Brief Report
Factors Associated with E-cigarette Use: A National Population Survey of Current and Former Smokers

https://doi.org/10.1016/j.amepre.2014.04.009Get rights and content

Background

Few national surveys document the prevalence of e-cigarette use in the U.S. The existing metric to assess current use likely identifies individuals who have recently tried an e-cigarette but do not continue to use the product.

Purpose

To document the prevalence of e-cigarette ever use, current use, and established use in a nationally representative survey of current and former cigarette smokers in the U.S.

Methods

A random sample of current and former cigarette smokers completed a web-based survey in June 2013 (n=2,136). Data were analyzed in November 2013. Multivariate logistic regression identified demographic and smoking-related factors associated with each use category. Point estimates with 95% CIs described e-cigarette use behaviors (e.g., preferred brand, purchasing patterns) for each group.

Results

Almost half of respondents had tried e-cigarettes (46.8%), but prevalence of established use remained low (3.8%). Although trial of e-cigarettes was highest among daily smokers, the odds of being an established e-cigarette user were greater for former smokers (OR=3.24, 95% CI=1.13, 9.30, p<0.05). Furthermore, e-cigarette preference and use patterns varied among ever, current, and established users. Established users reported using rechargeable e-cigarettes, having a regular brand, and using e-cigarettes at home and in the workplace at much higher levels than the “current use” metric captures.

Conclusions

Improved survey measures for e-cigarette use are needed. The identification of established e-cigarette users may provide insight to product features or other individual factors that are associated with sustained use of e-cigarettes.

Introduction

Electronic cigarettes (e-cigarettes) are battery-operated devices that deliver nicotine vapor to the user when inhaled.1 E-cigarette sales approached $1.8 billion in 2013, and some analysts predict that e-cigarette consumption will surpass traditional cigarettes within the next decade.2 Unfortunately, few nationally representative studies document prevalence of e-cigarette use, and all define “current use” as any use in the past 30 days.3, 4, 5, 6, 7 Given the sharp rise in “ever use3” and the increasing pervasiveness of e-cigarettes in popular culture,8 the existing metric to assess current use potentially captures individuals who have recently tried an e-cigarette but do not continue using (i.e., “recent experimenters”).

Indeed, trade publications have noted that e-cigarette trial is high among cigarette smokers, but adoption is low.9 To better delineate e-cigarette use patterns, the prevalence of ever use, current use, and a newly created category of “established use” were examined in a nationally representative web survey of current and former cigarette smokers. An analysis of e-cigarette behaviors identified how patterns of use vary between groups.

Section snippets

Participants

Eligible participants were randomly sampled from KnowledgePanel, a nationally representative, online panel maintained by GfK Knowledge Networks, which has been used in other studies to estimate prevalence of e-cigarette use.3, 4, 5, 7 Panel members are recruited using probability-based sampling from the U.S. Postal Service’s Delivery Sequence File, a sampling frame of addresses that covers approximately 97% of U.S. households. Thus, KnowledgePanel is not susceptible to non–probability sampling

Results

Among current and former smokers, the prevalence of ever, current, and established e-cigarette use was 46.8%, 16.1%, and 3.8%, respectively (Table 1). Factors associated with ever use differed from those associated with established use, with the exception of race/ethnicity. Whites were more likely than non-whites to report e-cigarette use for both categories. Younger age and high cigarette tax were associated with higher odds of ever use, but these relationships disappeared for current and

Discussion

Many of this study’s findings, like higher odds of ever use among young adults and non-Hispanic whites, are consistent with existing e-cigarette surveillance studies.5, 15, 16 This is the first study, however, to highlight patterns of e-cigarette use employing a threshold to identify individuals who are not experimenters, but have likely become established users.

Factors associated with established use do not predict current use, suggesting that differences exist between established users and

Acknowledgments

The project described was supported by grant no. R21CA155956 and grant no. R21CA159160 from the National Cancer Institute.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or NIH.

No financial disclosures were reported by the authors of this paper.

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