Is the use of e-cigarettes for smoking cessation associated with alcohol consumption? A population-level survey of successful quitters in England

Smoking, vaping and drinking: A qualitative analysis of Aotearoa New Zealand young adults who tried e-cigarettes to stop smoking tobacco

BACKGROUND AND AIM

Social practices such as smoking-drinking co-use often go 'hand-in-hand', linked by the coordination of materials, skills and meanings. However, the experience of using e-cigarettes while drinking among people who smoke (and drink) remains underexplored. We used social practice theory to show how smoking, vaping and drinking intersect and to explain how vaping created two new social practices among people who tried e-cigarettes to stop smoking: 'vaping-drinking' co-use and 'smoking-vaping-drinking' poly-use.

METHODS

We conducted five in-depth interviews over 18-24 weeks during 2018-19, with each of nine Aotearoa New Zealand young adults aged 20-29 years. Participants smoked daily, did not regularly use e-cigarettes at entry and wished to try vaping to stop smoking. We analysed participants' reports of smoking or vaping while drinking using thematic analysis.

RESULTS

Individual participants reported both co-use and poly-use occasions throughout the study. Vaping-drinking co-use arose from practice 'replacement' processes, where vaping fully substituted smoking. Smoking-vaping-drinking poly-use arose from 'adjacency' processes where vaping complemented smoking. Participants used both processes flexibly over time, which required new skills in material, temporal, pleasure and social coordination to try to recreate valued meanings of comfort, security and communality associated with well-established smoking-drinking practices. Unsuccessful coordination attempts maintained smoking-drinking co-use.

CONCLUSION

Among Aotearoa New Zealand young adult smokers who want to use vaping to stop smoking, drinking occasions may help to maintain existing smoking-drinking practices and facilitate the development of vaping-drinking co-use and smoking-vaping-drinking poly-use practices, potentially prolonging individuals' exposure to smoking.

The prevalence of electronic cigarettes vaping globally: a systematic review and meta-analysis

BACKGROUND

The purpose of this systematic review study was to determine the national, regional, and global prevalence of electronic cigarettes (e-cigarettes) vaping.

METHOD

The articles were searched in July 2020 without a time limit in Web of Science (ISI), Scopus, PubMed, and Ovid-MEDLINE. At first, the titles and abstracts of the articles were reviewed, and if they were appropriate, they entered the second stage of screening. In the second stage, the whole articles were reviewed and articles that met the inclusion criteria were selected. In this study, search, selection of studies, qualitative evaluation, and data extraction were performed by two authors independently, and any disagreement between the two authors was reviewed and corrected by a third author.

RESULTS

In this study, the lifetime and current prevalence of e-cigarettes vaping globally were 23% and 11%, respectively. Lifetime and current prevalence of e-cigarettes vaping in women were 16% and 8%, respectively. Also, lifetime and current prevalence of e-cigarettes vaping in men were 22% and 12%, respectively. In this study, the current prevalence of e-cigarettes vaping in who had lifetime smoked conventional cigarette was 39%, and in current smokers was 43%. The lifetime prevalence of e-cigarettes vaping in the Continents of America, Europe, Asia, and Oceania were 24%, 26%, 16%, and 25%, respectively. The current prevalence of e-cigarettes vaping in the Continents of America, Europe, Asia, and Oceania were 10%, 14%, 11%, and 6%, respectively.

CONCLUSIONS

Based on the results of this study, it can be concluded that the popularity of e-cigarettes is increasing globally. Therefore, it is necessary for countries to have more control over the consumption and distribution of e-cigarettes, as well as to formulate the laws prohibiting about the e-cigarettes vaping in public places. There is also a need to design and conduct information campaigns to increase community awareness about e-cigarettes vaping.

