Abstract
Background: Dual use of e-cigarettes and combustible tobacco products is common in young adults. We aimed to explore how ratings of subjective and contextual factors differed between discrete episodes of e-cigarette use vs. combustible tobacco product smoking among a sample of young adults. Methods: Young adults (N = 29, ages 18–30) who used e-cigarettes and ≥1 combustible tobacco product at least once weekly completed a 1-week smartphone-based ecological momentary assessment (EMA). Twice daily random prompts assessed past-15-min use of tobacco products, ratings of subjective factors (e.g., negative affect, craving), and contextual factors related to activity, location, and companionship. A multivariable GEE model assessed whether subjective or contextual factors were associated with e-cigarette vs. combustible tobacco product episodes. Results: 184 tobacco use episodes were reported (39.7% e-cigarette, 60.3% combustible tobacco product). High baseline cigarette dependence, as measured by the Fagerström Test for Cigarette Dependence, was associated with lower odds of e-cigarette vs. combustible tobacco product episodes (aOR 0.01, 95% CI (0.002–0.08); p < 0.001). Neither between- or within-subjects negative affect or craving scores were associated with e-cigarette use. Activities of eating/drinking (aOR 0.20, 95% CI (0.08–0.49); p = 0.001) and being in the companionship of a person who smoked cigarettes (aOR 0.13, 95% CI (0.04–0.43); p = 0.001) were associated with lower odds of e-cigarette vs. combustible tobacco product use episodes. However, traveling (aOR 12.02, 95% CI (3.77–38.26); p ≤ 0.001) and being in a public space (aOR 2.76, 95% CI (1.10–6.96); p = 0.03) were associated with higher odds of e-cigarette than combustible tobacco product use episodes. Conclusions: This pilot data suggests that unique contextual factors may be associated with e-cigarette use, compared to combustible tobacco smoking in a sample of young adults who use both e-cigarettes and combustible tobacco products. Future research with larger samples is needed to better characterize varying contexts and cues for tobacco use among young adults who are dual users.
Highlights
We focus this study on young adults who use both e-cigarettes and combustible tobacco products due to the high prevalence of this dual use pattern in this population [1]
AOR = adjusted Odds Ratio; LCI = Lower 95% Confidence Interval; UCI = Upper 95% Confidence Interval. In this pilot ecological momentary assessment (EMA) study of a sample of young adults who used both e-cigarettes and combustible tobacco products, we identified unique contextual factors that were associated with episode type, such as being in a public place, traveling or eating/drinking
EMA studies of adults who are dual users include cigarette smokers who smoke more than five cigarettes/day [33], this study examined a young adult population exclusively; many of whom smoked less than five cigarettes per day and had low levels of cigarette dependence
Summary
Use of both combustible cigarettes and e-cigarettes (“dual use”) is the most common poly-tobacco use pattern among U.S young adults [1]. From a public health perspective, dual use has been argued to have the potential to reduce the overall burden of tobacco-related disease if it is part of a trajectory of combustible tobacco product cessation. A 2021 Cochrane Systematic Review reported “moderate certainty” that use of nicotine-containing e-cigarettes increases combustible cigarette cessation rates as compared to nicotine replacement therapy [2]. A longitudinal analysis of data from the Population Assessment of Tobacco and Health (PATH) Study, an ongoing U.S nationally
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