scholarly journals Cross-Sectional Association of Lifetime Electronic Cigarette Use with Wheezing and Related Respiratory Symptoms in U.S. Adults

2020 ◽  
Vol 22 (Supplement_1) ◽  
pp. S85-S92
Author(s):  
Dongmei Li ◽  
Zidian Xie
Keyword(s):  
Tobacco Use ◽  
Respiratory Symptoms ◽  
Electronic Cigarettes ◽  
Electronic Cigarette ◽  
Cigarette Use ◽  
Cross Sectional ◽  
Logistic Regression Models ◽  
The Past ◽  
Study Results ◽  
The Cross

Abstract Introduction Electronic cigarette use (vaping) has been found to be associated with respiratory symptoms like wheezing or whistling in the chest. Whether or not lifetime vaping occurrences are associated with wheezing has not yet been investigated. Methods Population Assessment of Tobacco and Health (PATH) Study Wave 4 data with 22,233 adults collected from December 2016 to January 2018 were used. The cross-sectional association of lifetime vaping occurrences with wheezing and related respiratory symptoms was examined using multivariable weighted logistic regression models considering the complex sampling design. Results According to the weighted PATH Wave 4 data, about 89.9% adults never vaped, 3.2% adults vaped one time, 3.2% vaped 2–10 times, 1.3% vaped 11–20 times, 1.1% vaped 21–50 times, 0.4% vaped 51–99 times, and 0.9% vaped 100 or more times in their entire life. Compared to adults who never vaped, adults who vaped 2–10 times had a significantly higher association with ever wheezing (aOR = 1.4, 95% CI: 1.1 to 1.6), past 12-month wheezing (aOR = 1.5, 95% CI: 1.2 to 1.9) and the number of wheezing attacks in the past 12 months (aOR = 1.5, 95% CI: 1.2 to 1.8). Adults who vaped 11–20 times and 100 or more times had similar associations with wheezing as that for adults who vaped 2–10 times. Controlling other tobacco use attenuated the associations. Conclusions Lifetime vaping occurrences were found to be associated with some definitions of self-reported wheezing in cross-sectional analyses adjusted for other tobacco use. Implications Using the cross-sectional PATH Wave 4 data with 22,233 adults, we found significant associations between lifetime vaping occurrences and ever wheezing or whistling in the chest, past 12 months wheezing or whistling in the chest, as well as the number of wheezing attacks in the past 12 months. The study results suggest that larger studies with more precise time frames and measures are needed to further understand possible connections between vaping experimentation and wheezing symptoms that could inform our understanding of the health effects of electronic cigarettes and resultant policy decisions.

scholarly journals Association of smoking and electronic cigarette use with wheezing and related respiratory symptoms in adults: cross-sectional results from the Population Assessment of Tobacco and Health (PATH) study, wave 2

2019 ◽  
pp. tobaccocontrol-2018-054694 ◽  
Author(s):  
Dongmei Li ◽  
Isaac K Sundar ◽  
Scott McIntosh ◽  
Deborah J Ossip ◽  
Maciej Lukasz Goniewicz ◽  
...  
Keyword(s):  
Lower Risk ◽  
Respiratory Symptoms ◽  
Electronic Cigarettes ◽  
Electronic Cigarette ◽  
Health Study ◽  
Cigarette Use ◽  
Cross Sectional ◽  
Population Assessment ◽  
Increased Risk ◽  
The Cross

BackgroundWheezing is a symptom of potential respiratory disease and known to be associated with smoking. Electronic cigarette use (‘vaping’) has increased exponentially in recent years. This study examined the cross-sectional association of vaping with wheezing and related respiratory symptoms and compare this association with smokers and dual users.MethodsThe Population Assessment of Tobacco and Health study wave 2 data collected from October 2014 to October 2015 with 28 171 adults were used. The cross-sectional association of vaping with self-reported wheezing and related respiratory symptoms relative to smokers and dual users of tobacco and electronic cigarettes were studied using multivariable logistic and cumulative logistic regression models with consideration of complex sampling design.ResultsAmong the 28 171 adult participants, 641 (1.2%) were current vapers who used e-cigarettes exclusively, 8525 (16.6%) were current exclusive smokers, 1106 (2.0%) were dual users and 17 899 (80.2%) were non-users. Compared with non-users, risks of wheezing and related respiratory symptoms were significantly increased in current vapers (adjusted OR (aOR)=1.67, 95% CI: 1.23 to 2.15). Current vapers had significantly lower risk in wheezing and related respiratory symptoms compared with current smokers (aOR=0.68, 95% CI: 0.53 to 0.87). No significant differences were found between dual users and current smokers in risk of wheezing and related respiratory symptoms (aOR=1.06, 95% CI: 0.91 to 1.24).ConclusionsVaping was associated with increased risk of wheezing and related respiratory symptoms. Current vapers had lower risk in wheezing and related respiratory symptoms than current smokers or dual users but higher than non-users. Both dual use and smoking significantly increased the risk of wheezing and related respiratory symptoms.