Factors affecting smoking initiation and cessation among adult smokers in Fiji: A qualitative study

INTRODUCTION

Smoking as a public health challenge is globally considered the main risk factor of many non-communicable diseases (NCDs). Knowing factors contributing to smoking commencement and cessation is the necessary step to develop prevention strategies to combat this issue. To date, no study has been conducted in Fiji, therefore this study aimed to explore the reasons adult smokers initiate smoking and cessation in Fiji.

METHODS

A qualitative study was conducted among 35 current smokers who were interviewed between 1 May and 31 July 2020 in Suva, Fiji. Three health centers were chosen randomly to collect data and purposive sampling was applied to reach study participants. A semi-structured, open-ended questionnaire was used to guide the interviews. The content of in-depth interviews was transcribed and data were analyzed using content and thematic analysis.

RESULTS

The results of this study showed that most of the participants were male (57%), I-taukei (77%), single (54%), had attained tertiary education level (69%), were of Christian religion (77%), and unemployed (63%). Two main themes were identified including: ‘factors affecting smoking initiation’ and ‘factors affecting smoking cessation’. ‘Peer pressure’, ‘smoking myth’, ‘smoking as a fun’, ‘unpleasant event in life’ and ‘smoking establishes friendships’ were factors affecting initiation of smoking; while ‘knowledge on smoking harms’, ‘financial constraints’, ‘desire to improve health’, ‘constant request from family members’, ‘desire to save time’, ‘religious factors’ and ‘cultural factors’, were factors affecting smoking cessation among smokers.

CONCLUSIONS

This study highlights the main factors affecting smoking among adult smokers in Fiji. Considering these factors in future health planning will help policy makers and decision makers to develop tailored interventions to combat this health issue.

Prevalence and characteristics of ever regular use of non-combustible nicotine for 1 year or more: a population survey in England

INTRODUCTION

Up-to-date monitoring of non-combustible nicotine products (e.g. e-cigarettes, nicotine replacement therapies (NRT), heated tobacco products (HTP); NNP) is important to assess their impact. To date, there is little evidence on the association between ever regular use (defined here as 1 year or more) of NNP and current smoking status.

AIMS/METHODS

The purpose of this study was to examine the prevalence, and sociodemographic, alcohol and smoking status correlates, of ever regular use of NNP in England in 2020. A cross-sectional survey of adults in England was conducted between February and June 2020.

RESULTS

A total of 8486 adults were surveyed; 94.9% (8055) were complete cases. The weighted prevalence of ever regular NNP use was 5.4% (n = 436; 95% CI 5.0-6.0), of which 82% (n = 360; 95% CI 78.7-85.8) was single and 18% (n = 79; 95% CI 14.8-22) multiple product use. Amongst ever regular NNP users, the prevalence of ever regular NRT, e-cigarette and HTP use was 64.7% (95% CI 60.1-69), 43.4% (95% CI 38.8-48) and 2.5% (95% CI 1.4-4.5), respectively. In adjusted analysis, ever regular NNP use was associated with smoking status, being significantly higher among current (22.3%; adjusted OR (aOR) 34.9, 95% CI 24.0-50.8) and ex-smokers (12.7%, aOR 19.8, 95% CI 11.1-14.4) than among never-smokers (0.6%). More advantaged occupational grade (aOR, 1.27 95% CI 1.02-1.57) and at least hazardous alcohol use (aOR, 1.38 95% CI 1.06-1.78) were associated with greater prevalence of ever regular NNP use.

CONCLUSIONS

Ever regularly using NNP was highest among smokers and ex-smokers and rare among never-smokers. Among people who have ever regularly used NNP, NRT is the most popular.

