Elsevier

Addictive Behaviors

Volume 95, August 2019, Pages 6-10
Addictive Behaviors

Correlates of electronic cigarette use in the general population and among smokers in Australia – Findings from a nationally representative survey

https://doi.org/10.1016/j.addbeh.2019.02.012Get rights and content

Highlights

  • The prevalence of e-cigarette use was low in Australia.

  • Smoking status was the strongest correlate of e-cigarette use.

  • Male, younger age, and psychological distress were associated with e-cigarette use.

  • An intention to quit smoking was associated with daily use among smokers.

  • Recent quitting was associated with daily e-cigarette use.

Abstract

Aims

In Australia, sales of nicotine containing electronic cigarettes (also known as e-cigarette) are banned unless approved as a therapeutic good. The aims of this study were to estimate the prevalence of e-cigarette use and its correlates in Australia using a nationally representative survey.

Method

We analysed data from the largest drug use survey in Australia (the National Drug Strategy Household Survey [NDSHS]; N = 22,354).

Results

We estimated that 227,000 Australians (1.2% of the population) were current e-cigarettes users, and 97,000 (0.5%) used them daily. Individuals who were male, younger, had higher level of psychological distress, and smoked were more likely to use electronic cigarettes. Among smokers, an intention to quit and reduction in smoking was associated with experimentation and daily use of e-cigarette, but not with occasional use. Recent quitting was associated with daily use.

Conclusion

Overall, the prevalence of e-cigarette use was low in 2016 in Australia. Smoking status was the strongest correlates of e-cigarette use. Patterns of vaping were differentialy associated with an intention to quit smoking, smoking reduction and recent quitting. Some smokers may attempt to use e-cigarettes to cut-down their tobacco use, and those who vaped daily were mostly likely to be recent quitters.

Introduction

The prevalence of electronic cigarette (e-cigarette) use, known as vaping, has increased dramatically in many developed countries while the prevalence of tobacco smoking has steadily decreased (Farsalinos, Poulas, Voudris, & Le Houezec, 2016; Johnston et al., 2018). Proponents support e-cigarettes as a promising cessation aid or a less harmful substitute for combustible tobacco. Opponents argue that e-cigarettes may renormalize smoking among young people and hinder quit attempts in smokers by encouraging dual use of e-cigarette with cigarettes (Green, Fielding, & Brownson, 2018). A consensus report by the US National Academies of Science, Engineering and Medicine concluded that there was observational evidence that smokers who switch to e-cigarettes will reduce their exposure to harmful chemicals and that they may be an effective cessation aid, but youth who vape are at greater likelihood of also experimenting with smoking (National Academies of Sciences E, 2018).

In most developed countries, such as the UK and USA, e-cigarettes can be sold and used as consumer products (European Commission, 2018; Kennedy, Awopegba, De León, & Cohen, 2017; UK Government Digital Service, 2018). Australia has taken a more restrictive approach to e-cigarettes and remains the only Westernized democracy that prohibits the sale, and possession or use of non-therapeutic nicotine containing e-cigarettes (Gartner & Bromberg, 2019). E-cigarettes that don't contain nicotine can be sold in most states and territories as consumer products, however one state has also banned the sale of nicotine-free e-cigarettes.

The distinctive regulatory environment in Australia reduces the generalizability of studies done in other countries to the Australian context. Yet, few empirical e-cigarette studies have been conducted in Australia, and most were not based on population samples (Adkison et al., 2013; Sutherland et al., 2016; Yong et al., 2017). The aim of this study is to:

  • 1.

    estimate the prevalence of vaping based on data from the latest and largest nationally representative survey on substance use in Australia and identify correlates of use;

  • 2.

    examine the association between vaping, intention to quit smoking, and reduction in smoking among smokers and recent quitters (participants who reported past year smoking but no current smoking).

Section snippets

Sample

The data were drawn from the 2016 National Drug Strategy Household Survey (NDSHS) dataset. Households were randomly selected using a multistage stratified design based on statistical local areas in every State and Territory. Detailed information on methods of the NDSHS can be found elsewhere (AIHW, 2017). The response rate was 51.1% and this was comparable to past NDSHS and other international surveys of alcohol and drug use (AIHW, 2014; Kraus, Baumeister, Pabst, & Orth, 2009). Sample weights

Results

Among the 22,354 participants, 269 reported current vaping and 117 reported daily vaping. It was estimated that 227,000 Australians (1.2% of the population 18 years old or above; 95% confidence interval [1.03%–1.40%]) were current e-cigarette users and 97,000 (0.5%; 95% CI [0.4%–0.7%]) vaped daily. Among daily users, 18% were non-smokers, 32% were daily smokers, 11% were non-daily smokers, and 38% were ex-smokers. Table 1 shows the results from logistic regression analyses predicting current

Discussion

The prevalence of vaping was substantially lower than in other countries such as the US (Mirbolouk et al., 2016) and UK (Office for National Statistics, 2018), possibly because of a more restrictive e-cigarette regulations in Australia. Males and younger people were more likely to use e-cigarettes and these findings are consistent with existing literature from other countries (Levy, Yuan, & Li, 2017). Indigenous Australians in this study were also more likely to use e-cigarettes daily compared

Conclusion

The prevalence of vaping was low in 2016 in Australia, likely reflecting the ban on sales of nicotine-containing e-cigarettes. Being male, young, being either a current or ex-smoker, and having a higher level of psychological distress were associated with increased odds of current vaping. Among smokers, patterns of vaping were differentially associated with an intention to quit, reduction in smoking and recent quitting.

The following are the supplementary data related to this article.

Role of funding sources

This research was supported by a research fellowship from the University of Queensland and funding from the Department of Health, Australia. The funding body has no role in the study design, analysis or interpretation, writing the manuscript, or the decision to submit the paper for publication.

Contributors

GC and JL performed the analyses and drafted up the manuscript. CG, HHY, RB and WH provided guidance on the research direction, and commented and revised on all drafts of the manuscript. All authors contributed to and have approved the final manuscript.

Conflict of interest

There is no conflict of interest.

Acknowledgement

We would like to acknowledge the Australian Institute of Health and Welfare for the provision of the National Drug Strategy Household Survey data (NDSHS). We would also like to acknowledge the Australian Data Archive for access to the NDSHS.

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