Changes in Smoking and Vaping over 18 Months among Smokers and Recent Ex-Smokers: Longitudinal Findings from the 2016 and 2018 ITC Four Country Smoking and Vaping Surveys
Abstract
:1. Introduction
2. Methods
2.1. Study Sample and Procedure
2.2. Measures
2.2.1. Wave 1 (2016) Baseline Measures
2.2.2. Country NVP Regulations
2.2.3. Classification of Point Prevalence Smoking and Vaping Status
2.2.4. Wave 2 (2018) Transition Outcomes
2.3. Statistical Analyses
2.4. Ethics approval
3. Results
3.1. User Group Transitions among Daily Smokers and Non-Daily Smokers: Point Prevalence W2 Estimates
3.2. Transitions among Daily Smokers
3.3. Transitions among Non-Daily Smokers
3.4. Transitions among Recent Ex-Smokers
3.5. Wave 1 to Wave 2 Transition Subgroup Comparisons
3.6. Comparisons between Wave 1 Daily and Non-Daily Smokers
3.7. Comparisons between Wave 1 Daily Smokers: Exclusive Daily Smokers vs. Concurrent Users
3.8. Comparisons between Wave 1 Non-daily Smokers: Exclusive Non-daily Smokers vs. Concurrent Users
3.9. Comparisons between Wave 1 Concurrent Users
3.10. Comparisons between Recent Ex-smokers, Vapers and Non-Vapers:
3.11. Country Differences
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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# | Group Category | Smoking | Vaping |
---|---|---|---|
Exclusive smokers | |||
1 | Exclusive daily smokers | Daily | None |
2 | Exclusive non-daily smokers | Non-daily | None |
Concurrent users | |||
3 | Dual-daily users | Daily | Daily |
4 | Predominant smokers | Daily | Non-daily |
5 | Predominant vapers | Non-daily | Daily |
6 | Concurrent non-daily users | Non-daily | Non-daily |
Recent ex-smokers | |||
7 | Ex-smokers who vape | None | Daily/Non-daily |
8 | Ex-smokers not vaping | None | None |
Characteristics, n (%) | Exclusive Smokers n = 3319 (66.2%) | Concurrent Users n = 1117 (22.3%) | Ex-Smokers n = 580 (11.6%) | Overall N = 5016 | |
---|---|---|---|---|---|
Country | Australia | 636 (19.2) | 90 (8.1) | 93 (16.0) | 819 (16.3) |
Canada | 972 (29.3) | 439 (39.3) | 187 (32.2) | 1598 (31.9) | |
England | 1040 (31.3) | 359 (32.1) | 151 (26.0) | 1550 (30.9) | |
United States | 671 (20.2) | 229 (20.5) | 149 (25.7) | 1049 (20.9) | |
Sex | Male | 1592 (48.0) | 592 (53.0) | 263 (45.3) | 2447 (48.8) |
Female | 1727 (52.0) | 525 (47.0) | 317 (54.7) | 2569 (51.2) | |
Age | Mean (SD) | 50.9 (13.7) | 44.2 (15.2) | 49.6 (14.7) | 49.3 (14.5) |
Age group | 18–24 | 184 (5.5) | 162 (14.5) | 30 (5.2) | 376 (7.5) |
25–39 | 536 (16.2) | 298 (26.7) | 126 (21.7) | 960 (19.1) | |
40–54 | 1097 (32.0) | 331 (29.6) | 177 (30.5) | 1605 (32.0) | |
55+ | 1502 (41.4) | 326 (29.2) | 247 (42.6) | 2075 (41.4) | |
Education level | Low | 1154 (34.8) | 310 (27.8) | 171 (29.5) | 1635 (32.6) |
Moderate | 1350 (40.7) | 445 (39.8) | 250 (43.1) | 2045 (40.8) | |
High | 789 (23.8) | 351 (31.4) | 156 (26.9) | 1296 (25.8) | |
