Electronic Cigarette Users Research Articles

Predicting Electronic Cigarette Use Among Adults in the Philippines

Background: The Philippines has one of the highest cigarette smoking rates in Southeast Asia. Tobacco prevention and control efforts should not be a one-size-fits-all approach. One of the most recent and highly marketed way of cutting down smoking is the use of E-cigarettes. But its use may also have potential harmful effects which would be similar to cigarette smoking. Purpose: This study aimed to determine the factors predicting electronic cigarette use among adults in a large metropolitan area in the Philippines. Methods:The study used a descriptive-correlational multivariate research design. Adults who are at least 18 years of age, who are electronic cigarettes users, dual users (electronic cigarette and cigarette users), and non-smokers were chosen for this study. The researchers utilized a researcher- made questionnaire based on the Theory of Planned Behavior (TPB) in gathering the data. Results: Multiple regression analysis suggests that positive attitude and high perceived behavioral control significantly predict intent to use electronic cigarettes. Moreover, intent to use is a significant predictor of actual e-cigarette use. Conclusion: People who have positive attitudes and high perceived behavioral control towards e-cigarette use are most likely to have higher intent to use e-cigarettes. Further, people who have high intent to use e-cigarettes will most likely use e-cigarettes. With reverence to the findings of this study, health managers and professionals should look into how e-cigarettes are being marketed to the public which may shape their attitude and behavior. Lastly, further studies should be conducted on other variables that may predict electronic cigarette use and measure health outcomes.

Electronic Cigarette Terminology: Where Does One Generation End and the Next Begin?

The electronic cigarette (ECIG) research community faces several challenges when it comes to regulatory science; not only is the ECIG market changing at a rapid pace, but the terms used by researchers, health organizations, ECIG users, and ECIG manufacturers/distributors to describe devices are inconsistent. These discrepancies make it difficult to advance science and develop regulations. Although researchers have used "generations" to categorize ECIG device types based on various characteristics, with the constantly evolving ECIG market, it is unclear where one "generation" of devices ends and the next begins.

Has increased youth e-cigarette use in the USA, between 2014 and 2020, changed conventional smoking behaviors, future intentions to smoke and perceived smoking harms?

IntroductionAn increase in electronic cigarette (EC) use among US youth has raised concerns that their use may increase conventional cigarette smoking. MethodsRepeated cross-sectional data from two large nationally representative samples of US youth were drawn from the National Youth Tobacco Survey (NYTS) and Monitoring the Future (MTF). Students from grade 6–12 of the NYTS (N = 98,454–132,003) and students from grade 12 of the MTF (N = 17,870–30,981) were included in the analyses. Trends in smoking behavior, intention to smoke in the future and perceived smoking harms among youth who do and do not use ECs were estimated from 2014 to 2020 using weighted multinomial logistic regression and predicted marginal probabilities. ResultsThe prevalence for regular smoking decreased among youth who regularly use ECs. For example, among regular EC users, smoking prevalence decreased from 27.8% to 6.7% (−21%; 99.67% CI:[−32.3%, −9.9%]) in the NYTS between 2014 and 2020 and from 31.8% to 10.6% (−21.2%, 99.67% CI:[−35.0%, −7.3%]) in the MTF between 2014 and 2018. Intent to smoke in the future and perceiving smoking as harmless decreased or remained unchanged during the same period. For example, among regular EC users, there was no significant change in intention to smoke next year in the NYTS between 2014 and 2018; intention to smoke in the next 5 years decreased significantly from 30.7% to 11.2% (−19.5%, 99.67% CI:[−37.7%, −1.3%]) in the MTF. ConclusionsIn two national samples of US youth, smoking prevalence declined by a sizeable relative percentage. Intent to smoke in the future and harm perceptions of smoking declined or remained unchanged while EC use increased. Results provide little evidence that EC use has increased conventional cigarette smoking among youth.

The impact of COVID-19 lockdown on gambling habit: A cross-sectional study from Italy.

