Addictiveness Of E-cigarettes Research Articles

Nicotine information disclosed online by e-cigarette brands popular with young people.

E-cigarette use is most prevalent among adolescents and young adults - and there are often misperceptions about product risk. The purpose of this study was to determine what nicotine information is provided on e-cigarette brand websites. Based on national and local surveys, we identified 44 e-cigarette brands commonly used in the US by adolescents and young adults. For each of these brands, their associated websites were analyzed for disclosed nicotine information. Specifically, for each brand's website, we coded whether there was information on nicotine concentration (recorded if a numerical value was provided such as '5% nicotine'), nicotine form (free-base, nicotine salts, or not stated), and nicotine type (tobacco-derived, synthetically derived, or not stated). Coding allowed for both lay (e.g. 'nic salts') as well as scientific (e.g. 'isomers') terms. Of the 44 brands examined, all provided basic information on nicotine concentration (e.g. '5% nicotine'). However, 23% of brands did not disclose information on nicotine form (i.e. nicotine salt vs free-base), and 66% of brands did not disclose information on nicotine type (i.e. synthetic vs tobacco-derived). Overall, these results suggest that the e-cigarette industry is not fully informing its consumers about the nicotine in their products. Given that nicotine form and type have implications for e-cigarette addiction potential, these findings highlight a public health concern. There is a need for more comprehensive national regulations for mandating product constituents and emissions disclosures.

Subjective experiences of the addictive potential of E-cigarettes: results from focus group discussions

BackgroundElectronic cigarettes (e-cigarettes) have specific properties, such as their taste, vapor, or technicality, which might facilitate experiences of addiction. In this study, we aimed to investigate the subjective experience of the addictive potential of e-cigarettes using qualitative methodology.MethodWe conducted semi-structured focus groups with adult e-cigarette users to discuss subjective experiences of addiction. Informed by Braun and Clarke’s approach to thematic analysis, we conducted a deductive-inductive analysis in MAXQDA. First, deductive codes were based on the 10 domains of e-cigarette addiction previously identified by Bold and colleagues. Second, we inductively coded those e-cigarette properties that were identified by users to have addictive potential.ResultsWe conducted five focus group discussions with a total of 14 e-cigarette users (8 male, 6 female). Subjective experiences of e-cigarette addiction discussed by focus group participants accorded with domains of e-cigarette addiction as defined by Bold and colleagues. For example, users reported automatic use, craving, or sensory dependence. The only domains not reported were preference over competing rewards and impaired control. Second, we inductively identified three central properties of the addictive potential of e-cigarettes: unlimited usability, unobtrusiveness, and pleasant taste.ConclusionOur findings were summarized in the Model of the Addictive Potential of E-cigarettes (MAPE). Understanding which e-cigarette properties lead to subjective experiences of addiction can inform cessation programs for those who want to quit as well as the refinement of measures to assess e-cigarette addiction.

Family social responsibility in combating adolescent addiction to e-cigarettes

The main objective of this study is to understand the social responsibility of families towards the phenomenon of adolescent e-cigarette addiction. Emphasizing the importance of monitoring and accountability of parents as part of the social education process and efforts to prevent the possibility of being accustomed to inappropriate deviant behaviour holds Because the social environment in general and the family environment, in particular, have a great role and influence on individual thinking and behaviour. Adolescence, which is a sensitive stage, requires more parental supervision and accountability. Therefore, the importance of this study lies in presenting the role and importance of the family in the social responsibility of the next generation. For this purpose, the researcher has tried to reach out to the cases that exist among the students and conduct discussions and interviews with them, through the use of an ethnographic research strategy within the framework of qualitative method, ie putting Non-statistical presentation of results. During the case study, one of the obstacles faced by the researcher was to convince the students to interview and obtain information, because despite the prevalence of the phenomenon among adolescents, but still a sensitive behaviour they deal with. As the researcher noticed, students tried to avoid eye contact while vaping. As a result, the researcher was able to take 10 cases and use them as samples for the study. After analysing the data, it was found that most adolescents are familiar with the harms of e-cigarettes, and some parents find it normal for their children to vape. It also found that in most cases, one or more members of their family smoke cigarettes and hookahs and are largely unaware of the situation, that their adolescents learned to vape because of their friends and are not held accountable for how to spend the money they give their adolescents as daily expenses.