Not reported | 26 (0.8) | 11 (1.0) | 3 (0.5) | 40 (0.8) | |
Smoking Status | Daily smoking | 3063 (92.3) | 920 (82.4) | - | 3983 (79.4) |
Non-daily smoking | 256 (7.7) | 197 (17.6) | - | 453 (9.0) | |
Recent ex-smoker | - | - | 580 (100.0) | 580 (11.6) | |
Vaping Status | Daily vaping | - | 410 (36.7) | 109 (18.8) | 519 (10.4) |
Non-daily vaping | - | 707 (63.3) | 27 (4.7) | 734 (14.6) | |
No current vaping | 3319 (100.0) | - | 444 (76.6) | 3763 (75.0) |
Wave 1 | Wave 2 | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Smoking | Not Smoking | |||||||||||
Exclusive Smoking | Concurrent Use | Total Smoking | ||||||||||
Exclusive Daily Smokers (1) | Exclusive Non-Daily Smokers (2) | Dual-Daily Users (3) | Predominant Smokers (4) | Predominant Vapers and Concurrent Non-Daily Users * (5 + 6) | Total Daily Smokers (1 + 3 + 4) | Total Non-Daily Smokers (2 + 5 + 6) | Ex-Smokers Who Vape (7) | Ex-Smokers Not Vaping (8) | Total Discontinued Smoking (7 + 8) | |||
Exclusive smokers (n = 3319) | ||||||||||||
1 | Exclusive daily smokers (n = 3063) | % | 71.4 | 3.0 | 3.7 | 8.9 | 1.5 | 84.0 | 4.5 | 2.6 | 9.0 | 11.6 |
n | 2296 | 79 | 94 | 223 | 37 | 2613 | 116 | 73 | 261 | 334 | ||
2 | Exclusive non-daily smokers (n = 256) | % | 21.1 | 31.2 | 4.2 | 8.0 | 8.4 | 33.3 | 39.6 | 4.8 | 22.5 | 27.3 |
n | 55 | 84 | 7 | 16 | 22 | 78 | 106 | 11 | 61 | 72 | ||
Concurrent users (n = 1117) | ||||||||||||
3 | Dual-daily users (n = 322) | % | 21.4 | 1.5 | 38.5 | 18.6 | 8.3 | 78.5 | 9.8 | 9.5 | 2.2 | 11.7 |
n | 46 | 3 | 129 | 76 | 34 | 251 | 37 | 25 | 9 | 34 | ||
4 | Predominant smokers (n = 598) | % | 42.2 | 2.7 | 14.9 | 25.4 | 5.4 | 82.5 | 8.1 | 5.0 | 4.5 | 9.5 |
n | 216 | 16 | 89 | 187 | 40 | 492 | 56 | 26 | 24 | 50 | ||
5 | Predominant vapers (n = 88) | % | 4.2 | 1.7 | 12.0 | 18.7 | 39.7 | 34.9 | 41.4 | 18.0 | 5.8 | 23.8 |
n | 6 | 3 | 17 | 12 | 29 | 35 | 32 | 15 | 6 | 21 | ||
6 | Concurrent non-daily users (n = 109) | % | 5.3 | 9.9 | 7.1 | 9.0 | 51.2 | 21.4 | 61.1 | 8.2 | 9.4 | 17.6 |
n | 6 | 8 | 10 | 15 | 48 | 31 | 56 | 10 | 12 | 22 | ||
Recent ex-smokers † (n = 580) | ||||||||||||
Relapsed (exclusive smoking or concurrent use) | Continued smoking abstinence | |||||||||||
7 | Ex-smokers who vape (n = 136) | % | 4.4 (1 + 2) | 8.1 (3 − 6) | 12.5 (1 − 6) | 67.3 | 20.2 | 87.5 | ||||
n | 2 | 8 | 10 | 94 | 32 | 126 | ||||||
8 | Ex-smokers not vaping (n = 444) | % | 11.3 (1 + 2) | 2.0 (3 − 6) | 13.3 (1 − 6) | 4.6 | 82.1 | 86.7 | ||||
n | 47 | 8 | 55 | 21 | 368 | 389 | ||||||
Row Totals | ||||||||||||
All daily smokers (n = 3983) | % | 67.2 | 2.9 | 5.8 | 10.6 | 2.1 | 83.6 | 5.0 | 2.9 | 8.4 | 11.3 | |
All non-daily smokers (n = 453) | % | 17.7 | 26.1 | 5.5 | 9.2 | 15.5 | 32.4 | 41.6 | 6.5 | 19.6 | 26.1 | |
All recent ex-smokers (n = 580) | % | 10.5 (1 + 2) | 2.8 (3 − 6) | 13.3 (1 − 6) | 12.2 | 74.6 | 86.8 |