Background and aimsFew preliminary studies have shown an impact of COVID-19 confinement on gambling habits. We aim to evaluate short-term effects of lockdown restrictions on gambling behaviors in Italy.MethodsWithin the project Lost in Italy, a web-based cross-sectional study was conducted on a representative sample of 6,003 Italians aged 18–74 years, enrolled during April 27–May 3 2020, and were asked to report gambling activity before the lockdown and at the time of interview.ResultsThe prevalence of participants reporting any gambling decreased from 16.3% before lockdown to 9.7% during lockdown. Traditional gambling decreased from 9.9 to 2.4% and online gambling from 9.9 to 8.0%. Among gamblers, median time of gambling grew from 4.5 to 5.1 h/month. Among non-players before lockdown, 1.1% started playing. Among players before lockdown, 19.7% increased gambling activity. Multivariate analysis showed an increase in gambling activity in younger generations (p for trend = 0.001), current smokers (odds ratio, OR 1.48), users of electronic cigarettes (OR 1.63), heated tobacco products (OR 1.82), cannabis (OR 5.16), psychotropic drugs (OR 3.93), and subjects having hazardous alcohol drinking (OR 1.93). Self-reported low quality of life (OR 1.97), low sleep quantity (OR 2.00), depressive symptoms (OR 3.06) and anxiety symptoms (OR 2.93) were significantly related to an increase in total gambling activity during lockdown.Discussion and conclusionsAlthough gambling substantially decreased during lockdown, time spent in gambling slightly increased. The strong relationship found between compromised mental health and addictive behaviors calls for urgent policies to prevent vulnerable populations from increasing and developing severe gambling addiction.

Addicted to smoking or addicted to nicotine? A focus group study on perceptions of nicotine and addiction among US adult current smokers, former smokers, non-smokers and dual users of cigarettes and e-cigarettes.

In 2017, the US Food and Drug Administration (FDA) proposed to reduce nicotine in cigarettes to minimally or non-addictive levels. This study qualitatively explored perceptions of nicotine and addiction, both independently and in response to messages communicating about nicotine reduction. Qualitative study using focus groups. Participants described their perceptions of nicotine and addiction and their responses to messages about the nicotine reduction. Atlanta, GA and San Francisco, CA, USA. Semi-structured focus groups were conducted virtually in Spring 2020. Exclusive smokers (n=27), dual users (of cigarettes and electronic cigarettes) (n=25), former smokers (n=32) and young adult non-smokers (n=31). Inductive thematic analysis of transcripts was conducted, and results were compared across smoking status groups. Participants across all smoking status groups associated nicotine with tobacco products, but consistently misperceived that nicotine caused disease. Perceptions of addiction were largely negative and varied by smoking status. Experienced smokers (exclusive smokers, former smokers and dual users) differentiated tobacco use from other addictions and minimized their own experiences of addiction. Perceptions of addiction across experienced smokers included not only the chemical properties of nicotine, but also the behavioral aspects of tobacco use, including oral fixation, having a smoking routine and response to internal and external cues. In response to messages, many believed that removing the nicotine would not make cigarettes less addictive because of the multi-factorial nature of smoking addiction that includes non-pharmacological cues. Perceptions of nicotine and addiction among non-smokers, former smokers, exclusive smokers and dual users of cigarettes and e-cigarettes vary based on smoking status, but there is a common tendency to believe that nicotine is addictive, that addiction results from more than just nicotine, and that very low nicotine cigarettes will not necessarily reduce the addictiveness of cigarettes.