‘Ice’ flavoured e-cigarette use among young adults

2021 ◽  
pp. tobaccocontrol-2020-056416
Author(s):  
Adam Leventhal ◽  
Hongying Dai ◽  
Jessica Barrington-Trimis ◽  
Steve Sussman
Keyword(s):  
Young Adults ◽  
Los Angeles ◽  
Tobacco Use ◽  
Cross Sectional Study ◽  
Cigarette Use ◽  
Cross Sectional ◽  
Web Based ◽  
The Past ◽  
Frequency Of Use ◽  
Exposure Variable

Background‘Ice’ e-cigarette flavours—marketed as a combination of fruity/sweet and cooling flavours (eg, ‘blueberry ice’ or ‘melon ice’)—recently entered the US market. The prevalence and correlates of ice flavoured e-cigarette use in young adults are unknown.MethodsThis cross-sectional study of a Los Angeles, California, USA, cohort analysed data from the past 30-day e-cigarette (current) users (n=344; M (SD)=21.2 (0.4) years old) who completed web-based surveys from May–August 2020. The exposure variable was self-reported e-cigarette flavour used most often in the past month (menthol/mint, fruit/sweet or ice). Outcomes included self-reported combustible tobacco use, vaping dependence symptoms, frequency of use and device type used.ResultsAmong current e-cigarette users, 48.8% reported using ice flavours most often, 33.7% predominately used fruit/sweet and 17.4% used menthol/mint. Using primarily ice-flavour was associated with reporting more past-30-day vaping days (vs menthol/mint: b=4.4, 95% CI (1 to 7.7); vs fruit/sweet: b=3.6, 95% CI (0.8 to 6.4)) and more episodes per vaping day versus fruit/sweet users (b=2.4, 95% CI (0.5 to 4.3)). Ice-flavour users were less likely than menthol/mint users to use JUUL/cartridge-based rechargeable (OR=0.1, 95% CI (0.03 to 0.45)) and more likely than sweet/fruit users to use disposable non-cartridge (OR=3.9, 95% CI (2.1 to 7.4)) devices than refillable/rechargeable tank/pen or other devices. Ice users had greater odds of past 30-day combustible tobacco use versus menthol/mint users (OR=2.7, 95% CI (1.3 to 5.7)) and vaping dependence symptoms than versus sweet/fruit users (OR=2.6, 95% CI (1.5 to 4.4)).ConclusionYoung adult use of ice flavoured e-cigarettes may be common and positively associated with combustible tobacco use, nicotine vaping frequency and dependence and use of disposable e-cigarette devices. Further study of the prevalence, determinants and health effects of ice flavoured e-cigarette use is warranted.

scholarly journals Invited Commentary: The Epidemiology of Electronic Cigarettes and Reproductive Health Begins

2020 ◽  
Author(s):  
David A Savitz
Keyword(s):  
Reproductive Health ◽  
Tobacco Use ◽  
Electronic Cigarettes ◽  
Electronic Cigarette ◽  
Cigarette Use ◽  
Full Spectrum ◽  
Extensive Documentation ◽  
Exposure Profile ◽  
Individual Decisions ◽  
Complex Subject

Abstract Harlow et al. (Am J Epidemiol. 2020;000(00):000–000) are among the first to tackle the complex subject of electronic cigarette use and reproductive health, focused on fecundity but pertinent to the full spectrum of reproductive health concerns. Despite extensive documentation of the health harm from tobacco use and a shared exposure to nicotine, electronic cigarette (e-cigarette) users have a markedly different exposure profile. Because e-cigarettes might help to curtail or eliminate tobacco smoking, the health comparisons of interest for e-cigarettes should include cigarette smoking as well as no use of such products. These researchers confront significant methodological challenges in the study of reproductive health effects of e-cigarettes: addressing confounding with little information on the characteristics of e-cigarette users, a complex connection between e-cigarette and tobacco use, multiple and poorly understood exposure to e-cigarette vapors, and lack of a standard method for quantifying exposure. Evidence is urgently needed to inform regulation and individual decisions regarding the use of this potentially harmful product that might well entice new users of nicotine, some of whom progress to tobacco use, but that also has the potential to enable otherwise recalcitrant smokers to substitute a less harmful product.

