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Lohner V, McNeill A, Schneider S, Vollstädt-Klein S, Andreas M, Szafran D, Grundinger N, Demjén T, Fernandez E, Przewozniak K, Tountas Y, Trofor A, Zatonski W, Willemsen MC, Vardavas C, Fong GT, Mons U. Understanding perceived addiction to and addictiveness of electronic cigarettes among electronic cigarette users: a cross-sectional analysis of the International Tobacco Control Smoking and Vaping (ITC 4CV) England Survey. Addiction 2023. [PMID: 36772958 DOI: 10.1111/add.16162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 01/25/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND AND AIMS The addictive potential of electronic cigarettes (e-cigarettes) remains to be fully understood. We identified patterns and correlates of perceived addiction to e-cigarettes and perceived addictiveness of e-cigarettes relative to tobacco cigarettes (relative addictiveness) in dual users as well as exclusive e-cigarette users. DESIGN, SETTING AND PARTICIPANTS Observational study using cross-sectional survey data from England (2016) from the International Tobacco Control Project (ITC) Four Country Smoking and Vaping (4CV) survey. The study comprised 832 current e-cigarette users who had been vaping for at least 4 months. MEASUREMENTS Perceived addiction to e-cigarettes and relative addictiveness of e-cigarettes were examined. Socio-demographic factors were age, gender and education; markers of addiction included urge to vape, time to first vape after waking and nicotine strength used; vaping and smoking characteristics included frequency and duration of e-cigarette use, intention to quit, adjustable power or temperature, enjoyment, satisfaction relative to tobacco cigarettes and tobacco cigarette smoking status. FINDINGS A total of 17% of participants reported feeling very addicted to e-cigarettes, while 40% considered e-cigarettes equally/more addictive than tobacco cigarettes. Those who felt very addicted had higher odds of regarding e-cigarettes as more addictive than tobacco cigarettes (odds ratio 3.4, 95% confidence interval 2.3-5.1). All markers of addiction, daily use and enjoyment were associated with higher perceived addiction, whereas time to first vape after waking, daily vaping and perceiving vaping as less satisfying than smoking were associated with relative addictiveness. CONCLUSIONS Markers of addiction to e-cigarettes appear to correspond with perceived addiction to e-cigarettes, suggesting that self-reported perceived addiction might serve as an indicator of addiction. Prevalence both of markers of addiction and perceived addiction were comparatively low overall, suggesting a limited but relevant addictive potential of e-cigarettes. Additionally, positive and negative reinforcement, reflected here by enjoyment and relative satisfaction, might play a role in e-cigarette addiction.
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Affiliation(s)
- Valerie Lohner
- Cardiovascular Epidemiology of Aging, Department of Cardiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Ann McNeill
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Shaping Public Health Policies to Reduce Inequalities and Harm (SPECTRUM), UK
| | - Sven Schneider
- Center for Preventive Medicine and Digital Health Baden-Württemberg, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Sabine Vollstädt-Klein
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Marike Andreas
- Center for Preventive Medicine and Digital Health Baden-Württemberg, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Daria Szafran
- Center for Preventive Medicine and Digital Health Baden-Württemberg, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Nadja Grundinger
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Tibor Demjén
- Smoking or Health Hungarian Foundation, Budapest, Hungary
| | - Esteve Fernandez
- Tobacco Control Unit and WHO Collaborating Center for Tobacco Control, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain.,School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Krzysztof Przewozniak
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.,Collegium Civitas, Warsaw, Poland.,Health Promotion Foundation, Warsaw, Poland
| | - Yannis Tountas
- Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Antigona Trofor
- University of Medicine and Pharmacy 'Grigore T. Popa' Iasi, Iasi, Romania.,Aer Pur Romania, Bucharest, Romania
| | - Witold Zatonski
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.,European Observatory of Health Inequalities, President Stanisław Wojciechowski State University of Applied Sciences, Kalisz, Poland
| | - Marc C Willemsen
- Maastricht University, Department of Health Promotion (CAPHRI), Maastricht, the Netherlands.,Trimbos Institute, Netherlands Expertise Centre for Tobacco Control, Utrecht, the Netherlands
| | - Constantine Vardavas
- School of Medicine, University of Crete, Crete, Greece.,Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada.,School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada.,Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Ute Mons
- Cardiovascular Epidemiology of Aging, Department of Cardiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
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Lohner V, Schneider S, Andreas M, Szafran D, Grundinger N, Vollstädt-Klein S, Fong GT, McNeill A, Mons U. Understanding addiction in e-cigarette users – the EVAPE project. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac130.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Electronic cigarettes (e-cigarettes) are often advertised as a healthier option to combustible cigarettes and as smoking cessation aid. However, e-cigarettes are a growing health concern and their addictive potential remains to be fully understood. Within the EValuation of the Addictive Potential of E-cigarettes (EVAPE) project, we studied subjective and objective measures of addiction in relation to e-cigarette use.