Prevalence of use, perceptions of harm and addictiveness, and dependence of electronic cigarettes among adults in Kuwait: A cross-sectional study.

Electronic cigarettes (e-cigarettes) have become one of the most common forms of nicotine delivery used by youth and young adults worldwide. Given the lack of epidemiologic data in Kuwait, this study sought to estimate the prevalence of e-cigarette use, assess perceptions of harm and addictiveness of e-cigarettes, measure the level of dependence on e-cigarettes and assess factors associated with dependence level among adults. A cross-sectional study enrolled adults (n=3032, aged ≥18 years) living in Kuwait using a web-based questionnaire. Participants self-reported ever and current (past 30-day) e-cigarette use and self-completed the 10-item Penn State E-cigarette Dependence Index. Associations were evaluated using multinomial logistic regression. The prevalence of ever and current e-cigarette use was estimated to be 40.2% (1220/3032) and 29.4% (892/3032), respectively. The prevalence of current e-cigarette use was higher in males compared to females (47.6% vs 14.4%, p<0.001). Relative to cigarette smoking, 40.6% of participants reported that e-cigarettes are less harmful, and 41.8% indicated that e-cigarettes are equally addictive. Among current e-cigarette users (n=892), 84.8% were ascertained to have developed either low, medium, or high dependence. The use of pod-based devices compared to disposable devices was associated with a high dependence level (adjusted odds ratio, AOR=8.56; 95% CI: 4.52-16.22). These findings suggest that a large proportion of adults in Kuwait use e-cigarettes, and a considerable proportion of current users have developed dependence. Therefore, such results should alert public health authorities and warrant the development of evidence-based awareness campaigns, policies, and prevention measures to protect and improve the health of people.

An empirical analysis of e-cigarette addiction

ABSTRACT This paper examines the role of addiction in influencing the demand for e-cigarettes using the Nielsen Retail Scanner Data and the Nielsen Consumer Panel Data between 2012 and 2017. With a comparison of a myopic addiction model, a forward-looking model, and a rational addiction model, this paper tests whether the consumption of e-cigarettes is addictive and rational. Results from both the macro data and the microdata support the rational addictiveness of e-cigarettes. Applying an OLS method and an instrumental variable method in causal inference, results show that the long-run price elasticity estimates are larger than the estimates of the short-run price elasticity of demand for e-cigarettes. Estimates of both long-run and short-run elasticities are greater than one, −1.50 and −1.05, suggesting e-cigarette demand is elastic in both the long run and short run.

Addictive Potential of e-Cigarettes as Reported in e-Cigarette Online Forums: Netnographic Analysis of Subjective Experiences

While e-cigarettes usually contain nicotine, their addictive potential is not yet fully understood. We hypothesized that if e-cigarettes are addictive, users will experience typical symptoms of addiction. The aim of our study was to investigate whether and how e-cigarette users report signs of addiction. We identified 3 large German-language e-cigarette online forums via a systematic Google search. Based on a netnographic approach, we used deductive content analysis to investigate relevant posts in these forums. Netnography has the advantage of limiting the social desirability bias that prevails in face-to-face research, such as focus groups. The data were coded according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria for tobacco use disorder, adapted for e-cigarettes. The DSM-5 criteria were used to portray a broad spectrum of possible experiences of addiction. Overall, 5337 threads in 3 forums were screened, and 451 threads containing relevant information were included in the analysis. Users reported experiences consistent with the DSM-5 criteria, such as craving e-cigarettes, excessive time spent vaping, and health issues related to e-cigarette use. However, our analysis also showed that users reported the absence of typical tobacco use disorder criteria, such as successful attempts to reduce the nicotine dosage. For most themes, reports of their absence were more frequent than of their presence. The absence of perceived addiction was mostly reported in contrast to prior tobacco smoking. This is the first study to use a netnographic approach to explore unfiltered self-reports of experiences of e-cigarette addiction by users in online forums. As hypothesized, some but not all users reported subjective experiences that corresponded to the criteria of tobacco use disorder as defined by the DSM-5. Nevertheless, subjective reports also indicated that many e-cigarette users felt in control of their behavior, especially in contrast to their prior use of tobacco cigarettes. The finding that some e-cigarette users subjectively experience addiction highlights the need for effective cessation programs to support users who experience their e-cigarette use as burdensome. This research can guide the refinement of instruments to assess e-cigarette addiction and guide cessation programs. RR2-10.1186/s40359-021-00682-8.

