Transition from experimentation with tobacco and nicotine products to regular smoking in Europe
 
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1
Imperial College London, Primary Care and Public Health, United Kingdom
2
Office on Smoking and Health, CDC, United States of America
3
University of Crete, Clinic of Social and Family Medicine, School of Medicine, Greece
Publication date: 2018-03-01
 
Tob. Induc. Dis. 2018;16(Suppl 1):A279
 
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ABSTRACT
Background:
Most of the tobacco-attributable deaths are from combustible tobacco products. We explored transitions from experimentation of different tobacco/nicotine products to regular use of combustible products in a European population.

Methods:
We analysed a representative sample of persons aged ≥15 years from 28 European Union member states (Eurobarometer wave 87.1; March 2017; n=27,901). Respondents who indicated ever trying tobacco/nicotine products, including combustible products (boxed and hand-rolled cigarettes; cigars/cigarillos; pipe; waterpipe); e-cigarettes; and smokeless products (oral/nasal/chewing tobacco), were asked which product they first tried. Questions on history of regular tobacco use (≥1-time weekly) were further asked to determine whether ever tobacco users became established users at a point in their lifetime, regardless of their current use status. We used multilevel logistic regression to measure the association between first product tried and ever becoming an established smoker of combustible tobacco (ESCT), adjusting for age, sex, area of residence and financial difficulties We restricted analysis to those aged < 40 years (n=8,125) to reduce differential smoking-attributable mortality from different age cohorts.

Results:
Overall, 58.7% of persons aged < 40 years had ever tried a tobacco/nicotine product. Among these 79.7% first tried boxed cigarettes, 7.0% hand-rolled cigarettes, 6.2% waterpipe and 1.9% e-cigarettes. Compared to those who first tried e-cigarettes, the odds of ever becoming an ESCT were higher among those who first tried boxed (aOR=3.50; 95%CI: 2.26-5.44) or hand-rolled cigarettes (aOR=4.70; 95%CI: 2.74-8.04), but lower among those who first tried waterpipe (aOR=0.30; 95%CI: 0.18-0.51). Adjusted odds did not differ significantly among those who first tried pipe or smokeless tobacco compared to first trial with e-cigarettes.

Conclusions:
About 4 in 5 EU smokers first tried cigarettes, and these had increased likelihood of becoming established combustible tobacco smokers in their lifetime. Exploring reasons for experimenting with emerging products (e.g., e-cigarettes, hookahs) can inform public policy.

 
CITATIONS (2):
1.
Study protocol of EUREST-PLUS - European Regulatory Science on Tobacco: Policy Implementation to Reduce Lung Disease
Constantine Vardavas, Nicolas Bécuwe, Tibor Demjén, Esteve Fernández, Ann McNeill, Ute Mons, Yannis Tountas, Antigona Trofor, Aristides Tsatsakis, Gernot Rohde, Marc Willemsen, Krzysztof Przewoźniak, Witold Zatoński, Geoffrey Fong
Tobacco Induced Diseases
 
2.
Transitions in product use during the implementation of the European Tobacco Products Directive: cohort study findings from the EUREST-PLUS ITC Europe Surveys
Constantine Vardavas, Christina Kyriakos, Pete Driezen, Charis Girvalaki, Katerina Nikitara, Filippos Filippidis, Esteve Fernández, Ute Mons, Krzysztof Przewoźniak, Antigona Trofor, Tibor Demjén, Paraskevi Katsaounou, Witold Zatoński, Marc Willemsen, Geoffrey Fong, Constantine Vardavas, Andrea Glahn, Christina Kyriakos, Dominick Nguyen, Katerina Nikitara, Cornel Radu-Loghin, Aristidis Tsatsakis, Charis Girvalaki, Chryssi Igoumenaki, Sophia Papadakis, Aikaterini Papathanasaki, Manolis Tzatzarakis, Alexander Vardavas, Nicolas Bécuwe, Lavinia Deaconu, Sophie Goudet, Christopher Hanley, Oscar Rivière, Tibor Demjén, Judit Kiss, Anna Kovacs, Esteve Fernández, Yolanda Castellano, Marcela Fu, Sarah Nogueira, Olena Tigova, Ann McNeill, Katherine East, Sara Hitchman, Ute Mons, Sarah Kahnert, Yannis Tountas, Panagiotis Behrakis, Filippos Filippidis, Christina Gratziou, Paraskevi Katsaounou, Theodosia Peleki, Ioanna Petroulia, Chara Tzavara, Antigona Trofor, Marius Eremia, Lucia Lotrean, Florin Mihaltan, Gernot Rohde, Tamaki Asano, Claudia Cichon, Amy Far, Céline Genton, Melanie Jessner, Linnea Hedman, Christer Janson, Ann Lindberg, Beth Maguire, Sofia Ravara, Valérie Vaccaro, Brian Ward, Marc Willemsen, Vries de, Karin Hummel, Gera Nagelhout, Witold Zatoński, Aleksandra Herbeć, Kinga Janik-Koncewicz, Krzysztof Przewoźniak, Mateusz Zatoński, Geoffrey Fong, Thomas Agar, Pete Driezen, Shannon Gravely, Anne Quah, Mary Thompson
European Journal of Public Health
 
eISSN:1617-9625