Tracing the movement of electronic cigarette flavor chemicals and nicotine from refill fluids to aerosol, lungs, exhale, and the environment

BackgroundGiven the high concentrations of nicotine and flavor chemicals in EC (electronic cigarette) fluids, it is important to determine how efficiently they transfer to aerosols, how well they are retained by users (exposure), and if they are exhaled into the environment where they settle of surfaces forming ECEAR (EC exhaled aerosol residue). ObjectivesTo quantify the flavor chemicals and nicotine in refill fluids, inhaled aerosols, and exhaled aerosols. Then deduce their retention and contribution to ECEAR. MethodsFlavor chemicals and nicotine were identified and quantified by GC-MS in two refill fluids, smoking machine-generated aerosols, and aerosols exhaled by 10 human participants (average age 21; 7 males). Machine generated aerosols were made with varying puff durations and two wattages (40 and 80). Participants generated exhale ad libitum; their exhale was quantified, and chemical retention and contribution to ECEAR was modeled. Results“Dewberry Cream” had five dominant (≥1 mg/mL) flavor chemicals (maltol, ethyl maltol, vanillin, ethyl vanillin, furaneol), while “Cinnamon Roll” had one (cinnamaldehyde). Nicotine transferred well to aerosols irrespective of topography; however, transfer efficiencies of flavor chemicals depended on the chemical, puff volume, puff duration, pump head, and EC power. Participants could be classified as “mouth inhalers” or “lung inhalers” based on their exhale of flavor chemicals and nicotine and retention. Lung inhalers had high retention and exhaled low concentrations of EC chemicals. Only mouth inhalers exhaled sufficient concentrations of flavor chemicals/nicotine to contribute to chemical deposition on environmental surfaces (ECEAR). ConclusionThese data help distinguish two types of EC users, add to our knowledge of chemical exposure during vaping, and provide information useful in regulating EC use.

Cross-Sectional Associations of Multiple Tobacco Product Use with Depressive and Anxiety Symptoms among Young Adult E-Cigarette Users

Background Tobacco users with mental health conditions are a vulnerable population in tobacco research, yet few studies have evaluated the association of depressive and anxiety symptoms with multiple tobacco product (MTP) use among young adult electronic cigarette (ENDS) users. Methods Cross-sectional survey data on U.S. young adult past 30-day ENDS users (N = 2348) were collected via Amazon MTurk from May-July 2019. Binary logistic regressions evaluated the association of tobacco use pattern (exclusive ENDS use, ENDS + one other tobacco product [OTP; dual use], ENDS + two or more OTPs [poly-use]) with depressive (PHQ-9) and anxiety (GAD-7) symptoms. Among MTP users (n = 1736), we evaluated the association of ENDS use relative to OTP use and same-day MTP use with depressive and anxiety symptoms. Results The sample included 26% exclusive ENDS, 27% dual, and 47% poly-users. We observed a gradient-relationship for depressive and anxiety symptoms: poly-users had greater odds of depressive and anxiety symptoms compared to dual users (aOR = 1.86 [95%CI:1.50–2.30] and aOR = 1.61 [95%CI:1.30–2.01], respectively), and dual users had greater odds of depressive and anxiety symptoms compared to exclusive ENDS users (aOR = 1.42 [95%CI:1.11–1.81] and aOR = 1.56 [95%CI:1.20–2.02], respectively). MTP users who used ENDS more often than OTPs (vs. less often than OTPs) had greater odds of depressive (aOR = 1.38 [95%CI:1.06–1.80]) and anxiety (aOR = 1.37 [95%CI:1.04–1.79]) symptoms. Conclusions The majority of young adult past 30-day ENDS users in this sample reported OTP use. Future research on MTP use should distinguish between dual and poly-use. Tobacco prevention efforts for young adults with mental health symptoms are needed.