Methods
This cross-sectional analysis was based on 832 participants of the first wave (2016) of England from the ITC Four Country Smoking and Vaping (4CV) Survey, who were using e-cigarettes daily or weekly for at least four months. Perceived addiction to e-cigarettes was categorised as very vs. not/somewhat addicted, and perceived addictiveness of e-cigarettes relative to combustible cigarettes as equally/more addictive vs. less addictive. Objective measures of addiction included urge to vape, time to first vape after waking, frequency of use, and used nicotine strength. We examined associations between these objective and subjective measures of addiction using multivariate logistic regression, adjusted for age, gender, education, and cigarette smoking.
Results
17.8% of participants reported feeling very addicted to e-cigarettes and 42.3% considered e-cigarettes equally/more addictive than combustible cigarettes. Those who felt very addicted had higher odds of regarding e-cigarettes as more addictive (OR 3.43 (95%-CI 2.29-5.19)). All objective measures of addiction were associated with higher perceived addiction, whereas only a shorter time to first vape was associated with perceived product addictiveness.
Conclusions
Subjective measures of addiction to e-cigarettes, in particular perceived addiction, correspond with objective measures. Understanding the addictive potential of e-cigarettes is the cornerstone for developing new strategies for prevention and treatment, and ultimately understanding their role from a public health perspective.
Key messages
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Affiliation(s)
- V Lohner
- Department of Cardiology, University of Cologne , Cologne, Germany
| | - S Schneider
- Medical Faculty Mannheim, University of Heidelberg , Mannheim, Germany
| | - M Andreas
- Medical Faculty Mannheim, University of Heidelberg , Mannheim, Germany
| | - D Szafran
- Medical Faculty Mannheim, University of Heidelberg , Mannheim, Germany
| | - N Grundinger
- Medical Faculty Mannheim, University of Heidelberg , Mannheim, Germany
| | - S Vollstädt-Klein
- Medical Faculty Mannheim, University of Heidelberg , Mannheim, Germany
| | - GT Fong
- Department of Psychology, University of Waterloo , Waterloo, Canada
- School of Public Health Sciences, University of Waterloo , Waterloo, Canada
- Ontario Institute for Cancer Research , Toronto, Canada
| | - A McNeill
- Psychology and Neuroscience, King’s College London , London, UK
- SPECTRUM , London, UK
| | - U Mons
- Department of Cardiology, University of Cologne , Cologne, Germany
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Andreas M, Szafran D, Vollstädt-Klein S, Grundinger N, Mons U, Lohner V, Görig T, Schneider S. „Dauernuckler“ oder „Genussdampfer“?
Eine netnographische Analyse selbstberichteter Anzeichen möglicher
Abhängigkeitssymptome in E-Zigaretten-Online-Foren. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- M Andreas
- Medical Faculty of Mannheim, University of Heidelberg, Center for
Preventive Medicine and Digital Health Baden-Württemberg (CPD-BW),
Mannheim, Deutschland
| | - D Szafran
- Medical Faculty of Mannheim, University of Heidelberg, Center for
Preventive Medicine and Digital Health Baden-Württemberg (CPD-BW),
Mannheim, Deutschland
| | - S Vollstädt-Klein
- Medical Faculty of Mannheim, University of Heidelberg, Department of
Addictive Behavior and Addiction Medicine, Central Institute of Mental Health,
Mannheim, Deutschland
- Medical Faculty of Mannheim, University of Heidelberg, Mannheim Center
for Translational Neurosciences (MCTN), Mannheim, Deutschland
| | - N Grundinger
- Medical Faculty of Mannheim, University of Heidelberg, Department of
Addictive Behavior and Addiction Medicine, Central Institute of Mental Health,
Mannheim, Deutschland
| | - U Mons
- University of Cologne, Medical Faculty and University Hospital Cologne,
Köln, Deutschland
| | - V Lohner
- University of Cologne, Medical Faculty and University Hospital Cologne,
Köln, Deutschland
| | - T Görig
- Friedrich-Alexander-University Erlangen-Nürnberg, Institute for
Medical Informatics, Biometry and Epidemiology, Erlangen,
Deutschland
| | - S Schneider
- Medical Faculty of Mannheim, University of Heidelberg, Center for
Preventive Medicine and Digital Health Baden-Württemberg (CPD-BW),
Mannheim, Deutschland
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