E-cigarette addiction and harm perception: Does initiation flavor choice matter?

IntroductionThe 21st century was marked by a dramatic increase in adolescent e-cigarette use in the United States (US). The popularity of non-traditional flavor types, including fruit and pastry, is thought to contribute toward growing product use nationally, leading to a variety of federal and state regulations limiting the use of non-traditional flavors in the US. The relationship between flavor type and increased adolescent use suggests a possible link between flavor use and addiction and harm perception. This study assessed if the flavor type used when initiating e-cigarette use predicted addiction and harm perceptions.MethodsThe study utilized data from the multi-wave youth Population Assessment of Tobacco Health Study. It explored the impact initiating e-cigarette use with traditional versus non-traditional flavor types among cigarette users on the outcome variables: e-cigarette addiction and harm perception. Both e-cigarette addiction and harm perception were measured using self-report, Likert scale questionnaires. Descriptive statistics characterized the study variables and linear regression analyses performed to test whether flavor initiation type is associated with addiction and harm perception.ResultsThe study sample consisted of 1,043 youth (weighted N = 1,873,617) aged 12 to 17 years who reported at least one instance of e-cigarette use. After adjusting for age, age of onset, sex, race and annual household income there was no statistically significant difference in addiction levels between those initiating with traditional versus non-traditional flavors (p = 0.294). Similarly, traditional versus non-traditional flavor initiation did not show a statistically significant difference in adolescent e-cigarette harm perceptions (p = 0.601).ConclusionsTraditionally flavored e-cigarette initiation produces similar risk for addiction and harm perceptions as non-traditionally flavored initiation. These findings suggest that banning non-traditional flavors alone may be ineffective in curbing e-cigarette addiction and harm perception. Additional research is needed to better understand which e-cigarette product characteristics and behaviors may be associated with greater addiction and reduced harm perceptions.

Does virtual versus in-person e-cigarette education have a differential impact?

Background: E-cigarette prevention education aims to mitigate adolescent e-cigarette use. Such education is increasingly delivered through virtual/video-based teaching platforms (e.g. Zoom, Google Classrooms). However, there is little evidence about the effectiveness of virtual e-cigarette education compared to in-person education on adolescents’ knowledge about e-cigarettes, perceived addictiveness and intent to try e-cigarettes, cigarettes, and marijuana. Objective: To evaluate the effectiveness of virtual e-cigarette education compared to in-person education on student knowledge and perceived addictiveness of e-cigarettes and intent to try e-cigarettes. Design, Setting and Method: We conducted a pre- and post-education evaluation among 10 middle and high school students in the Greater Birmingham area, Alabama, who were non-randomly assigned to receive either virtual ( n = 745) or in-person e-cigarette education ( n = 286) (mean age: 14.36 years). The study used a 25-minute educational presentation about the health effects of e-cigarettes, the risks of second- and third-hand smoke, the addictive nature of nicotine, and marketing strategies of e-cigarette companies. Participants completed a 10-minute self-administered survey immediately before and after the presentation. Results and conclusion: Except for certain e-cigarette knowledge-related items, our study shows that both virtual and in-person education had similar effects on improving knowledge about e-cigarettes, increasing perceived addictiveness and reducing intent to try e-cigarettes, cigarettes and marijuana among participants. Virtual education may be applied where in-person education is not feasible (e.g. in rural communities).

Less harmful ≠ safe: Effects of cigarette graphic health warnings on E-cigarette evaluations

ABSTRACTAs mandated by the FDA, color graphics depicting some of the lesser-known negative health consequences of smoking will soon be required on all cigarette packaging and advertising. Extensive prior research has demonstrated that Graphic Health Warnings (GHW) are a highly cost-effective way to demarket cigarettes. However, the results of this study suggest that GHW may have unintended negative health implications for consumers. While e-cigarette Addiction Warnings (AW) increased fears about the negative health effects of vaping, cigarette GHW decreased fears and beliefs about the negative health effects of vaping. GHW also had an indirect effect on consumers’ beliefs about the negative health risks of vaping. Consumers’ mindfulness (low vs. high) moderated these effects. The results provide initial insight into the inter-relationships between cigarette GHW, e-cigarette AW, and individual difference.