A Cross-Sectional Study of Electronic Cigarette Use Among Chinese Adult Populations in Four Cities of China. Part I. Questionnaire Survey

Summary The use of electronic cigarettes (ECs) has grown exponentially over the past few years in China. To obtain the basic information of Chinese EC users, a questionnaire survey was performed to collect the data that describe characteristics of study populations, including daily usage, consumption preference, and risk perception. Volunteers were recruited from Beijing, Shanghai, Guangzhou, and Shenzhen cities of China. In total, among the 511 participants that were included in the analysis, 491 participants (95%) used refillable ECs in the past 3 months. There was a strong association between EC use and traditional cigarette smoking. The majority of participants were dual users and the number of cigarettes smoked decreased with the use of ECs. After using an EC, 20.7% of conventional cigarette smokers attempted to quit smoking. Young people were the primary users across all geographic locations. Specifically, the daily usage for the participants who were 18–39 years old, was higher than those over 40 years old. The majority of participants (59.9%) preferred fruit flavors and 57.8% of them used 1–5 mg/mL nicotine-concentration liquids. Most EC users are motived to quit smoking, and 74.6% claimed that the ECs had no irritant effect on the oral cavity. A total of 50.5% of family members of the study participants reported an improvement of health status while the participants used ECs instead of traditional cigarettes. Overall, the results of this Chinese survey indicate that the per-day cigarette consumption of the dual users decreased whereas their proportion of smokers of low-“tar” cigarettes increased.

Electronic and Tobacco Cigarettes Alter Polyunsaturated Fatty Acids and Oxidative Biomarkers.

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Preliminary assessment of the subjective effects of electronic-cigarettes in young-adult low-dose electronic-cigarette users: Effects of nicotine dose and e-liquid flavor

Objective The present study evaluated the effects of nicotine concentration (0-10 mg/ml) and flavor (gummy bear vs unflavored) on the subjective experiences of vaporized nicotine in young adult low-dose nicotine (3 mg/ml) ECIG users. Participants Eight young adult ECIG users were recruited. Methods A single blinded crossover study was used. Participants were instructed to take ten 1.5 second puffs, each separated by 20 seconds. After self-administration, heart rate was recorded, and participants completed the Drug Effects, Direct Effects of Nicotine, and Direct Effects of ECIG questionnaires. Results ECIG user’s standard daily nicotine dose influenced the rewarding and aversive effects of nicotine as the 10 mg/ml dose was found to be aversive in this user group. The combination of flavor and nicotine increased the subjective effects of ECIGs. Conclusions Flavored e-liquids contribute to the reinforcing properties of nicotine by enhancing the subjective effects, which may lead to continued ECIG use.

Smoking cessation support for dual users of cigarettes and electronic cigarettes

The latest Cochrane review in October 2020 concluded with moderate confidence that e-cigarettes with nicotine help more adults to stop smoking than nicotine replacement therapy or nicotine-free e-cigarettes.1 Population-level time-series analyses of UK and US data also showed that increases in the prevalence of e-cigarette use have been associated with the overall rate of smoking cessation,2,3 and indirect simulation modelling suggests a decline in overall prevalence coinciding with the growth in the use of the products between 2012 and 2019 in England.

Targeted smoking cessation for dual users of combustible and electronic cigarettes: a randomised controlled trial

SummaryBackgroundAlthough many smokers use electronic cigarettes (e-cigarettes) to quit smoking, most continue to smoke while vaping. This dual use might delay cessation and increase toxicant exposure. We aimed to test the efficacy of a self-help intervention designed to help dual users to quit smoking.MethodsIn this three-arm randomised controlled trial we recruited individuals in the USA using Facebook and multimedia advertisements. Included participants were 18 years or older, smoked at least weekly in the preceding year, and vaped at least weekly in the preceding month. We used computer generated randomisation with balanced-permuted blocks (block size 10, with 2–4-4 ratio) to allocate participants to assessment only (ASSESS group), generic smoking cessation self-help booklets (GENERIC group), or booklets targeting dual users (eTARGET group). Individuals in the generic or targeted intervention groups received monthly cessation materials for 18 months, with assessments every 3 months for 24 months. The main outcome was self-reported 7-day point-prevalence smoking abstinence at each assessment point. All randomly allocated participants were included in primary analyses using generalised estimating equations for each of 20 datasets created by multiple imputation. Analysis of the χ2s produced an F test. The trial is registered with ClinicalTrials.gov, NCT02416011, and is now closed.FindingsBetween July 12, 2016, and June 30, 2017, we randomly assigned 2896 dual users (575 to assessment, 1154 to generic intervention, and 1167 to targeted self-help). 7-day point-prevalence smoking abstinence increased from 14% at 3 months to 42% at 24 months (F7,541·7=67·1, p<0·0001) in the overall sample. Targeted self-help resulted in higher smoking abstinence than did assessment alone throughout the treatment period (F1,973·8=10·20, p=0·0014 [α=0·017]). The generic intervention group had abstinence rates between those of the assessment and targeted groups, but did not significantly differ from either when adjusted for multiple comparisons (GENERIC vs eTARGET F1,1102·5=1·79, p=0·18 [α=0·05]; GENERIC vs ASSESS F1,676·7=4·29, p=0·039 [α=0·025]). Differences between study groups attenuated after the interventions ended.InterpretationA targeted self-help intervention with high potential for dissemination could be efficacious in promoting smoking cessation among dual users of combustible cigarettes and e-cigarettes.

