An Examination of the Variation in Estimates of E-Cigarette Prevalence among U.S. Adults

Introduction: Accurate estimates of e-cigarette use are needed to gauge its impact on public health. We compared the results of online and traditional, large scale surveys and provide additional estimates from the Population Assessment of Tobacco and Health (PATH) survey, with the aim of assessing the extent of variation in prevalence estimates. Materials and Methods: We searched the peer-reviewed literature for nationally representative estimates of U.S. adult e-cigarette prevalence, and developed our own estimates from waves one, two, and three of the PATH survey. We compared estimates by age, gender, cigarette smoking status, and e-cigarette use intensity both between online and traditional surveys and among the traditional surveys. Results: For specific years, online surveys generally yielded higher adult use rates than most traditional surveys, but considerable variation was found among traditional surveys. E-cigarette prevalence was greater for less intensive than for more intensive use. Levels of use were higher among current and recent former cigarette smokers than among former smokers of longer quit duration and never smokers, and by those of younger ages. Conclusions: Considerable variation in e-cigarette use estimates was observed even for a specific year. Further study is needed to uncover the source of variation in e-cigarette prevalence measures, with a view towards developing measures that best explain regular use and transitions between the use of e-cigarettes and other tobacco products.

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

Cannabis use among a nationally representative cross-sectional sample of smokers and non-smokers in the Netherlands: results from the 2015 ITC Netherlands Gold Magic Survey

BMJ Open ◽

10.1136/bmjopen-2018-024497 ◽

2019 ◽

Vol 9 (3) ◽

pp. E024497 ◽

Cited By ~ 6

Author(s):

Brian Vincent Fix ◽

Danielle Smith ◽

Richard O’Connor ◽

Bryan W Heckman ◽

Marc C Willemsen ◽

...

Keyword(s):

Cigarette Smoking ◽

Cannabis Use ◽

Nicotine Exposure ◽

Cross Sectional ◽

Cigarette Smokers ◽

Current Cigarette ◽

Former Smokers ◽

Nationally Representative ◽

Never Smokers ◽

Current Tobacco

ObjectivesExisting evidence shows that co-occurring use of tobacco and cannabis is widespread. Patterns of co-use of tobacco and cannabis may change as more jurisdictions legalise medicinal and/or recreational cannabis sales. This analysis examined predictors of current cannabis use and characterised methods of consumption among smokers and non-smokers in a context where cannabis use is legal.SettingThe 2015 International Tobacco Control Netherlands—Gold Magic Survey conducted between July and August 2015.ParticipantsParticipants (n=1599; 1003 current smokers, 283 former smokers and 390 non-smokers) were asked to report their current (past 30-day) use of cigarettes and cannabis. Cigarette smokers reported whether they primarily used factory made of roll-your-own cigarettes. Those who reported any cannabis use in the last 30 days were asked about forms of cannabis used. X2and logistic regression analyses were used to assess relationships among combustible tobacco and cannabis use.ResultsPast 30-day cannabis use was somewhat higher among current tobacco (or cigarette) smokers (n=57/987=5.8%) than among former or never smokers (n=10/288=3.5% and n=6/316=1.9%, respectively). Joints were the most commonly used form of cannabis use for both current cigarette smokers (96.9%) and non-smokers (76.5%). Among those who smoked cannabis joints, 95% current smokers and 67% of non-smokers reported that they ‘always’ roll cannabis with tobacco.ConclusionsIn this Netherlands-based sample, most cannabis was reported to be consumed via smoking joints, most often mixed with tobacco. This behaviour may present unique health concerns for non-cigarette smoking cannabis users, since tobacco use could lead to nicotine dependence. Moreover, many non-cigarette smoking cannabis users appear to be misclassified as to their actual tobacco/nicotine exposure.

Download Full-text

Role of flavours in vaping uptake and cessation among New Zealand smokers and non-smokers: a cross-sectional study

Tobacco Control ◽

10.1136/tobaccocontrol-2019-055469 ◽

2020 ◽

Vol 30 (1) ◽

pp. 108-110 ◽

Cited By ~ 3

Author(s):

Philip Gendall ◽

Janet Hoek

Keyword(s):

New Zealand ◽

Online Survey ◽

Smoking Status ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Cigarette Smokers ◽