Associations Between Perceptions of e-Cigarette Harmfulness and Addictiveness and the Age of E-Cigarette Initiation Among the Population Assessment of Tobacco and Health (PATH) Youth.

IntroductionYouth perceptions of harmfulness and addictiveness of e-cigarettes may impact the age that they initiate e-cigarette use, but this has not been investigated previously.MethodsYouth (12-17 years old) never e-cigarette users at their first wave of PATH participation (waves 1-3, 2013-2016) were included. PATH questions on absolute perceptions of e-cigarette harmfulness and addictiveness were used as exposures. Interval-censored Cox proportional hazards models were used to estimate the impact of perceptions of harmfulness, and perceptions of addictiveness on (i) the age of initiation of e-cigarette use and (ii) age of first reporting past 30-day e-cigarette use, while controlling for covariates.ResultsYouth who perceive e-cigarettes as having no/little harm had increased risk of initiating both ever e-cigarette use (AHR = 2.04; 95%CI = 1.74-2.40) and past 30-day e-cigarette use (AHR = 2.64; 95%CI = 2.07-3.37) at earlier ages compared to youth who perceive e-cigarettes as having a lot of harm. Youth who perceive the likelihood of becoming addicted to e-cigarettes to be very/somewhat unlikely had increased risk of an earlier age of both ever (AHR = 1.28; 95%CI = 1.07-1.52) and past 30-day (AHR = 1.36; 95%CI = 1.04-1.79) e-cigarette initiation compared to youth who perceived the likelihood of becoming addicted to e-cigarettes to be somewhat/very likely.ConclusionThese results highlight the importance of communicating to youth the potential for health harms and addiction from e-cigarette use in prevention and intervention campaigns, as those with the lowest perceptions of harmfulness and addictiveness had the earliest ages of e-cigarette initiation.

Less Harmful ¹ Safe: Effects of Cigarette Graphic Health Warnings on E-Cigarette Evaluations

As mandated by the FDA, color graphics depicting some of the lesser-known negative health consequences of smoking will soon be required on all cigarette packaging and advertising. Extensive prior research has demonstrated that Graphic Health Warnings (GHW) are a highly cost-effective way to demarket cigarettes. However, the results of this study suggest that GHW may have unintended negative health implications for consumers. While e-cigarette Addiction Warnings (AW) increased fears about the negative health effects of vaping, cigarette GHW decreased fears and beliefs about the negative health effects of vaping. GHW also had an indirect effect on consumers’ beliefs about the negative health risks of vaping. Consumers’ mindfulness (low vs. high) moderated these effects. The results provide initial insight into the inter-relationships between cigarette GHW, e-cigarette AW, and individual differences.

Evaluation of a virtual reality E-cigarette prevention game for adolescents

ObjectiveTo test preliminary efficacy and acceptability of Invite Only VR: A Vaping Prevention Game (Invite Only VR), an electronic cigarette (e-cigarette) prevention game that uses virtual reality (VR) hardware. Methods285 adolescents (146 boys; ages 11–14; M = 12.45 years; SD = 0.57) were enrolled in this non-equivalent control groups design through their middle school. Participants who played Invite Only VR for 1.5 h were compared to treatment as usual at 4 timepoints: baseline, post gameplay, 3 and 6 months. Evidence of the efficacy of the game to influence e-cigarette use, e-cigarette knowledge, nicotine addiction knowledge, perceived addictiveness of e-cigarettes, perceived likelihood of using e-cigarettes, perceptions of harm, self-efficacy to refuse, social approval of e-cigarettes, and e-cigarette social perceptions was assessed using mixed between-within subjects ANOVAS. Intervention acceptability was indicated by measures of gameplay experience/satisfaction, VR experience, and perceived responsibility for game-based decisions. ResultsFrom baseline to 6 months, Invite Only VR players improved in e-cigarette knowledge, nicotine addiction knowledge, perceived addictiveness of e-cigarettes, perceptions of harm, and social perceptions about e-cigarette use compared to the control group. No significant changes were observed for the other dependent variables, including e-cigarette use. Ratings of gameplay experience and satisfaction, VR experience, and game-based decisions were high. ConclusionsInvite Only VR may help players develop knowledge about e-cigarettes and nicotine addiction, as well as encourage the development of healthy harm and social perceptions regarding e-cigarette use that persist 6 months beyond gameplay. Adolescents’ satisfaction with the VR gameplay indicates preliminary intervention acceptability.