Wave 1 to Wave 2 Transitions | Transition Code * | Comparisons between Wave 1 Subgroups | OR | 95% CI | |
---|---|---|---|---|---|
No change in smoking frequency (daily) | A (i) | 1 | Exclusive daily smokers | Reference | |
3 vs. 1 | Dual-daily users | 0.72 | 0.49–1.05 | ||
4 vs. 1 | Predominant smokers | 0.91 | 0.67–1.24 | ||
No change in smoking frequency (non-daily) | A (ii) | 2 | Exclusive non-daily smokers | Reference | |
5 vs. 2 | Predominant vapers | 0.99 | 0.51–1.90 | ||
6 vs. 2 | Concurrent non-daily users | 2.60 | 1.45–4.67 | ||
Decreased smoking from daily to non-daily | B | 1 | Exclusive daily smokers | Reference | |
3 vs. 1 | Dual-daily users | 2.41 | 1.42–4.10 | ||
4 vs. 1 | Predominant smokers | 1.90 | 1.23–2.95 | ||
Increased smoking from non-daily to daily | C | 2 | Exclusive non-daily smokers | Reference | |
5 vs. 2 | Predominant vapers | 1.12 | 0.58–2.15 | ||
6 vs. 2 | Concurrent non-daily users | 0.54 | 0.28–1.04 | ||
Discontinued smoking | D (i) | 1 + 3 + 4 | Daily smokers | Reference | |
2 + 5 + 6 vs. 1 + 3 + 4 | Non-daily smokers | 2.48 | 1.80–3.43 | ||
D (ii) | 1 | Exclusive daily smokers | Reference | ||
3 vs. 1 | Dual-daily users | 0.87 | 0.53–1.41 | ||
4 vs. 1 | Predominant smokers | 0.75 | 0.50–1.12 | ||
D (iii) | 2 | Exclusive non-daily smokers | Reference | ||
5 vs. 2 | Predominant vapers | 0.89 | 0.43–1.83 | ||
6 vs. 2 | Concurrent non-daily users | 0.55 | 0.29–1.06 | ||
D (iv) | 3 | Dual-daily users | Reference | ||
4 vs. 3 | Predominant smokers | 0.83 | 0.48–1.45 | ||
5 vs. 3 | Predominant vapers | 2.40 | 1.07–5.35 | ||
6 vs. 3 | Concurrent non-daily users | 1.86 | 0.92–3.75 | ||
Relapsed back to smoking | E | 7 | Ex-smokers who vape | Reference | |
8 vs. 7 | Ex-smokers who don’t vape | 1.04 | 0.36–3.03 | ||
Initiated Vaping | F | 1 | Exclusive daily smokers | Reference | |
2 vs. 1 | Exclusive non-daily smokers | 1.52 | 1.02–2.25 | ||
Discontinued smoking and switched to vaping | G (i) | 1 + 3 + 4 | Daily smokers | Reference | |
2 + 5 + 6 vs. 1 + 3 + 4 | Non-daily smokers | 2.21 | 1.25–3.91 | ||
G (ii) | 1 | Exclusive daily smokers | Reference | ||
3 vs. 1 | Dual-daily users | 3.55 | 1.90–6.64 | ||
4 vs. 1 | Predominant smokers | 1.88 | 1.09–3.23 | ||
G (iii) | 2 | Exclusive non-daily smokers | Reference | ||
5 vs. 2 | Predominant vapers | 4.99 | 1.82–13.72 | ||
6 vs. 2 | Concurrent non-daily users | 1.81 | 0.61–5.35 | ||
G (iv) | 3 | Dual-daily users | Reference | ||
4 vs. 3 | Predominant smokers | 0.52 | 0.27–1.01 | ||
5 vs. 3 | Predominant vapers | 2.25 | 0.89–5.70 | ||
6 vs. 3 | Concurrent non-daily users | 1.09 | 0.44–2.72 |
W1 Smoking Status | W1 Vaping | W2 Smoking Status | Canada (n = 1411) | United States (n = 900) | England (n = 1399) | Australia (n = 726) | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
n | % | 95% CI | n | % | 95% CI | n | % | 95% CI | n | % | 95% CI | |||