Promotion of e-cigarettes by providers and users’ feedback in some social networks in Vietnam in 2019

E-cigarettes (e-cigarettes) have been using social media as an informative platform to promote e-cigarettes for their users. The most popular social media in Vietnam were YouTube and Facebook. The information and knowledge could affect e-cigarette user’s belief and the way they make a decision. Despite this, there is a gap in our knowledge of policy maker’s in user’s perceptions about how they feel with promotion on social media platform in Vietnam. This study aimed to describe the promotion of e-cigarettes by providers on some social networks and to describe electronic cigarette users’ feedback about videos/posts of providers on some social networks in Vietnam in 2019. Searches in major electronic databases, including Facebook and YouTube, were conducted using the following search terms: “electronic cigarette,” “electronic vaporizer,” “electronic pod,”. The video/post was selected if they’re from providers and include advertising content on the social media platform during 2019. Of the 104 e-cigarette related videos/posts retrieved, there were 27% on Facebook and 28% on YouTube. The three most common advertising contents were beneft of using e-cigarette, negative health consequences and entertainment effects.

Characteristics of electronic cigarette user and traditional smokers: 2017 Youth risk behavior surveillance system.

Although electronic cigarette (e-cigarette) use among adolescents rapidly has increased over the past decade, which has raised concerns over the corresponding behavioral health risks, the current literature presents limited data for understanding the characteristics of adolescent e-cigarette users. The purpose of this study was to (1) identify general characteristics that may be shared between e-cigarette users and traditional cigarette smokers and (2) examine the unique characteristics of e-cigarette users vis-à-vis traditional cigarette smokers. Cross-sectional descriptive study. A total of 14,765 9th- to 12-grade students drawn from the CDC 2017 Youth Risk Behavior Surveillance System. We observed that the prevalence of marijuana, alcohol, and other illicit drug use was higher among e-cigarette users and traditional tobacco users than non-users. Moreover, physically active adolescents were more likely to use e-cigarettes than those who were physically inactive, although the level of the activity did not predict smoking status. We recommend that primary prevention strategies for e-cigarette use should be incorporated in physical education programs and target adolescents who engage in not only health risk behaviors, but also health promoting behaviors, such as physical activity.

Objective assessment of nasal resistance among electronic cigarette users.

Electronic cigarettes have been a popular alternative to tobacco smoking. The effect of tobacco smoking on nasal airway resistance has been investigated before; however, the effect of the aerosol generated by electronic cigarettes is still unknown. This study aimed to evaluate the short-term effects of e-cigarettes on nasal airway resistance. Sixty-one participants were recruited into a vapers group and a control group. The vapers group was instructed to smoke for 5 minutes, and their nasal resistance was measured pre-procedure and at 1 and 5 minutes post-procedure. The results were compared between both groups. Repeated measures analysis of variance demonstrated that vaping has no statistically significant effect on total nasal airway resistance. Although the differences between both groups were not statistically significant overall, the vapers group showed a reduction in nasal airway resistance in the short term.