Successful Smoking Cessation among Women Smokers Based on Utilizing National Smoking Cessation Service Type in Korea

Background: This study aimed to evaluate the successful smoking cessation across different national smoking cessation services. Methods: This study included data that had been previously entered into the integrated information system for smoking cessation services and comprised 144,688 participants after excluding missing data. These clinics provide face-to-face counseling, phone calls, text messages, and e-mail services for six months and nine sessions. Results: The women-only program had the lowest success rate (11.3%). Compared with the women-only program, the six-month success rate of smoking cessation clinic at public health centers (OR = 3.72, CI = [3.52, 3.92]), visiting-type smoking cessation clinics (OR = 2.97, CI = [2.79, 3.16]), the residential 4 -night 5-day program (OR = 7.79, CI = [6.49, 9.35]), and a program for inpatients (OR = 2.36, CI = [1.89, 2.94]) showed a significant increase. Conclusions: Emotional labor workers who participated in the women-only program had low smoking cessation success rates, while those who participated in the residential 4-night 5-day program had high success rates.

England SimSmoke: the impact of nicotine vaping on smoking prevalence and smoking-attributable deaths in England

BACKGROUND AND AIMS

Whereas the use of nicotine vaping products (NVPs) is widespread, their impact on smoking prevalence is controversial. This study considered the potential impact of NVPs on smoking prevalence in England.

DESIGN

Indirect simulation model. The England SimSmoke model is validated through 2012, before NVP use became more widely used by smokers. Because information on NVP-related transitions is limited, an indirect method is used; the difference in observed smoking prevalence (reflecting NVPs) is compared with a 2012-2019 counterfactual No-NVP scenario (without NVPs) to estimate the impact of NVPs on smoking and smoking-attributable deaths.

SETTING

England, 2000-2019.

PARTICIPANTS

Nationally representative sample of population.

MEASUREMENTS

England's population, mortality rates and smoking prevalence estimates from three national surveys and tobacco control policies.

FINDINGS

Between 2000 and 2012, SimSmoke projected a decline in age 18+ smoking prevalence of 23.5% in men and 27.0% in women. These projections, as well as those by specific age groups, were generally consistent with findings from the three national surveys. Comparing 2012-2019 relative reduction in age 18+ prevalence from the Annual Population Survey (males, 27.5%) with the model-predicted No-NVP reduction (males, 7.3%), the implied NVP-attributable relative reduction in adult smoking prevalence was 20.2% (95% CI, 18.8%-22.0%) for males and 20.4% (18.7%-22.2%) for females. The NVP-attributable reduction was 27.2% (22.8%-31.6%) for males and 31.7% (27.4%-36.5%) for females ages 18-24 and 18.6% (15.2%-21.8%) for males and 15.0% (11.1%-18.8%) for females ages 25-34, with similar reductions for ages 35+. The implied reduction in smoking prevalence between 2012 and 2019 equates to 165 660 (132 453-199 501) averted deaths by 2052. Other surveys yielded smaller, but relatively consistent results.

CONCLUSIONS

An indirect method of simulation modelling indicates that substantial reductions in smoking prevalence occurred in England from 2012-2019 coinciding with the growth in nicotine vaping product use.

An Experimental Test of the Relationship between Electronic Nicotine Delivery System Use and Alcohol Consumption

BACKGROUND

Increasing research shows that the use of electronic nicotine delivery systems (ENDS) is associated with a higher rate and quantity of alcohol consumption.

METHODS

The present study used a 2-session, within-subjects design to experimentally examine the relationship between ENDS use and laboratory ad libitum alcohol consumption. A total of N = 31 (mean age = 28.71, SD = 11.17; 45.2% women; 54.8% White/Caucasian) healthy adults from the community who use ENDS and endorsed liking beer completed the study, which included a beer consumption taste-test task that assessed the volume of beer consumed by the participants across 2 counterbalanced sessions: 1 in which concurrent ENDS use was allowed and 1 in which it was not. All analyses controlled for age, race, and gender.

RESULTS

The effect of ENDS condition on the volume of beer consumed was not statistically significant, F(1, 30) = 0.03, p = 0.86). Results of linear mixed modeling showed that ENDS puffs were significantly related to alcohol sips (estimate = 0.23, SE = 0.07, p = 0.002) across the ad libitum session.

