How Are Self-Reported Physical and Mental Health Conditions Related to Vaping Activities among Smokers and Quitters: Findings from the ITC Four Country Smoking and Vaping Wave 1 Survey

Perceived Health and Capacity to Cope With Stress in Recent Ex-smokers: Impact of Vaping Versus Quitting All Nicotine

INTRODUCTION

Little is known about the continued use of nicotine following smoking cessation on perceived well-being in comparison to complete cessation of nicotine use.

AIMS AND METHODS

To explore aspects of perceived well-being and coping among recent ex-smokers as a function of vaping status. Ever-daily smokers in the International Tobacco Control 4 country smoking and vaping surveys in 2016 (w1 N = 883) and 2018 (w2 N = 1088). Cross-sectional associations and longitudinal samples for those who quit between waves and those who quit at w1 and maintained abstinence to w2. Main outcome measures were: Past 30 days of depression symptoms, perceived stress, stress management since quitting, and change in perceived day-to-day health.

RESULTS

In the cross-sectional analyses vapers were more likely to report both improved stress management (aOR = 1.71, 95% CI 1.23-2.36) and perceived day-to-day health (aOR = 1.65, 95% CI 1.26-2.16) than nicotine abstainers. In the longitudinal analyses, smokers who switched to vaping between waves (n = 372) were more likely to report depression symptoms at w2 (aOR = 2.00, 95% CI 1.09-3.65) but reported improved perceived health (aOR = 1.92, 95% CI 1.16-3.20). For the past daily smokers who remained quit between waves (n = 382), vapers were more likely to report improved stress management relative to abstainers (RRR = 5.05. 95% CI 1.19-21.40). There were no other significant differences between vapers and nicotine abstainers.

CONCLUSIONS

There is little evidence to support the view that perceptions of well-being deteriorate in vapers compared to complete nicotine abstainers in the immediate years after smoking cessation.

IMPLICATIONS

This study could find no conclusive evidence that the continued use of nicotine via e-cigarettes was detrimental to health compared to completely stopping nicotine intake altogether. Our results would suggest that continuing to use nicotine may even result in some benefits in the short term such as improved stress management, however further longitudinal studies are required to examine if these effects are restricted to the early post-quitting phase and whether other positive or negative effects on psychosocial health emerge in the future.

Awareness, trial and use of heated tobacco products among adult cigarette smokers and e-cigarette users: findings from the 2018 ITC Four Country Smoking and Vaping Survey

OBJECTIVE

To evaluate heated tobacco product (HTP) awareness, trial and current use among adult cigarette smokers and vaping product users in four countries with varying regulations governing HTP sales.

DESIGN

Data came from Wave 2 of the ITC Four Country Smoking and Vaping Survey, collected from February to July 2018. Respondents were current and former smokers and/or users of vaping products (18 years or older) from Canada (CA; n=3778), England (EN; n=4848), the USA (US; n=2846) and Australia (AU; n=1515). At the time of the survey, only Canada and England permitted the sale of contemporary HTPs (eg, IQOS).

RESULTS

Overall, 30.2% of respondents reported being aware of HTPs (CA=30.4%; EN=31.0%; US=30.2%; AU=27.4%; p=0.346), 2.4% had ever tried HTPs (CA=3.3%; EN=2.4%; US=2.0%; AU=0.9%; p=0.001) and 0.9% currently used HTPs at least monthly (CA=0.8%; EN=1.2%; US=0.7%; AU=0.2%; p<0.001). Trial and current use were higher among those who concurrently smoked and vaped (at least monthly) versus other nicotine use categories (trial: 10.9% v. 1.2%-2.0%, p<0.001; current use: 8.4% v. 0.1%-1.0%, p<0.001). In multivariable analyses, HTP awareness did not differ across countries, whereas odds of trial and current use were lower where HTPs were unavailable. Odds of HTP trial did not differ by regulatory environment when restricting analysis to HTP-aware concurrent smokers-vapers.

CONCLUSION

Approximately one third of respondents were aware of HTPs, even in the USA and Australia, where contemporary HTPs were not yet on the market. Trial and use were uncommon, except among concurrent smokers-vapers. Restrictions on availability may have limited HTP use generally, but less so for concurrent smokers-vapers.

Characterizing heated tobacco product use among adult cigarette smokers and nicotine vaping product users in the 2018 ITC Four Country Smoking & Vaping Survey

INTRODUCTION

Heated tobacco products (HTP) have diversified global tobacco markets, and user characteristics remain understudied. This study evaluated sociodemographic characteristics, nicotine-related perceptions and behaviors of current HTP users within a sample of adult (18+ years) nicotine users across four countries.

METHODS

Data were from current smokers or nicotine vaping product (NVP; known as "e-cigarettes") users from Canada, England, the United States and Australia (n=11,421) who participated in the 2018 ITC Four Country Smoking and Vaping Survey. Current (at-least-monthly) HTP users were characterized (n=441), and weighted multivariable logistic regressions examined correlates of HTP use.

RESULTS

Compared to non-users, current HTP users were younger (mean age: 44.4 vs 31.0 years; p<0.001) and had higher socioeconomic status (p<0.001). A majority of current HTP users used HTPs non-daily (daily: 40.3% vs non-daily: 59.7%). Most HTP users concurrently used both cigarettes and NVPs (90.5%). Among concurrent cigarette-HTP-NVP users, 36.2% used all three products daily. Use of other combusted tobacco products (cigars, cigarillos, pipe, waterpipe/hookah), cannabis, and binge drinking were each associated with current HTP use. HTP use was more common among smokers intending to quit within 6 months or reporting a quit attempt in the past 18 months, and vapers who had experienced negative side effects.

