Brief Original ReportProfile of e-cigarette use and its relationship with cigarette quit attempts and abstinence in Kansas adults
Introduction
Electronic cigarettes (e-cigarettes) are battery-powered devices that emit an aerosol for users to inhale. The aerosol is often flavored and includes nicotine. It is generally assumed that part of the appeal of e-cigarette use (“vaping”) to cigarette smokers is that the act mimics cigarette smoking.
E-cigarette use is an emerging behavior with a developing epidemiologic profile. Recent national surveillance has documented rising prevalence of e-cigarette awareness and ever-use in both adults and youth. The percent of U.S. 6–12th grade students who have ever used e-cigarettes doubled between 2011 (3.3%) and 2012 (6.8%) (CDC, 2013). A similar increase was documented among U.S. adults between 2010 and 2011 when the prevalence of having ever tried e-cigarettes rose from 3.3% to 6.2%. The same study noted that 1 in 5 cigarette smokers had tried e-cigarettes as of 2011 (King et al., 2013). A more recent study in Great Britain found that cigarette smokers started using e-cigarettes because they were concerned about their health, wanted to cut down on cigarette smoking or wanted to quit cigarette smoking. Smokers who use e-cigarettes were also more likely to have tried to quit in the past year (Brown et al., 2014a).
The most recent scientific review of e-cigarettes included a meta-analysis of population studies that have examined the association between e-cigarette use and combustible cigarette cessation (Grana et al., 2014a, Grana et al., 2014b, Adkison et al., 2013, Choi and Forster, 2014, Popova and Ling, 2013). The results indicate that, in the overall population, adults who use e-cigarettes are less likely to have quit smoking cigarettes. A cross-sectional study of high school students also found that e-cigarette use was negatively associated with cigarette abstinence (Dutra and Glantz, 2014). One cross-sectional study that was limited to smokers who used e-cigarettes specifically as cessation devices found them to be more strongly associated with cigarette abstinence than over-the-counter nicotine replacement therapy (Brown et al., 2014b). Clinical trials examining whether e-cigarettes are effective cessation aids have largely been underpowered or found no significant difference between e-cigarettes and placebo or other approved cessation methods (Polosa et al., 2011, Caponnetto et al., 2013a, Caponnetto et al., 2013b, Bullen et al., 2013).
In 2011, an evaluation of the Kansas Tobacco Quitline documented that, although not proven to be effective, e-cigarettes were being used by Quitline callers as cessation aids (KDHE. Kansas Department of Health and Environment, 2011). Since then, Kansas has monitored the adoption of e-cigarettes by youth and adults for recreation and as cessation aids. Here we present a profile of Kansas e-cigarette use in adults, highlighting its association with cigarette smoking, cigarette smoking quit attempts and cigarette abstinence.
Section snippets
Data collection
The 2013 Kansas Adult Tobacco Survey (ATS) is a point-in-time population-based random digit dial survey of non-institutionalized adults aged 18 years and older living in a private residence with landline and/or cell phone service in Kansas. The ATS was collected from September 2012 through September 2013 and consists of 9656 responses from Kansas adults. Sample design, data collection and post-stratification weighting of the ATS were very similar to methods used by the 2012 Kansas Behavioral
Results
In 2013, 11.8% (95% CI: 10.9%–12.7%) of Kansas adults had tried e-cigarettes and 3.4% (95% CI: 2.9%–3.9%) had used e-cigarettes in the past month. The prevalence of having ever tried e-cigarettes was 45% (95% CI: 41.7%–48.4%) among current smokers, 10.5% (95% CI: 8.7%–12.3%) among former smokers and 2.2% (95% CI: 1.6%–2.9%) among never-smokers. A similar pattern was observed for current e-cigarette use (Fig. 1). Alternatively, the prevalence of current cigarette smoking was 76.5% among
Discussion
These data corroborate previous population-based studies of e-cigarette use, indicating a use prevalence that continues to climb and a pattern of use that is strongly associated with conventional cigarette smoking. Furthermore, this study demonstrates that the demographic profiles of adults who only use e-cigarettes and adults who only smoke cigarettes differ. Adults who only use e-cigarettes appear to be younger and more affluent than adults who only smoke cigarettes. The use of celebrity
Role of funding sources
The Kansas Department of Health and Environment collected the Kansas Adult Tobacco Survey (ATS) with funding from the Kansas Health Foundation (KHF) (201204025-01). KHF contributed to the content of the ATS, but KHF had no role in the study design, analysis, interpretation of data, writing the manuscript or the decisions to submit the manuscript for publication.
