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Are e-cigarettes reviving the popularity of conventional smoking among Taiwanese male adolescents? A time-trend population-based analysis for 2004-2017
  1. Wayne Gao1,
  2. Mattia Sanna1,
  3. Enkhzaya Chuluunbaatar1,
  4. Min-Kuang Tsai2,
  5. David T Levy3,
  6. Chi Pang Wen2,4
  1. 1 Master's Program in Global Health and Development, Taipei Medical University, Taipei City, Taiwan
  2. 2 Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
  3. 3 Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
  4. 4 China Medical University Hospital, Taichung City, Taiwan
  1. Correspondence to Dr Wayne Gao, Master's Program in Global Health and Development, Taipei Medical University, Taipei City 10675, Taiwan; waynegao{at}


Introduction In Taiwan, national tobacco use surveys show that e-cigarette use has increased since 2014 among youth, while, at the same time, conventional cigarette smoking has continuously decreased. The purpose of this study is to examine whether the increased popularity of e-cigarettes has undermined this favourable declining trend for cigarette smoking.

Methods We examined conventional cigarette and e-cigarette prevalence among male high school students (aged 16–18 years) and adults from 2004 to 2017, using data from cross-sectional nationally representative surveys. Applying interrupted time series analysis, we assessed whether there was a change in trend in 2014, when e-cigarette use started to gain popularity from long-term trends in prior years (2004–2013).

Results E-cigarette use prevalence increased from 2.5% in 2014 to 6.4% in 2017 among male high school students but was negligible among male adults, declining from 1.4% in 2015 to 0.8% in 2017. The annual relative decline in the cigarette smoking rate after e-cigarettes started to gain popularity was greater (−10%) than the long-term trend (−2%) among high school students. Among adults, the change in trend over time after e-cigarettes started to gain popularity was not significant (ie, not significantly different from 0).

Conclusions The increased popularity of e-cigarettes since 2014 is associated with a greater decline in youth smoking, compared with previous years. On the contrary, e-cigarette use has remained very low among Taiwanese male adults and no additional impact on the conventional smoking trend is found.

  • electronic nicotine delivery devices
  • surveillance and monitoring
  • global health

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  • Contributors WG designed the study, interpreted the results, and drafted the manuscript. MS contributed to designing the analysis and interpreting the results, drafted, reviewed and revised the manuscript. EC and MKT organised and analysed the data. DTL provided crucial feedback on both methodology and data interpretation. DTL and CPW critically reviewed the manuscript. All authors helped to shape the research, discussed the results, commented on the manuscript, approved the final version and agreed to be accountable for all aspects of the work. WG and MS are co-first authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.