Lipid profiles in users of combustible and electronic cigarettes.

Electronic cigarette use has especially risen among adolescents and young adults. The aim of this study was to investigate fasting blood glucose and lipid profiles in chronic combustible cigarette and electronic cigarette users. We evaluated participants aged 21 to 45 (n = 525, mean age 31 ± 7 years, 45% women) without established cardiovascular disease or risk factors who were combustible cigarette users (n = 290), electronic cigarette users (n = 131; 65 sole users and 66 dual users), or never users (n = 104). In the first wave of enrollment (2014-2017), electronic cigarette users reported their products as first, second and third generation devices (e-cig users) and were all largely current (i.e., dual) or former (sole) combustible cigarette users, whereas in the second wave of enrollment (2019-2020), electronic cigarette users all reported pod-based device use (pod users) and included more sole users who were never smokers. In multivariable-adjusted analyses comparing to never users, both sole e-cig users and combustible cigarette users had higher glucose and triglycerides and lower high-density lipoprotein (HDL) cholesterol levels. Dual e-cig users showed higher triglycerides and very-low-density lipoprotein cholesterol, and lower HDL cholesterol compared to never users. In contrast, pod users (both sole and dual) had lipid profiles and glucose levels similar to never users. Overall, users of early generation electronic cigarettes display adverse metabolic profiles. In contrast, pod-based electronic cigarette users have similar lipid profiles to never users. Future studies are needed to understand the cumulative effects of electronic cigarette use on cardiometabolic health.

Nicotine Dependence Evaluated by Urinary Cotinine and Heaviness of Smoking Index among Smokers, Vapers, and Dual Users: A Cross-Sectional Study Using the Korea National Health and Nutrition Examination Survey Data.

BackgroundMany people use both combustible cigarette (CC) and electronic cigarette (EC). We compared nicotine dependence among CC, EC, and dual users using questionnaires and urinary cotinine levels.MethodsData from the Korea National Health and Nutrition Examination Survey (2014–2017) databases were analyzed; 3,917 CC, EC, and dual users were administered the urinary cotinine test, and 1,045 current CC and dual users completed the Heaviness of Smoking Index (HSI) questionnaires. Weighted geometric means of urine cotinine levels were compared between exclusive CC, exclusive EC, and dual users. The distribution rate, based on time to first cigarette (TTFC), cigarettes per day (CPD), and the HSI was analyzed in two weighted groups, exclusive CC and dual users.ResultsAmong those who currently use any type of cigarette, 89.4%, 1.4%, and 9.2% were exclusive CC, exclusive EC, and dual users, respectively. Weighted geometric means of urine cotinine were highest in dual users (1,356.4 ng/mL), followed by exclusive CC (1,270.3 ng/mL), and exclusive EC (867.7 ng/mL) with significant differences between all three groups (P<0.05). There were no statistically significant differences in CPD between exclusive CC and dual users (P=0.626). The proportion of TTFC ≤5 minutes was 21.5% and 29.5% in the two groups, respectively (P=0.010); however, HSI differences in the two groups was marginal (P=0.557).ConclusionIn this study, the urinary cotinine value could distinguish the three groups, CC, EC, and dual users, but the questionnaire using HSI could not distinguish the three groups.

Microbiome and oral squamous cell carcinoma: a possible interplay on iron metabolism and its impact on tumor microenvironment.

