BACKGROUND: Despite the increasing promotion of e-cigarettes as a cessation aid/less harmful alternative to smoking in low-and middle-income countries, only limited information is available outside of high-income countries on the pattern of e-cigarette use, especially in relation to combustible cigarette smoking. This study therefore sought to describe the pattern of e-cigarette use and its association with concurrent combustible cigarette smoking and quitting behaviour.
METHODS: Data was collected during 2021 via an online survey of adult South Africans aged ≥ 18 years (N=10,587), including current/past-week e-cigarette users (n=764) and daily cigarette smokers (n=4,076). In addition to participants’ sociodemographic characteristics, information obtained included participants’ use of other tobacco or nicotine products, motivation for initiating e-cigarette use, device type - refillable e-liquid (Tank/Mods/Vape pens/others) or pre-filled e-liquid (disposables or pre-filled pods), flavour used mostly in the past-year, attempt to quit smoking in past-year and intention to quit smoking and e-cigarette in next 6month. Data were weighted to match the South African population distribution. The analysis included chi-square statistics and multi-variable adjusted logistic regression (p<0.05).
RESULTS: Of the survey participants, 25.3% (22.8-28.1%) smoked cigarettes daily and 3.0% (2.4-3.7%) currently use e-cigarettes, of whom 46.5% also smoke daily (dual users). The most used device was refillable (67.5%); a majority (60.8%) had not consistently used a particular flavour, while 23.6% and 9.9% mainly used fruit and menthol flavours, respectively. However, as compared to exclusive e-cigarette users, dual users were more likely to use pre-filled devices (OR=4.34; 95%CI=1.67-11.24), less likely to be daily users (OR=0.19; 0.07-0.49), more likely to consistently use tobacco (OR=9.91; 1.40-70.11) and menthol (OR=4.05; 1.80-15.19) flavours than varying flavours and, more likely motivated by perceived less harm/quitting and promotions/social influence than by device’s attractiveness/curiosity. Daily smokers’ quit attempts and quit intent were not associated with e-cigarette use.
CONCLUSIONS: Regulating e-cigarette promotions, including flavour restriction may benefit public health.