Contributors
TC and EW designed the study with input from BF. TC conducted the statistical analysis and wrote the first draft of the manuscript. EW and BF provided significant input during revisions. BF and TC conducted literature searches. All authors contributed to and have approved the final manuscript.
Conflict of interest
All authors declare that they have no conflicts of interest.
Acknowledgments
The authors would like to acknowledge Ginger Taylor, Jeanie Santaularia, Ghazala Perveen and the Bureau of Health Promotion Health Risk Studies Section team for their assistance with data collection and management; as well as Paula Clayton of the Bureau of Health Promotion and Jeffrey Willett of the Kansas Health Foundation for making this project possible.
References (21)
- et al.
Electronic nicotine delivery systems: international tobacco control four-country survey
Am. J. Prev. Med.
(2013) - et al.
Prevalence and characteristics of e-cigarette users in Great Britain: findings from a general population survey of smokers
Addict. Behav.
(2014) - et al.
Electronic cigarettes for smoking cessation: a randomised controlled trial
Lancet
(2013) - et al.
Authors' response
Am. J. Prev. Med.
(2014) - et al.
“Smoking revolution”: a content analysis of electronic cigarette retail websites
Am. J. Prev. Med.
(2014) - et al.
Real-world effectiveness of e-cigarettes when used to aid smoking cessation: a cross-sectional population study
Addiction
(2014) - et al.
EffiCiency and Safety of an eLectronic cigAreTte (ECLAT) as tobacco cigarettes substitute: a prospective 12-month randomized control design study
PLoS ONE
(2013) - et al.
Impact of an electronic cigarette on smoking reduction and cessation in schizophrenic smokers: a prospective 12-month pilot study
Int. J. Environ. Res. Public Health
(2013) Notes from the field: electronic cigarette use among middle and high school students—United States, 2011–2012
MMWR Morb. Mortal. Wkly Rep.
(2013)- et al.
Promotion of electronic cigarettes: tobacco marketing reinvented?
BMJ
(2013)
Cited by (48)
The association between excise taxes and smoking and vaping transitions–Findings from the 2016–2020 ITC United States surveys
2024, International Journal of Drug PolicyCharacteristics of us adults attempting tobacco use cessation using e-cigarettes
2020, Addictive BehaviorsE-cigarettes Associated With Depressed Smoking Cessation: A Cross-sectional Study of 28 European Union Countries
2018, American Journal of Preventive MedicineAssessing electronic cigarette effects and regulatory impact: Challenges with user self-reported device power
2017, Drug and Alcohol DependenceElectronic cigarette use as an aid to quit smoking in the representative Italian population PASSI survey
2017, Preventive MedicineCitation Excerpt :Major strengths of this study are the use of a large and representative sample of the Italian population, and the assessment of the use of e-cigarette as a quitting method. To our knowledge, this is one of the largest cross-sectional studies of real-world use of e-cigarettes, comparable with those conducted in England (Brown et al., 2014), and Kansas (Christensen et al., 2014). The study had some limitations.
Racial/ethnic differences in electronic cigarette knowledge, social norms, and risk perceptions among current and former smokers
2017, Addictive BehaviorsCitation Excerpt :Second, the lower knowledge among African American/Black and Hispanic respondents in this sample may indicate a greater susceptibility to e-cigarette use. While this could be beneficial from a harm reductive perspective, it could also lead to greater dual use and difficulty quitting smoking (Christensen, Welsh, & Faseru, 2014; Kalkhoran & Glantz, 2016; Patnode et al., 2015). Additional research on the impact of knowledge on e-cigarette use across demographic sub-groups is needed.