Changes in E-Cigarette Perceptions Over Time: A National Youth Tobacco Survey Analysis

This multiyear, cross-sectional study explores the changes over time in how U.S. middle- and high-school students perceive the harm and addiction risk of E-cigarettes. This study analyzed 83,779 participants in the National Youth Tobacco Survey from 2015 to 2019. Associations of survey year with perceived harm and addiction risk of E-cigarettes were assessed using multivariable multinomial logistic regression models, adjusted for sociodemographic characteristics. Smoking decreased over the 5 years (-1.85 percentage points, p=0.07); vaping increased (9.03 percentage points, p<0.01). Perceived harm of both combustible cigarettes and E-cigarettes increased with time. Male, older, and non-White students perceived less harm from smoking or vaping. Perceptions of the addictiveness of E-cigarettes increased over time: 26.31% of students considered E-cigarettes to be more addictive than combustible cigarettes in 2019, compared with 7.26% in 2016. Female and non-White students were more likely to think that E-cigarettes were at least as addictive as combustible cigarettes but also reported less knowledge about them. The perceptions of both harm and addictiveness of E-cigarettes have increased over time, independent of current use. Perceptions vary on the basis of age, sex, race/ethnicity, and current use. Efforts should be made to further educate adolescents about E-cigarettes and to regulate their sale and advertisement. Efforts to reduce the uptake of combustible cigarettes among adolescents have been successful and should be duplicated for E-cigarettes.

The Road to Vaping: E-cigarette Susceptibility and Curiosity Among U.S. Adolescents Susceptible and Nonsusceptible to Cigarette Smoking.

Background. Electronic cigarettes (e-cigarettes) are the most commonly used tobacco product among adolescents. We aimed to identify factors associated with e-cigarette susceptibility and curiosity among adolescents who are and are not susceptible to cigarette smoking. Method. Data were drawn from the 2018 U.S. National Youth Tobacco Survey. The study sample comprised 13,428 never cigarette or e-cigarette users. Four distinct weighted multivariable regression models were performed to assess associations between covariates and e-cigarette curiosity and susceptibility. Results. Among adolescents susceptible to smoking cigarettes, non-Hispanic (NH) Black participants were less likely to be susceptible to (adjusted odds ratio [aOR] = 0.42, 95% confidence interval [CI] [0.26, 0.67]) and curious about (aOR = 0.61, 95% CI [0.39, 0.95]) e-cigarettes than NH Whites. Among adolescents nonsusceptible to smoking cigarettes, Hispanics were more susceptible to (aOR = 1.33, 95% CI [1.04, 1.71]) and curious about (aOR = 1.29, 95% CI [1.02, 1.62]) e-cigarettes than NH Whites. Among adolescents (both susceptible and nonsusceptible to smoking cigarettes), being female, exposure to e-cigarette aerosol in public places, exposure to e-cigarette ads at point-of-sale, and having low perceived harm and addictiveness of e-cigarettes versus cigarettes were associated with having greater odds of susceptibility toward and curiosity about e-cigarette use. Conclusions. Future regulatory policies and tobacco control prevention campaigns should focus on increasing health awareness (e.g., potential harm and addictiveness) of e-cigarettes among adolescents and restrict marketing and the use of e-cigarettes in public places.

School-based e-cigarette education in Alabama: Impact on knowledge of e-cigarettes, perceptions and intent to try