There is increasing evidence showing positive association between changes in oral microbiome and the occurrence of oral squamous cell carcinoma (OSCC). Alcohol- and nicotine-related products can induce microbial changes but are still unknown if these changes are related to cancerous lesion sites. In an attempt to understand how these changes can influence the OSCC development and maintenance, the aim of this study was to investigate the oral microbiome linked with OSCC as well as to identify functional signatures and associate them with healthy or precancerous and cancerous sites. Our group used data of oral microbiomes available in public repositories. The analysis included data of oral microbiomes from electronic cigarette users, alcohol consumers, and precancerous and OSCC samples. An R-based pipeline was used for taxonomic and functional prediction analysis. The Streptococcus spp. genus was the main class identified in the healthy group. Haemophilus spp. predominated in precancerous lesions. OSCC samples revealed a higher relative abundance compared with the other groups, represented by an increased proportion of Fusobacterium spp., Prevotella spp., Haemophilus spp., and Campylobacter spp. Venn diagram analysis showed 52 genera exclusive of OSCC samples. Both precancerous and OSCC samples seemed to present a specific associated functional pattern. They were menaquinone-dependent protoporphyrinogen oxidase pattern enhanced in the former and both 3',5'-cyclic-nucleotide phosphodiesterase (purine metabolism) and iron(III) transport system ATP-binding protein enhanced in the latter. We conclude that although precancerous and OSCC samples present some differences on microbial profile, both microbiomes act as "iron chelators-like" potentially contributing to tumor growth.

Geographic isolation predicts tobacco product use among youth: A latent class analysis.

The purpose of the current study was to evaluate associations between geographic rurality and tobacco use patterns among adolescents. High school students (N = 566) from north-central Appalachia reported on their lifetime and/or current use of cigarettes, electronic cigarettes (ECIGs), cigars, and smokeless tobacco. Geographic rurality was measured via the Isolation scale, whereby residential ZIP Codes determined the degree to which respondents have access to health-related resources. Latent class analysis (LCA) was used to identify discrete classes of adolescent tobacco users based on their use of tobacco products. Then, associations between participants' geographic rurality and class membership were evaluated using a series of multinomial logistic regressions. LCA classified participants as Nonusers, Current ECIG Users, Cigarette/ECIG Experimenters, and Polytobacco Users. Individuals with higher Isolation scores were more likely to be Polytobacco Users and Cigarette/ECIG Experimenters than Nonusers, and were more likely to be Polytobacco Users than Current ECIG Users. The continuous Isolation scale used in the present study predicted polytobacco use patterns among adolescents in a manner that is consistent with, while simultaneously expanding upon, prior work. Tobacco control practices and policies should be viewed through a lens that considers the unique needs of geographically isolated areas.

Heated tobacco product use and its relationship to quitting combustible cigarettes in Korean adults.

ObjectiveWe assessed the prevalence of, and factors associated with, heated tobacco product (HTP) use and analysed the association between HTP use and quitting combustible cigarettes (CCs) in Korean adults.MethodsWe conducted an online survey with 7,000 adults (males, 2,300; females, 4,700; ages 20–69) out of 70,000 age-, sex- and provincial-distribution-matched individuals based on 2018 national population statistics. Females were oversampled because the prevalence of tobacco product use is very low among women in Korea. Chi-square tests were used for bivariate analyses, and odds ratios were assessed after adjusting for sociodemographic variables.ResultsThe prevalence of current CC, electronic cigarette (EC), and HTP use was 24.8% (males, 40.4%; females, 9.3%), 6.8% (males, 10.1%; females, 3.4%), and 10.2% (males, 16.2%; females, 4.3%), respectively. Among the 574 current HTP users, 77 (13.4%) were HTP-only users and >80% were either dual users of HTP and CC/EC, or triple users of HTP, EC, and CC. Among the current CC users, the odds of having attempted to quit CCs in the past year were greater among EC-only users (aOR 2.92; 95% CI 1.81–4.69) and dual users of HTPs and ECs (aOR 8.42; 95% CI 4.85–14.62) than among non-HTP and non-EC users. Among 2,121 ever CC smokers, the likelihood of being a former CC smoker was 0.19 (95% CI 0.15–0.24) for HTP users, 0.29 (95% CI 0.20–0.42) for EC users, and 0.03 (95% CI 0.01–0.06) for users of both HTPs and ECs compared with non-HTP and non-EC users.ConclusionEC-only use and dual use of HTPs and ECs were associated with increased attempts to quit CCs; however, HTP and EC use was associated with lower odds of CC smoking abstinence.