged to the 20-29 years age group. Majority (58.3%) of them were educated from secondary to graduate few percent below primary. Highest 22.9% respondents were students followed by 17.6% private job holder, 16.9% day labor and only 1.4% was jobless. About 40.2% started smoking by the influence of friends, 26.2% started on curiosity and 20% due to depression and majority 41.0% smoked 1-5 cigarette sticks per day. More than half (65.5%) of respondents felt relax to refreshing by smoking and about two third 77.6% continued their smoking due to habitual act or psychological pleasure Almost 93.4% gave attention to the pictorial warning on the cigarette packets. About 46.4% thought pictorial warning in cigarette packets alarms for not to smoke and only 23.8% thought smoking will cause cancer; 21.4% thought smoking is injurious to health. After seeing the pictorial warning on cigarettes 57.6% reduced the smoking number of sticks per day also attempted to quit smoking. To reduce this restricting the advertisement of tobacco, arranging campaign to raise awareness among people about the health and environmental hazards of smoking and increase the tax on tobacco.

Download Full-text

Beliefs Toward Smoking and COVID-19, and The Pandemic Impact on Smoking Behavior and Quit Intention: Findings from a Community-Based Cross-Sectional Study in Jordan

10.22541/au.162271681.14380296/v2 ◽

2021 ◽

Author(s):

Ala'a B. Al-Tammemi ◽

Muna Barakat ◽

Doa’a B. Al-Tamimi ◽

Sami A. Alhallaq ◽

Dima M. Al Hasan ◽

...

Keyword(s):

Electronic Cigarettes ◽

Smoking Behavior ◽

Cross Sectional Study ◽

Sectional Study ◽

Online Questionnaire ◽

Community Based ◽

Cross Sectional ◽

Quit Attempt ◽

Quit Smoking ◽

Never Smokers

Background: The relationship between smoking and Coronavirus Disease-2019 (COVID-19) is still topical with mixed epidemiological evidence. However, the pandemic may affect people’s beliefs towards smoking as well as smoking behavior and quit intentions. Considering high smoking rates in Jordan, our current study aimed to assess the following points in a community-based sample from Jordan: (i) the beliefs that surround smoking and COVID-19, (ii) the pandemic impact on smoking behavior and quit intention. Methods: A cross-sectional study was conducted in Jordan utilizing an online questionnaire. The questionnaire comprised 13 items on sociodemographic, health, and smoking profiles, 14 items to assess beliefs surrounding COVID-19 and the use of combustible cigarettes (CC), waterpipe (WP), and electronic cigarettes (EC), and 12 items to assess the pandemic impact on smoking behavior and quit intention. Results: Of 2424 survey respondents who participated in our study there were 1163 never-smokers, 1044 current smokers, and 217 ex-smokers. The mean age of participants was 35.2 years (SD:11.06). Most participants have shown anti-smoking beliefs with around 72.9% believed that WP smoking is related to the risk of contracting COVID-19. Also, 71.7% believed that smoking CC may worsen the COVID-19 clinical course, while 74.1% of respondents believed that smoking has no protective effect against COVID-19. During the pandemic, about 28.1% and 19.3% of current smokers reported increased or reduced smoking, respectively, and many smokers reported their willingness to quit smoking due to the pandemic. Besides, 459 current smokers have expressed their plans/intention to quit smoking during the pandemic, of whom 27.5% (n=126) confirmed that the driving force for their decision is a COVID-19 related reason, such as self-protection (n=123) and protection of family members (=121) which were the most reported ones. Also, around 63 participants have successfully ceased smoking during the pandemic. However, only 22 of them reported that the main driving motivation of their successful quit attempt was the COVID-19 pandemic. Conclusion: Most participants reported anti-smoking beliefs and attitudes during the pandemic. Nevertheless, the double-edged effect of the pandemic on smoking habits should be carefully considered, and reliable anti-smoking measures should be strengthened and sustained in the country.

Download Full-text