Background and objectivesEducational programs are needed to combat the sharp rise in adolescent e-cigarette use. We assessed adolescent knowledge about e-cigarettes, perceptions of harmfulness and addictiveness and intent to try e-cigarettes before and after an e-cigarette educational session. MethodsWe conducted a one-group pre- and post-test study among middle and high school students in Alabama in 2019. The intervention included a 30-minute educational session based on the Stanford Tobacco Prevention Toolkit on e-cigarette types, contents, marketing and advertising, health effects and nicotine addiction. McNemar tests of paired proportions and multi-level, mixed-effects logistic regression models were used to analyze intervention effects. ResultsSurveys were completed by 2,889 middle and high school students. The intervention was associated with significantly increased knowledge about e-cigarettes and perceptions that e-cigarettes are harmful and addictive, and with significantly lower intent to try e-cigarettes. At pre-test, middle school students had lower knowledge, believed that e-cigarettes were not as addictive and showed higher intent to try both e-cigarettes and cigarettes compared to high school students. Groups that were associated with lower perceived harmfulness and addictiveness were: ever-users of e-cigarettes, ever-users of both e-cigarettes and cigarettes and prior users of mint/menthol flavored e-cigarettes. ConclusionsA school-based educational session was significantly associated with improved adolescent knowledge about e-cigarettes, increased the perceived harmfulness and addictiveness of e-cigarettes, and reduced intent to try e-cigarettes. E-cigarette education should be prioritized for middle school students due to lower levels of knowledge and higher intent to try tobacco compared to high school students.

Perceived addiction to vaping among youth and young adult regular vapers

BackgroundThe prevalence of e-cigarette use among youth and young adults has increased markedly in recent years; however, little is known about young people’s perceptions of e-cigarette addiction. This study examines...

Protecting Youth From the Risks of Electronic Cigarettes

The rapid increase in e-cigarette use among adolescents and young adults has led to drastic changes in patterns of nicotine consumption worldwide. The use of e-cigarettes, many of which contain high levels of nicotine, is especially harmful in this age group and is associated with increased use of cigarettes and other substances among youth. While the risks of short- and long-term e-cigarette use and secondhand aerosol exposure remain only partially understood, e-cigarettes should not be recommended for smoking cessation for youth in any circumstances given the lack of evidence for effectiveness and potential harmful physical and mental health effects. The perceptions of low e-cigarette risk of adolescents and young adults combined with few market regulations and the appeal of youth-friendly flavors, have created ideal conditions for the e-cigarette industry to thrive and place millions of youth at risk of developing an addiction to nicotine. Policies and regulations aiming to prevent youth-directed marketing and sales of e-cigarette and all nicotine delivery products are needed to protect young people. Public health-led education campaigns and educational curricula are also needed to help inform youth and families about the risks of e-cigarette use. While more research is required to determine the best ways to help youth quit e-cigarette use, adolescent health providers can play a key role in screening and counseling youth about e-cigarette use and should be adequately trained and supported to care for youth with e-cigarette addiction.

Subjective sleep quality and electronic cigarette dependence, perceived risks of use, and perceptions about quitting electronic cigarettes

IntroductionAlthough subjective sleep quality has been associated with combustible cigarette use, little is known about its role in electronic cigarette (e-cigarette) use or beliefs about use. To address this gap, the current study examined subjective sleep quality among adult e-cigarette users in relation to e-cigarette dependence, perceived risks of e-cigarette use, and perceived barriers for quitting e-cigarettes. MethodsA cross-section design was employed. Participants included 304 e-cigarette users (53.6% female, Mage = 36.7 years,SD = 10.3, 75% were combustible cigarette users) using a Qualtrics platform. ResultsResults indicated that poorer subjective sleep quality was significantly related to greater e-cigarette dependence and perceived barriers for quitting e-cigarettes (ΔR2 = 0.06, p < .001 for each model) but was not significantly associated with perceived risks of e-cigarette use. ConclusionsThis work provides novel evidence for the potential role of subjective sleep quality in e-cigarette dependence and beliefs about quitting. To the extent sleep quality is related to e-cigarette addiction and cognition, it represents an important construct to assess and target for change in efforts to facilitate change in e-cigarette dependence and perceived barriers for quitting. ImplicationsThis study is among the first data to link subjective sleep quality to e-cigarette dependence and beliefs about risk of use and perceptions about barriers for quitting among adults. Similar to results found for combustible cigarettes, these findings suggest that subjective sleep quality may be important to consider in efforts to facilitate change in e-cigarette dependence and perceived barriers for quitting.

Positive perceptions of electronic cigarettes relative to combustible cigarettes are associated with weaker support for endgame policies on combustible cigarettes: A population-based cross-sectional study in Hong Kong.