Former Smokers ◽

Never Smokers

BackgroundConcerns about the effects of vaping have prompted calls to restrict e-cigarette flavours. Vaping proponents have criticised these proposals, which they argue may discourage smokers from taking up vaping or trigger relapse to smoking. We explored the role flavours play in vaping uptake and cessation among New Zealand cigarette smokers and vaping-susceptible never smokers (VSNS), and examined current vapers’ preferred flavours.MethodsWe conducted an online survey of 1005 New Zealanders aged 18–70 years that included 324 current vapers (vaped in the last 30 days) and 302 ‘past’ vapers (reported past vaping, but not within the last month). We asked respondents their reasons for vaping and explored current vapers’ preferred e-cigarette flavours; we analysed the data using descriptive statistics and logistic regression.ResultsIrrespective of smoking status, flavour was one of the main reasons respondents gave for vaping (smokers 83%; former smokers 77%; VSNS 80%). Flavour was less important to former vapers; 47% of smokers, 57% of former smokers and 64% of VSNS cited flavour as a reason for originally taking up vaping. Fruit flavours were most popular among all three groups; smokers also favoured tobacco flavour, while former smokers also favoured mint or menthol, and never smokers also favoured confectionery/sweets/lolly flavours.ConclusionsFlavours play a major role in vaping initiation for current smokers, former smokers and vaping-susceptible non-smokers, and remain important to those who continue vaping. Our findings highlight the need for regulation that allows some flavour diversity without the extravagant marketing currently used to promote vaping and e-liquids.

Download Full-text

Receipt of tobacco direct mail/email discount coupons and trajectories of cigarette smoking behaviours in a nationally representative longitudinal cohort of US adults

Tobacco Control ◽

10.1136/tobaccocontrol-2018-054363 ◽

2018 ◽

Vol 28 (3) ◽

pp. 282-288 ◽

Cited By ~ 4

Author(s):

Kelvin Choi ◽

Julia Cen Chen ◽

Andy S L Tan ◽

Samir Soneji ◽

Meghan B Moran

Keyword(s):

Smoking Status ◽

Smoking Initiation ◽

Direct Mail ◽

Health Study ◽

Demographic Correlates ◽

Former Smokers ◽

Nationally Representative ◽

Never Smokers ◽

Study Participants ◽

Smoking Behaviours

BackgroundWe assessed whether receipt of coupons—via direct mail or e-mail—was prospectively related to trajectories of smoking behaviours.MethodsData were from a cohort of US adults (n=26 447) who participated in wave 1 (2013–2014) and wave 2 (2014–2015) of the Population Assessment of Tobacco and Health Study. Participants reported receipt of tobacco direct mail/email coupons in the past 6 months in wave 1 and their smoking status in both waves. Weighted multiple logistic regressions were used to examine demographic correlates of receiving tobacco direct mail/email coupons at wave 1 and to examine the prospective effect of receiving tobacco coupons on trajectories of smoking behaviours.FindingsAt wave 1, 10.7% of never smokers, 13.9% of experimental smokers, 37.1% of current smokers and 16.5% of former smokers reported receiving tobacco direct mail/email coupons. Lower education and higher poverty adults and non-Hispanic white current smokers were more likely to have received these coupons (p<0.05). Receiving tobacco direct mail/email coupons at wave 1 was associated with increased odds of smoking initiation among never smokers (adjusted odds ratio (AOR)=2.28, 95% CI 1.36 to 3.83), becoming established smokers among experimenters (AOR=1.62, 95% CI 1.29 to 2.04), becoming daily smokers among non-daily smokers (AOR=1.56, 95% CI 1.23 to 1.99) and smoking relapse among former smokers between waves (AOR=1.91, 95% CI 1.39 to 2.65). Receiving these coupons at wave 1 was associated with reduced odds of smoking cessation ≥6 months among current smokers (AOR=0.71, 95% CI 0.58 to 0.88).ConclusionsTobacco direct mail/email coupons encourage and sustain smoking and disproportionately affect lower socioeconomic populations.

Download Full-text

Prevalence, Use Behaviors, and Preferences among Users of Heated Tobacco Products: Findings from the 2018 ITC Japan Survey

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16234630 ◽

2019 ◽

Vol 16 (23) ◽

pp. 4630 ◽

Cited By ~ 11

Author(s):

Edward Sutanto ◽

Connor Miller ◽

Danielle M. Smith ◽

Richard J. O’Connor ◽

Anne C. K. Quah ◽

...

