Abstract
This study proposed to identify factors associated with the dual use of electronic cigarettes (e-cigarettes) and cigarettes among undergraduate students who smoked cigarettes. This cross-sectional study employed a self-administered, anonymous online questionnaires to collect information from undergraduate smokers in northern Thailand. Of the 494 participants, 82.8% were dual users of e-cigarettes and cigarettes. The two main reasons for using e-cigarettes were an absence of cigarette smoke odor (76.8%) and availability of flavors (70.7%). Undergraduate smokers who initiated smoking at ≥18 years old were more likely to be dual users than those who initiated smoking at younger age (adjusted odds ratio [aOR]: 2.79, 95% confidence intervals [CI]: 1.32–5.89, p = 0.007). Undergraduate smokers who smoked ≥11 cigarettes daily were more likely to be dual users than those who smoked less (aOR: 2.64, 95% CI: 1.52–4.61, p = 0.001). Conversely, undergraduate smokers who had attempted to quit during the past year were less likely to be dual users (aOR: 0.26, 95% CI: 0.12–0.56, p = 0.001). In conclusion, dual use of e-cigarettes and cigarettes among undergraduate smokers was associated with older age at cigarette smoking initiation, a higher number of cigarettes smoked daily, and having no past year’s cigarette quit attempts.
Highlights
An electronic cigarette (e-cigarette) is a device with a heating element that warms a liquid solution that typically consists of nicotine, flavorings, and other substances in an aerosol that is inhaled by the user [1,2]
About one half of the participants were male (51.0%; n = 252) with an average age of 21.40 years (SD 1.20) and smoked less than or equal to 10 cigarettes daily (50.2%; n = 248). Most initiated their first cigarette smoking at 17 years or younger (78.3%; n = 387) and expressed a moderate level of nicotine dependence evaluated by Heaviness of Smoking Index (HSI) score (66.2%; n = 327)
The findings indicated three factors significantly associated with the dual use of e-cigarettes and cigarettes, including older age at cigarette smoking initiation, a higher number of cigarettes smoked daily, and having no past year’s cigarette quit attempts
Summary
An electronic cigarette (e-cigarette) is a device with a heating element that warms a liquid solution that typically consists of nicotine, flavorings, and other substances in an aerosol that is inhaled by the user [1,2]. Several national surveys have found that the percentage of e-cigarette use, as well as the dual use of e-cigarettes and cigarettes, has increased among young people [1]. In the US, young adults aged 18–24 years had the highest increase in the prevalence of current e-cigarette use, from 9.2% in 2016 to 15.0% in 2018 [5]. In 2020, Thai university students reported e-cigarette use of 18.1% [6]. France university students reported 36.4% having tried e-cigarettes and 3.6% currently using ecigarettes. 5.0% of those who smoked cigarettes used e-cigarettes [7]. Australian young adults reported e-cigarette use of 9.0%. 19.0% of those who smoked cigarettes used e-cigarettes [8]
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