Daily n = 3983 | Yes | Remained daily | 288 | 81.0 | 75.2–85.7 | 134 | 66.1 | 56.3–74.7 | 255 | 82.8 | 76.3–87.8 | 66 | 83.0 | 67.9–91.9 |
No | 731 | 82.7 | 79.5–85.4 | 519 | 76.7 | 70.4–82.0 | 834 | 88.4 | 85.3–90.9 | 529 | 85.5 | 81.1–89.0 | ||
Yes | Reduced to non-daily | 43 | 12.6 * | 8.7–17.9 | 23 | 16.2± | 9.9–25.5 | 21 | 7.5 † | 4.4–12.6 | 6 | 6.5 | 1.3–27.5 | |
No | 37 | 4.9 | 3.4–7.0 | 28 | 8.4 | 5.2–13.5 | 33 | 2.9 | 1.7–4.8 | 18 | 3.2 | 1.7–5.9 | ||
Yes | Discontinued smoking | 24 | 6.4 * | 3.9–10.3 | 24 | 17.7 | 11.3–26.5 | 26 | 9.7 | 6.0–15.4 | 10 | 10.5 | 4.8–21.6 | |
No | 104 | 12.4 | 10.1–15.2 | 68 | 14.9 | 10.5–20.7 | 99 | 8.8 | 6.6–11.5 | 63 | 11.3 | 8.2–15.5 | ||
Non-daily n = 453 | Yes | Remained smoking | 61 | 76.8 | 64.7–85.7 | 39 | 75.5 | 52.8–89.4 | 47 | 86.6 | 72.0–94.2 | 7 | 98.7 | 88.6–99.9 |
No | 73 | 77.1 | 65.7–78.9 | 37 | 54.5 | 34.6–73.0 | 57 | 80.1 | 66.6–89.0 | 17 | 60.2 | 38.7–78.4 | ||
Yes | Discontinued smoking | 23 | 23.2 | 14.3–35.3 | 9 | 24.5 | 10.6–47.2 | 10 | 13.4 | 5.8–28.0 | 1 | 1.3 * | 0.1–11.4 | |
No | 27 | 22.9 | 15.1–33.0 | 19 | 45.5 | 27.0–65.4 | 17 | 19.9 | 11.0–33.4 | 9 | 39.8 * | 21.6–61.3 |
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Gravely, S.; Meng, G.; Cummings, K.M.; Hyland, A.; Borland, R.; Hammond, D.; O’Connor, R.J.; Goniewicz, M.L.; Kasza, K.A.; McNeill, A.; Thompson, M.E.; Hitchman, S.C.; Levy, D.T.; Thrasher, J.F.; Quah, A.C.K.; Martin, N.; Ouimet, J.; Boudreau, C.; Fong, G.T. Changes in Smoking and Vaping over 18 Months among Smokers and Recent Ex-Smokers: Longitudinal Findings from the 2016 and 2018 ITC Four Country Smoking and Vaping Surveys. Int. J. Environ. Res. Public Health 2020, 17, 7084. https://doi.org/10.3390/ijerph17197084
Gravely S, Meng G, Cummings KM, Hyland A, Borland R, Hammond D, O’Connor RJ, Goniewicz ML, Kasza KA, McNeill A, Thompson ME, Hitchman SC, Levy DT, Thrasher JF, Quah ACK, Martin N, Ouimet J, Boudreau C, Fong GT. Changes in Smoking and Vaping over 18 Months among Smokers and Recent Ex-Smokers: Longitudinal Findings from the 2016 and 2018 ITC Four Country Smoking and Vaping Surveys. International Journal of Environmental Research and Public Health. 2020; 17(19):7084. https://doi.org/10.3390/ijerph17197084
Chicago/Turabian StyleGravely, Shannon, Gang Meng, K. Michael Cummings, Andrew Hyland, Ron Borland, David Hammond, Richard J. O’Connor, Maciej L. Goniewicz, Karin A. Kasza, Ann McNeill, Mary E. Thompson, Sara C. Hitchman, David T. Levy, James F. Thrasher, Anne C.K. Quah, Nadia Martin, Janine Ouimet, Christian Boudreau, and Geoffrey T. Fong. 2020. "Changes in Smoking and Vaping over 18 Months among Smokers and Recent Ex-Smokers: Longitudinal Findings from the 2016 and 2018 ITC Four Country Smoking and Vaping Surveys" International Journal of Environmental Research and Public Health 17, no. 19: 7084. https://doi.org/10.3390/ijerph17197084