CONCLUSION

HTP users in this sample tended to be younger and more affluent. Most reported concurrent use of multiple nicotine products and other substances. Those cigarette smokers who used HTPs appeared more interested in smoking cessation, while some characteristics of concurrent HTP-NVP users were suggestive of dissatisfaction with NVPs.

IMPLICATIONS

Few studies have scrutinized characteristics of HTP early-adopters in emerging markets. Our results indicate that in 2018, characteristics of established nicotine users who adopted HTP use in four high-income Western countries mirror those of HTP users in East Asian markets (South Korea and Japan) where HTPs are popular. HTP users reported high levels of concurrent use of non-cigarette combusted tobacco products (e.g., cigars, pipe tobacco). These findings point to the need for future longitudinal studies of HTP use given the implications of those use patterns on the harm reduction potential of HTPs. HTP user characteristics may yield important information to consider in regulation of these products.

Are health conditions and concerns about health effects of smoking predictive of quitting? Findings from the ITC 4CV Survey ( 2016-2018 )

INTRODUCTION

Limited research has investigated the relationship between multiple health conditions and subsequent quitting activities at the population level. This study examines whether nine health conditions and concerns related to smoking are predictive of quit attempts and success among those who tried.

METHODS

Data came from the International Tobacco Control Four Country Smoking and Vaping Survey conducted in Australia, Canada, England and the US. A total of 3998 daily smokers were surveyed in 2016 and recontacted in 2018. Respondents were asked in 2016 whether they had a medical diagnosis for depression, anxiety, alcohol problems, obesity, chronic pain, diabetes, heart disease, cancer, and chronic lung disease, and whether they had concerns about past/future health effects of smoking. Outcomes were quit attempts and success (having been abstinent for at least one month between surveys).

RESULTS

Across all four countries, 44.4% of smokers tried to quit between the two survey years, and of these 36.8% were successful. Concerns about past (adjusted odds ratio, AOR=1.66, 95% CI: 1.32–2.08, p<0.001) and future effects of smoking (AOR=2.17, 95% CI: 1.62–2.91, p<0.001) and most health conditions predicted quit attempts, but were mostly unrelated to quit success, with concerns about future effects (AOR=0.59, 95% CI: 0.35–0.99, p<0.05), chronic lung conditions (AOR=0.56, 95% CI: 0.37–0.86, p<0.01) and chronic pain (with a trend) being associated with lower success.

CONCLUSIONS

Having a major chronic health condition does, generally, motivate making quit attempts, but in some cases it is associated with failure among those who try. More effective cessation support is required for these high priority groups.

World vaping update

PURPOSE OF REVIEW

Although death and injury related to e-cigarette use and vaping products has decreased since the peak in 2019, concern over the popularity of electronic nicotine delivery systems (ENDS - a term which includes vape pens, electronic or e-cigarettes, and products that produce vapor for inhaling rather than combusting to produce smoke) continues. ENDS are used as an aid to quit smoking and for harm reduction.

RECENT FINDINGS

This review covers peer-reviewed literature from January 2019 through February 2020 on vaping (the process of using ENDS). Prevalence, risk factors for use, and health risks and benefits from use predominated. Policy articles, commentaries and editorials were excluded from review. E-cigarette or vaping product use-associated lung injury (EVALI)-related injury and death were in the news and literature this year. Because most EVALI-related injury and death occurred among young people who had vaped tetrahydrocannabinol (THC), data from the Healthy Minds (United States) study are reviewed to consider variation in risk factors for vaping THC compared with nicotine.

SUMMARY

Findings provide up-to-date information on vaping as a way to consume a drug, whether THC or nicotine. Harm reduction benefits were shown in a year-long follow-up of smoking cessation; harms continue to accumulate, including from passive consumption.

The association between smokers' self-reported health problems and quitting: Findings from the ITC Four Country Smoking and Vaping Wave 1 Survey

INTRODUCTION

This study aimed to systematically examine whether having health conditions or concerns related to smoking are associated with quitting activities among smokers across four western countries.

METHODS

Data came from the 2016 International Tobacco Control Four Country Smoking and Vaping Survey conducted in Australia, Canada, England and US. We asked smokers and recent quitters (n=11838) whether they had a medical diagnosis for heart disease, cancer, chronic lung disease, depression, anxiety, alcohol problems, diabetes, severe obesity and chronic pain (nine conditions), and whether they believed smoking had harmed/would harm their health, along with questions on quitting activities.

RESULTS

General concerns about smoking harming health and all specific health conditions, except for alcohol problems, were positively associated with quit attempts, but the relationships between health conditions and other quitting measures (being abstinent, planning to quit, use of quitting medications) were less consistent. Positive associations between conditions and use of quitting medications were only significant for depression, anxiety and chronic pain (adjusted odds ratios ranged from 1.4 to 1.5). There was a general tendency to report lower self-efficacy for quitting among those with the health conditions.

CONCLUSIONS

While those with smoking related conditions are somewhat more aware of the links to their smoking, and are largely taking more action, the extent of this is lower than one might reasonably expect. Enhanced awareness campaigns are needed and health professionals need to do more to use health conditions to motivate quit attempts and to ensure they are made with the most effective forms of help.