CONCLUSIONS

Overall, ENDS use did not increase alcohol consumption; however, the data suggest that ENDS puffs might act as a prime for beer sips or that these 2 behaviors are linked through habit. Future studies should more fully measure and compare global and event-level data on ENDS and alcohol use as they might show disparate patterns of relationships.

Protocol for expansion of an existing national monthly survey of smoking behaviour and alcohol use in England to Scotland and Wales: The Smoking and Alcohol Toolkit Study

Background The Smoking and Alcohol Toolkit Study (STS/ATS) in England has delivered timely insights to inform and evaluate strategies aimed at reducing tobacco smoking- and alcohol-related harm. From the end of 2020 until at least 2024 the STS/ATS is expanding to Scotland and Wales to include all constituent nations in Great Britain. Expanding data collection to Scotland and Wales will permit the evaluation of how smoking and alcohol related behaviours respond to divergent policy scenarios across the devolved nations. Methods The STS/ATS consists of monthly cross-sectional household interviews (computer or telephone assisted) of representative samples of adults in Great Britain aged 16+ years. Commencing in October 2020 each month a new sample of approximately 1700 adults in England, 450 adults in Scotland and 300 adults in Wales complete the survey (~n = 29,400 per year). The expansion of the survey to Scotland and Wales has been funded for the collection of at least 48 waves of data across four years. The data collected cover a broad range of smoking and alcohol-related parameters (including but not limited to smoking status, cigarette/nicotine dependence, route to quit smoking, prevalence and frequency of hazardous drinking, attempts and motivation to reduce alcohol consumption, help sought and motives for attempts to reduce alcohol intake) and socio-demographic characteristics (including but not limited to age, gender, region, socio-economic position) and will be reviewed monthly and refined in response to evolving policy needs and public interests. All data analyses will be pre-specified and available on a free online platform. A dedicated website will publish descriptive data on important trends each month. Discussion The Smoking and Alcohol Toolkit Study will provide timely monitoring of smoking and alcohol related behaviours to inform and evaluate national policies across Great Britain.

Prospective association of e-cigarette and cigarette use with alcohol use in two waves of the Population Assessment of Tobacco and Health

BACKGROUND AND AIMS

Prior cross-sectional research finds that electronic cigarette (e-cigarette) use clusters with higher rates of harmful alcohol consumption in the United States adult population. The current study examined prospectively the association between e-cigarette use, cigarette use and the combined use of e-cigarettes and tobacco cigarettes and alcohol use outcomes.

DESIGN

A nationally representative multi-wave cohort survey (wave 1: September 2013-December 2014, wave 2: October 2014-October 2015).

SETTING

United States.

PARTICIPANTS

A representative sample of civilian, non-institutionalized adults who completed waves 1 and 2 of the Population Assessment of Tobacco and Health survey (n = 26 427).

MEASUREMENTS

Participants were categorized into exposure groups according to their e-cigarette and cigarette use during wave 1. Past 30-day alcohol use outcomes were (1) National Institute on Alcohol Abuse and Alcoholism (NIAAA)-defined hazardous alcohol use, (2) total alcohol drinks consumed and (3) alcohol-related consequences.

FINDINGS

After controlling for socio-demographic risk factors and alcohol use at wave 1, all exposure groups showed higher odds of hazardous alcohol use [adjusted odds ratios (aORs) = 2.05-2.12, all P < 0.001] and reported higher past-month total drinks (B = 0.46-0.70, all P < 0.001) and more alcohol consequences (B = 0.63-0.89, all P ≤ 0.10) at wave 2 compared with non-users. Cigarette users (B = 0.24, P = 0.038) and dual e-cigarette/cigarette users (B = 0.32, P = 0.038) reported higher past-month total drinks compared with e-cigarette users. There was no conclusive evidence that non-daily use of e-cigarettes or cigarettes predicted poorer alcohol use outcomes compared with daily use.

CONCLUSIONS

In the United States between 2013 and 2015, after adjustment for socio-demographic characteristics, cigarette and e-cigarette use were associated with alcohol use 1 year later.