The prevalence, correlates and reasons for using electronic cigarettes among New Zealand adults
Introduction
Electronic nicotine delivery systems (ENDS) are electronically-powered devices which vaporise propylene glycol and/or glycerol by heating a solution that users inhale. Regulations on the selling and distributions of ENDS differ across countries (World Health Organization, 2014). In New Zealand, it is prohibited to sell unapproved products as medicine, medical devices, or therapeutic products. Nicotine-containing products, including nicotine-containing ENDS, are classified under the Medicines Act 1981 as medicines and, therefore, cannot be sold in New Zealand without approval (Medsafe, 2010). There are currently no nicotine-containing ENDS approved for sale in New Zealand. However, it is legal to sell nicotine-free ENDS that are not labelled as medical or therapeutic products, and they are available for purchase from a wide range of convenience retail outlets. It is also possible for people to purchase ENDS on the internet (nicotine-containing or nicotine-free) from overseas for recreational use. The advertising and promotion of ENDS is not subject to the same restrictions as cigarettes and other tobacco products.
The role of ENDS in tobacco control is controversial, and their potential benefits and threats to tobacco control efforts have been discussed elsewhere (Chapman, 2014, Drummond and Upson, 2014, Grana et al., 2014). A number of studies have reviewed existing evidence on the awareness, use, perception, cessation efficacy, and safety of ENDS (Brown and Cheng, 2014, Callahan-Lyon, 2014, Grana et al., 2014, Pepper and Brewer, 2013), including a report commissioned by the World Health Organization (WHO) in 2014 (World Health Organization, 2014). The WHO report also noted that data on ENDS use are lacking in many countries and, therefore, recommended governments to monitor ENDS use (World Health Organization, 2014).
Electronic cigarettes, often referred to as e-cigarettes, are the most common form of ENDS (World Health Organization, 2014). E-cigarette usage data available from Europe and the US show that the use of e-cigarettes has increased rapidly (Corey et al., 2013, Dockrell et al., 2013, Florida Health, 2014, King et al., 2013, Regan et al., 2013). Between 2011 and 2014, ever-use among adults was between 6 and 8% (Dockrell et al., 2013, King et al., 2013, Martínez-Sánchez et al., 2014, Zhu et al., 2013). The rate of current use was much lower, at about 1% (Martínez-Sánchez et al., 2014, Pearson et al., 2012, Zhu et al., 2013). A recent study of youth and young adults in Canada reported a much higher rate of ever-use (16.1%) and current use (5.7%) however the sample was not nationally representative (Czoli, Hammond, & White, 2014).
Despite the evidence showing that e-cigarette use is increasing internationally, published data on New Zealand use is limited. The only available data around adult use were drawn from the New Zealand Smoking Monitor (NZSM). This monitor specifically surveys current smokers and recent quitters. In 2011, it was found that 7% of smokers and recent quitters had ever purchased an e-cigarette (a proxy for ever-use) (Li, Bullen, Newcombe, Walker, & Walton, 2013). Two years later, in 2013, between 22 and 38% of smokers and recent quitters had ever used an e-cigarette (Li, Newcombe, & Walton, 2014). Between 8 and 16% of smokers and recent quitters reported using an e-cigarette in the past two weeks. The NZSM monitors e-cigarette use among current smokers and recent quitters; it does not, however, provide information on the general adult population. Understanding the use and purpose of use in the general population is important because the evidence internationally shows that e-cigarettes are used in combination with tobacco, and that they are also used by people who have never smoked tobacco (Brown et al., 2014, Czoli et al., 2014, Dockrell et al., 2013, Martínez-Sánchez et al., 2014, Pearson et al., 2012, Regan et al., 2013, Vardavas et al., 2014).
The marketing of e-cigarettes is tailored to different population groups (de Andrade, Hastings, Angus, Dixon and Purves, 2013, Durbin et al., 2014). They are often promoted as a smoking cessation product or a cheaper and safer alternative to current smokers, and as an attractive lifestyle product to young, never-smokers (de Andrade, Hastings and Angus, 2013, de Andrade, Hastings, Angus, Dixon and Purves, 2013, Durbin et al., 2014). Because of the diversity in marketing strategies, it is important to understand what motivates people to try an e-cigarette. Only two studies have explored the reasons why adults try an e-cigarette, including a population-based online survey conducted in US (Zhu et al., 2013) and a survey of UK smokers (Dockrell et al., 2013). The first study showed that 70% of ever-users said they tried an e-cigarette ‘just because’ (Zhu et al., 2013). In the study of UK smokers, the most common reasons for trying were to substitute smoking in places where tobacco smoking is prohibited (43%), quit smoking (35%), or to cut down (31%) (Dockrell et al., 2013). Given the discrepancy in these findings, further investigation is needed to understand the motivations behind using e-cigarettes.
The rapidly changing context of e-cigarette use both internationally, and nationally, increases the need to understand the current picture of e-cigarette use. The current study is the first to provide population estimates on ever-use and current use of e-cigarettes in New Zealand using data from a nationally representative adult sample. The study is also the first to explore in depth reasons for first trying an e-cigarette, by segmenting the sample by their current tobacco smoking status and e-cigarette use status. Finally, the study provides new information on the recall of previous brand(s) among ever-users and current e-cigarette brand(s) among current e-cigarette users.
Section snippets
Participants
The Health and Lifestyles Survey (HLS) is a nationwide in-home face-to-face survey conducted every two years since 2008. In 2014, the survey consisted of a sample of 2594 New Zealanders aged 15 years and over. The response rate is 75.1%.
Sampling procedure
A full description of the HLS methodology is available elsewhere (Health Promotion Agency, 2014). In brief, the survey adopts a multi-stage, stratified, clustered and random probability sampling method, including an oversample of Māori and Pacific peoples. In
Results
The weighted proportion estimates of sample characteristics are shown in Table 1.
Discussion
This is the first study that reports the use of e-cigarettes among New Zealand adults at a population level. We found that while around 13% of adults aged 15 years or over had ever used an e-cigarette, only 1% used them on a monthly basis. Applying official estimates of the adult population in New Zealand (MacPherson, 2014), these equate to an estimate of over 465,000 ever-users and over 27,000 current users in New Zealand. The rate of ever-use is higher than those reported elsewhere: 8.1% in
Role of funding sources
This work was funded by the Ministry of Health, New Zealand. The funder did not involve with the study design, collection, analysis, or interpretation of data, writing the manuscript, or the decision to submit the manuscript for publication.
Contributors
DW had overall responsibility for the study design and data collection. JL developed the survey questions and conducted the statistical analysis. JL wrote the first draft of the manuscript and all authors contributed to and have approved the final manuscript.
Conflict of interest
All authors declare that they have no conflicts of interest.
Acknowledgements
We thank the HLS participants and CBG Health Research for conducting the fieldwork. We also acknowledge Kate Holland for project managing the HLS, and the work she undertook alongside Danny Tu to check and cleanse the dataset.
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