INTRODUCTIONPositive perceptions of electronic cigarettes (e-cigarettes) relative to combustible cigarettes (CCs) may erode support for endgame policies on CCs through smoking renormalization (increasing public acceptance of smoking). We investigated the associations between perceptions of e-cigarettes relative to CCs and support for endgame policies on CCs in Hong Kong.METHODSAdult respondents (N=2004) were surveyed using landline random digit dialing in 2015. Perceived relative harm and relative addictiveness of e-cigarettes were combined as an overall perception of e-cigarettes relative to CCs with 5 levels and we analyzed individually ‘neutral/positive/mixed/unknown’ perceptions against the ‘negative’ perception. Five individual items with dichotomous responses assessed the support for endgame policies on CCs. Support for banning the sale/use of CCs (yes/no) was also assessed. Multivariable regressions yielded adjusted odds ratios (AORs) of supporting endgame policies (individual policy items, all 5 policy items, at least 1 policy item, banning the sale/use of CCs) in relation to perceptions of e-cigarettes relative to CCs, adjusting for age, education attainment, marital status, CC smoking status and ever e-cigarette use.RESULTSSupport for individual endgame policy items (from 51.8% to 80.0%), banning the sale (63.8%) and use (67.5%) of CCs were generally high. Few respondents perceived e-cigarettes as more harmful (16.6%) or more addictive (9.3%) than CCs. Positive perceptions of e-cigarettes (24.0%) were associated with less support for ‘ban CC sales in 10 years if there is a product providing nicotine not made from tobacco’ (AOR=0.62, 95% CI: 0.40–0.97), ‘ban CC use when it’s prevalence falls below 5%’ (AOR=0.66, 95% CI: 0.44–0.98) and ‘banning the sale of CCs’ (AOR=0.63, 95% CI: 0.42–0.94).CONCLUSIONSPositive perceptions of e-cigarettes relative to CCs were associated with less support for endgame policies on CCs in Hong Kong. Public health actions are needed to disseminate evidence-based knowledge of e-cigarettes.

Perceptions and use of e-cigarettes among young adults in Hong Kong

BackgroundLittle is known about the risk and addiction perceptions of e-cigarettes among Asian populations. We examined e-cigarette perceptions among young adults in Hong Kong and the association between the perceptions and e-cigarette use patterns.MethodsAn online survey was administered to a convenience sample of Hong Kong residents aged 18–35 (N = 1186). Measures of e-cigarette perceptions included perceived harm and addictiveness of e-cigarettes, perceived harm of secondhand e-cigarette aerosol, and perceived popularity of e-cigarette use among peers. Separate multinomial logistic regression models were conducted to examine the associations between the four perceptions and former and current use of e-cigarettes relative to never use, controlling for demographics and current cigarette smoking status. Interactions of e-cigarette perceptions and current cigarette smoking were assessed in all models. Among current e-cigarette users, bivariate exact logistic regression models were used to examine the relationships between each of the perceptions and frequent e-cigarette use (≥3 days in past 30-day vs. 1–2 days). Among participants who had never used e-cigarettes, separate multivariable logistic regression models were conducted to examine the associations between e-cigarette perceptions and susceptibility to e-cigarette use.ResultsOverall, 97.2% of participants were aware of e-cigarettes, and 16.1% had tried e-cigarettes (11.3% former users; 4.8% current users). Young adults perceived e-cigarettes (and aerosol) as less harmful, less addictive, and less popular than cigarettes. Current cigarette smokers reported significantly lower perceived harmfulness and addictiveness of e-cigarettes, lower perceived harmfulness of e-cigarette aerosol, and higher perceived popularity than nonsmokers. The lower degree of harm and addiction perceptions, and higher levels of popularity perceptions were associated with greater odds of e-cigarette use, and these relationships were generally stronger among nonsmokers compared to current cigarette smokers. E-cigarette perceptions were not associated with frequent e-cigarette use. Perceiving e-cigarettes (and aerosol) as less harmful and less addictive were associated with greater susceptibility to e-cigarette use. Compared to nonsmokers, current smokers were more likely to report e-cigarette use and susceptibility.ConclusionsContinued monitoring of e-cigarette use and perceptions is needed. Educational programs should emphasize the potential harmful and addictive properties of e-cigarettes and the risks of secondhand exposure to e-cigarette aerosol.