The authors are with the Center for Tobacco Control Research and Education, University of California, San Francisco. Pamela M. Ling is also with the Division of General Internal Medicine, Department of Medicine, University of California, San Francisco.
We investigated the frequency of alternative tobacco product use (loose leaf, moist snuff, snus, dissolvables, electronic cigarettes [e-cigarettes]) among smokers and the association with quit attempts and intentions.
A nationally representative probability-based cross-sectional survey of 1836 current or recently former adult smokers was completed in November 2011. Multivariate logistic regressions evaluated associations between alternative tobacco product use and smoking cessation behaviors.
Of the smokers, 38% had tried an alternative tobacco product, most frequently e-cigarettes. Alternative tobacco product use was associated with having made a quit attempt, and those intending to quit were significantly more likely to have tried and to currently use the products than were smokers with no intentions to quit. Use was not associated with successful quit attempts. Interest in future use of alternative tobacco products was low, except for e-cigarettes.
Alternative tobacco products are attractive to smokers who want to quit smoking, but these data did not indicate that alternative tobacco products promote cessation. Unsubstantiated overt and implied claims that alternative tobacco products aid smoking cessation should be prohibited.
"Current use was higher among both non - daily and heavy ( ! 20 cigarettes per day ) smokers . A representative cross - sectional US survey of 1836 current or recently former adult smokers found that 38% of the smokers had tried an alternative tobacco product , most frequently e - cigarettes ( Popova and Ling , 2013 ) . Alternative tobacco product use was associated with having made a quit attempt , and those intending to quit were significantly more likely to have tried and to currently use the products than were smokers with no intentions to quit . "
[Show abstract][Hide abstract] ABSTRACT: Waterpipe (WP) smoking is growing as an alternative to cigarette smoking, especially in younger age groups. E-cigarette use has also increased in recent years. A majority of smokers mistakenly believe that WP smoking is a social entertainment practice that leads to more social behavior and relaxation and that this type of smoking is safe or less harmful and less addictive than cigarette smoking. In reality, WP smokers are exposed to hundreds of toxic substances that include known carcinogens. High exposures to carbon monoxide and nicotine are major health threats. Persons exposed to secondhand WP smoke are also at risk. There is growing evidence that WP smoke causes adverse effects on the pulmonary and cardiovascular systems and is responsible for cancer.
"The findings demonstrate that current cigarette smokers are more likely to be aware of and to have used snus. These results could suggest the potential for dual use of snus and cigarettes, which poses a challenge for public health efforts to reduce tobaccoassociated morbidity and mortality (Kasza et al., 2013; Lee, Hebert, Nonnemaker, & Kim, 2014; Popova & Ling, 2013b). These results could also imply that current smokers may be nicotine & tobacco research interested in switching to snus if they hold certain perceptions of snus compared with cigarettes. "
[Show abstract][Hide abstract] ABSTRACT: Introduction:
Alternative tobacco products, such as snus, are emerging in the U.S. market. Understanding correlates of awareness and use, particularly judgments about harm and addictiveness, can inform public health communications about these products.
Data were collected from a web panel representative of the U.S. population in March 2013 (N = 2,067). The survey assessed awareness and use of snus among adults. Absolute and comparative snus judgments, intentions, smoking status, and sociodemographic variables were measured. Bivariate and multivariable logistic regression analyses were conducted to examine associations between these variables and snus awareness and use.
Nearly 36% of the population was aware of snus, and 5.2% reported ever using snus. Current cigarette smokers were about 4 times more likely as nonsmokers to report snus awareness and use. Sociodemographic correlates of snus awareness and use included being male, employed full time, and younger. Compared with respondents who perceived snus to be as harmful and as addictive as cigarettes, those who perceived snus to be less harmful and less addictive than cigarettes were more likely to have used snus.
Current smokers are more likely to be aware of and have used snus. Multiple tobacco product use poses a significant challenge for public health efforts to reduce tobacco-associated morbidity and mortality. Perceptions that snus is less harmful and less addictive compared with cigarettes are associated with snus use. These judgments can inform public health communications about emerging tobacco products and multiple product use.
"In this study of hospitalized smokers, we found almost universal awareness of e-cigarettes and higher rates of e-cigarette use than previously reported among smokers from the general population (Adkison et al., 2013; King et al., 2013; Pearson et al., 2012; Popova & Ling, 2013; Regan et al., 2013). This is consistent with reports of exponentially increasing awareness "
[Show abstract][Hide abstract] ABSTRACT: E-cigarette use has surged over the past few years while the debate about the product's safety and efficacy for smoking cessation continues. Little is known about the characteristics that distinguish users from nonusers; in this study, we aimed to elucidate these characteristics among hospitalized smokers, a heretofore unstudied population.
Cross-sectional data were collected from cigarette smokers via hospital bedside interviews. Participants reported e-cigarette use status, reasons for use (if used), e-cigarette advertising exposure, expected likelihood of future e-cigarette use, desire to quit smoking, and demographic characteristics.
Of the 657 English-speaking hospitalized smokers who provided data, 97% reported awareness of e-cigarettes and 46.4% reported e-cigarette use, with 20% reporting use in the previous 30 days. Previous e-cigarette use was significantly more likely among those who were White (odds ratio [OR] = 4.7; CI = 3.2-6.7), were married/domestic partner (OR = 1.5; CI = 1.0-2.2), had more than a high school education (OR = 1.7; CI = 1.1-2.7), had e-cigarette advertising exposure (OR = 1.6; CI = 1.1-2.4), and were younger (OR = 1.3; CI = 1.1-1.5). Expected likelihood of future e-cigarette use was high and positively correlated with desire to quit smoking (Spearman's ρ = .18, p < .0001).
Rates of awareness and use of e-cigarettes may be elevated among hospitalized smokers, with more use reported among those who were White, younger, more educated, in a relationship, and exposed to e-cigarette advertising. The association between desire to quit smoking and expected likelihood of future e-cigarette use suggests that cigarette smokers may perceive e-cigarettes as a useful cessation aid.
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