Use of E-Cigarettes Among Current Smokers: Associations Among Reasons for Use, Quit Intentions, and Current Tobacco Use

Abstract

Introduction: Research has documented growing availability and use of e-cigarettes in the United States over the last decade. Methods: We conducted a national panel survey of current adult cigarette smokers to assess attitudes, beliefs, and behaviors relating to e-cigarette use in the United States (N = 2,254). Results: Among current cigarette smokers, 20.4% reported current use of e-cigarettes on some days and 3.7% reported daily use. Reported reasons for e-cigarette use included: quit smoking (58.4%), reduce smoking (57.9%), and reduce health risks (51.9%). No significant differences in sociodemographic characteristics between e-cigarette users and nonusers were observed. Prior quit attempts were reported more frequently among e-cigarette users (82.8%) than nonusers (74.0%). Intention to quit was reported more frequently among e-cigarette users (64.7%) than nonusers (46.8%). Smokers intending to quit were more likely to be e-cigarette users than those not intending to quit (odds ratio [OR] = 1.90, CI =1.36-2.65). Those who used e-cigarettes to try to quit smoking (OR = 2.25, CI = 1.25-4.05), reduce stress (OR = 3.66, CI = 1.11-12.09), or because they cost less (OR = 3.42, CI = 1.64-7.13) were more likely to report decreases in cigarette smoking than those who did not indicate these reasons. Smokers who reported using e-cigarettes to quit smoking (OR = 16.25, or reduce stress (OR = 4.30, CI = 1.32-14.09) were significantly more likely to report an intention to quit than those who did not indicate those reasons for using e-cigarettes. Conclusions: Nearly a quarter of smokers in our study reported e-cigarettes use, primarily motivated by intentions to quit or reduce smoking. These findings identify a clinical and public health opportunity to re-engage smokers in cessation efforts.

E-Cigarettes and Smoking Cessation

“…Despite the fact that e-cigarettes have not been approved as a medication for smoking cessation by the Food and Drug Administration (FDA), they are widely promoted for smoking cessation, particularly to young adults, and smoking cessation is one of the main reasons that people try e-cigarettes. 6 Indeed, as of May 2016, no e-cigarette company had even submitted an application to the FDA to market e-cigarettes for smoking cessation.…”

Perceptions of harm from electronic-cigarette use among a sample of US Navy personnel

“…Although not explicitly described in the context of being cool or uncool, some avoid EC use because they believe that EC users are old and addicted to nicotine 9 . Smokers may attempt cessation with ECs as a harmreduction strategy because of a common belief that ECs are healthier than cigarettes 4,[8][9][10][11] . The general population's beliefs fluctuate widely regarding the health effects of ECs compared to cigarettes.…”

“…The general population's beliefs fluctuate widely regarding the health effects of ECs compared to cigarettes. Studies have revealed that most believe that ECs are less harmful than cigarettes and even some believe that they are harmless [11][12][13][14] . Even when EC users have concerns about safety, there is a pervasive belief that ECs are a healthier alternative to cigarettes and that the harmful effects of cigarettes outweigh the consequences of EC use 12,15 .…”

“…This is a concern, because if one compares EC risk to tobacco risk, the perceived risk of second-hand smoke and the perceived risk to children are highly correlated 19 . The beliefs regarding second-hand exposure risk seem to vary by population with EC users more often affirming the safety of EC vapor, while the general population more often tended to believe that the vapor was harmful 11,12,20 . The advent of ECs as an alternative to smoking, while not being subjected to the same regulations as cigarettes, presents a unique context for this emerging behavior.…”

“…Evidence indicates that healthcare providers are divided on EC-use-area prohibition with wide ranges of 16% to 62% favoring use in cigaretteprohibited areas 16,22 . The belief that ECs can be used indoors or where cigarettes are prohibited, such as in schools or at work, is appealing to smokers 8,11,13,15 . One study found that EC experimentation was 4 times higher in groups that believed ECs could be used anywhere 8 .…”