Keyword(s):

Market Share ◽

User Preferences ◽

Web Survey ◽

Cigarette Smokers ◽

Tobacco Products ◽

Adult Participants ◽

Current Cigarette ◽

Former Smokers ◽

Nationally Representative ◽

Never Smokers

Heated tobacco products (HTPs), such as IQOS, glo, and Ploom TECH, with a variety of flavored tobacco-containing inserts, have reportedly achieved a significant market share in Japan. We analyzed data from Wave 1 of the ITC Japan Survey, a nationally representative web survey conducted in February to March 2018 among 4684 adult participants to estimate the prevalence of HTP use, describe characteristics of HTP users, and explore user preferences for HTP device and flavor. The overall prevalence of monthly HTP use was 2.7% (1.7% daily use). Virtually all HTP users were current cigarette smokers (67.8%) or former smokers (25.0%); only 1.0% of HTP users were never smokers. Among HTP users, IQOS was the most frequently reported brand used (64.5%), and menthol was the most common flavor reported (41.5%). IQOS was used more by younger respondents and those who reported daily use, while Ploom TECH was more popular among older respondents and non-daily HTP users. This is one of the first non-industry funded studies to explore the use of HTPs in Japan.

Download Full-text

Smoking behavior and psychological dynamics during COVID-19 social distancing and stay-at-home policies: A survey

Health Psychology Research ◽

10.4081/hpr.2020.9124 ◽

2020 ◽

Vol 8 (1) ◽

Cited By ~ 4

Author(s):

Pasquale Caponnetto ◽

Lucio Inguscio ◽

Claudio Saitta ◽

Marilena Maglia ◽

Francesca Benfatto ◽

...

Keyword(s):

Online Survey ◽

Smoking Status ◽

Cigarette Smokers ◽

Tobacco Products ◽

Survey Tool ◽

Social Distancing ◽

Former Smokers ◽

Psychological Dynamics ◽

Never Smokers ◽

At Home

During the COVID-19 pandemic, about 60 million of Italians stayed at home. These circumstances may generate exceptional challenges and stress for people who regularly use cigarettes, ecigarettes, heated tobacco products, dual users, former smokers and never smokers. Here, we present results from a study that was aimed at surveying smoking behaviour and psychological dynamics during the Italian COVID-19 social distancing and stay-at-home policies. Participants living in Italy were invited to complete an online brief questionnaire. A questionnaire was prepared and uploaded in an online survey tool. They were asked to participate regardless of their current smoking status and were divided in seven subgroups. In total, 1825 participants were included in the analysis. Exclusive cigarette smokers; Dual users of cigarette and ecigarettes; Dual users of cigarette and heated tobacco products; Former smokers; Exclusive users of e-cigarette; Exclusive users of heated tobacco products; never smoker. Dual users of cigarette and e-cigarette and exclusive cigarette smokers perceived that their daily consumption has slightly decreased. Exclusive cigarette smokers and exclusive e-cigarette users changed the way of purchasing products. Most exclusive cigarette smokers have considered quitting but most exclusive e-cigarette users have not considered stopping the use of e-cigarettes. In former smokers’ group, about one third of participants declared thoughts about starting to smoke again and in never smokers’ group few participants declared intention to start smoking. The COVID-19 era could be considered a “transition” phase and as such requires a search for a new balance. These changes in everyday habits can be a significant moment to use established and emerging strategies to create a definitive smoke-free world.

Download Full-text

E-cigarette use frequency by smoking status among youth in the United States, 2014-2019

10.1101/2020.05.07.20094185 ◽

2020 ◽

Author(s):

Jamie Tam

Keyword(s):

United States ◽

Smoking Status ◽

The United States ◽

Self Report ◽

Cigarette Use ◽

Cross Sectional Survey ◽

Cross Sectional ◽

The Past ◽

Former Smokers ◽

Never Smokers

AbstractAimsTo report annual 2014-2019 youth estimates of past 30-day e-cigarette use frequency by smoking status in the United States (US).DesignWeighted prevalence estimates of student’s e-cigarette use using the 2014-2019 National Youth Tobacco Surveys (NYTS). For each year, t-tests for significance were used to compare estimates with those from the preceding year; t-tests were not performed on data for 2019 due to the change in survey format from paper to electronic.SettingThe NYTS is an annual school-based cross-sectional survey of US middle school (MS) and high school (HS) students.Participants117,472 students.MeasurementsSelf-report of past 30 day e-cigarette use based on students’ smoking status. Smoking status is assessed by asking if students have ever tried smoking, “even one or two puffs”, with never smokers responding “no”. Former smokers respond “yes” but have not smoked at all in the past 30 days. Current smokers used cigarettes at least once in the past 30 days. Frequent e-cigarette use is defined as use on ≥20 days in the past month.FindingsPast 30-day and frequent e-cigarette use increased among never, former, and current smoker youth from 2014-2019. In 2019, a greater proportion of current smokers used e-cigarettes frequently (HS = 46.1%, 95% CI: 39.1, 53.2; MS = 27.4%, 95% CI: 21.1, 33.6) compared to former smokers (HS = 23.2%, 95% CI: 18.1, 28.2; MS = 10.9%, 95% CI: 6.1, 15.7) and never smokers (HS = 3.7%, 95% CI: 3.0, 4.3; MS = 0.7%, 95% CI: 0.4, 0.9). From 2018 to 2019, the total number of youth using e-cigarettes frequently who were never smokers (2018: 180,000; 2019: 490,000) or former smokers (2018: 260,000; 2019: 640,000) surpassed that of current smokers (2018: 420,000; 2019: 460,000).ConclusionsThe proportion and number of never smoker youth using e-cigarettes frequently increased greatly since 2014.

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

Self-reported and cotinine-verified smoking and increased risk of incident hearing loss

Scientific Reports ◽

10.1038/s41598-021-87531-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Woncheol Lee ◽

Yoosoo Chang ◽

Hocheol Shin ◽

Seungho Ryu

Keyword(s):

Smoking Status ◽

Objective Measure ◽

Self Report ◽

Urinary Cotinine ◽

Increased Risk ◽

Former Smokers ◽

Never Smokers ◽

Time Varying Covariates ◽

New Onset

AbstractWe examined the associations of smoking status and urinary cotinine levels, an objective measure of smoking, with the development of new-onset HL. This cohort study was performed in 293,991 Korean adults free of HL who underwent a comprehensive screening examination and were followed for up to 8.8 years. HL was defined as a pure-tone average of thresholds at 0.5, 1.0, and 2.0 kHz ≥ 25 dB in both ears. During a median follow-up of 4.9 years, 2286 participants developed new-onset bilateral HL. Self-reported smoking status was associated with an increased risk of new-onset bilateral HL. Multivariable-adjusted HRs (95% CIs) for incident HL comparing former smokers and current smokers to never-smokers were 1.14 (1.004–1.30) and 1.40 (1.21–1.61), respectively. Number of cigarettes, pack-years, and urinary cotinine levels were consistently associated with incident HL. These associations were similarly observed when introducing changes in smoking status, urinary cotinine, and other confounders during follow-up as time-varying covariates. In this large cohort of young and middle-aged men and women, smoking status based on both self-report and urinary cotinine level were independently associated with an increased incidence of bilateral HL. Our findings indicate smoking is an independent risk factor for HL.

Download Full-text

E-Cigarette Use by Smoking Status in Estonia, 2012–2018

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17020519 ◽

2020 ◽

Vol 17 (2) ◽

pp. 519

Author(s):

Rainer Reile ◽

Kersti Pärna

Keyword(s):

General Population ◽

Smoking Status ◽

Multivariate Logistic Regression Analysis ◽

Sociodemographic Factors ◽

Cigarette Use ◽

Public Health Perspective ◽

Cross Sectional ◽

The Public ◽

Period Effects ◽

Nationally Representative

Background: In the context of declining smoking rates in Estonia, this study aims to analyze the recent trends in e-cigarette use and its associations with smoking status and sociodemographic factors. Methods: Nationally representative data from biennial cross-sectional health surveys in 2012–2018 (n = 9988) were used to describe the prevalence of smoking and e-cigarette use by smoking status in Estonia. Multivariate logistic regression analysis was used to describe the sociodemographic patterns of e-cigarette use in three subgroups: the general population, smokers, and ex-smokers. Results: The prevalence of current smoking decreased from 45.4% in 2012 to 31.5% in 2018 among men and from 26.6% to 20.0% among women. At the same time, e-cigarette use in the general population had increased to 3.7% among men and to 1.2% among women. The increase in the prevalence of e-cigarette use was statistically significant among men in the general population, smokers, and ex-smokers, but non-significant among women. In addition to period effects, e-cigarette use was patterned by age, gender, and education. Conclusion: In 2002–2018, the e-cigarette use had increased but smoking had decreased in Estonia. A timely and targeted tobacco policy may alleviate the harm of e-cigarette use from the public health perspective.

Download Full-text