scholarly journals Exclusive E-Cigarette Users Report Lower Levels of Respiratory Symptoms Relative to Dual E-Cigarette and Cigarette Users

2020 ◽  
Vol 22 (Supplement_1) ◽  
pp. S54-S60
Author(s):  
Rachel N Cassidy ◽  
Jennifer W Tidey ◽  
Suzanne M Colby
Keyword(s):  
Cigarette Smoking ◽  
Symptom Severity ◽  
Respiratory Symptom ◽  
Respiratory Symptoms ◽  
Smoking Status ◽  
Cross Sectional Study ◽  
Cigarette Use ◽  
Cross Sectional ◽  
The Past ◽  
Advanced Generation

Abstract Introduction Exclusive e-cigarette use has been shown to be associated with reduced levels of respiratory symptoms relative to smoking combustible cigarettes; this association has been less frequently studied in smokers using advanced-generation e-cigarette devices. Advanced-generation devices generate denser vapor than either early generation or pod-style devices, and engender longer inhalations; these vaping topography patterns may contribute to respiratory symptoms. Methods In a single-session, cross-sectional study of exclusive e-cigarette users (N = 59) and dual users of e-cigarettes and cigarettes (N = 54), participants completed questionnaires, including the American Thoracic Society Questionnaire (ATSQ) and were videotaped vaping their own device in the lab for 1 hour. Using a hierarchical regression method, we examined whether topography variables, level of nicotine concentration used in their e-cigarette device in the past month, e-cigarette dependence, amount of e-cigarette use in the past month, and smoking status (any smoking in the last month vs. none) predicted ATSQ score severity. Results There was a significant mean difference in ATSQ score across smoking status, with greater ATSQ scores for vapers who also smoked cigarettes (19.0, SD = 6.7) than for exclusive vapers (13.4, SD = 5.3). In the final model, of the predictors of interest, only cigarette smoking status predicted significantly greater ATSQ scores (overall F = 2.51, p = .006; R2 = .26; smoking status β = 0.39, p < .0001). Conclusions Findings suggest that differences in respiratory symptoms between dual and exclusive e-cigarette users appear to be attributable to combustible cigarette smoking, rather than more intense or frequent e-cigarette use across groups. Implications In this comparison of exclusive advanced-generation vape device users (N = 59) versus dual users of these devices and combustible cigarettes (N = 54), we set out to determine the extent to which smoking status and e-cigarette use variables predicted self-reported respiratory symptom severity. We found that dual users showed greater respiratory symptom severity (ATSQ scores) than exclusive vapers. Despite examining vaping topography and other variables, smoking status and race were the only significant predictor of respiratory symptoms. We conclude that combustible cigarette use, not individual vaping topography, likely accounts for differences in respiratory symptoms between dual users and exclusive vapers.

scholarly journals Cross-Sectional Association Between Lifetime Use of Electronic Cigarettes With or Without Marijuana and Self-Reported Past 12-Month Respiratory Symptoms as well as Lifetime Respiratory Diseases in U.S. Adults

2020 ◽  
Vol 22 (Supplement_1) ◽  
pp. S70-S75
Author(s):  
Zidian Xie ◽  
Dongmei Li
Keyword(s):  
Respiratory Symptoms ◽  
Respiratory Diseases ◽  
Respiratory Health ◽  
Electronic Cigarettes ◽  
Public Awareness ◽  
Smoking History ◽  
Health Study ◽  
Cigarette Use ◽  
Cross Sectional ◽  
Potential Health

Abstract Introduction The use of electronic cigarettes (vaping), especially with marijuana, has become increasingly popular among adults. Aims and Methods The Population Assessment of Tobacco and Health study Wave 4 data on 33 606 adult participants who indicated ever using electronic cigarettes were included in the study. By controlling for confounding variables (such as age and smoking history), multivariable weighted logistic regression models were used to examine the cross-sectional association between lifetime e-cigarette use with or without marijuana and self-reported past 12-month respiratory symptoms as well as lifetime respiratory diseases. Results Compared to adults who never vaped, adults who had ever vaped with marijuana had a significantly higher association with self-reported past 12-month respiratory symptoms but not lifetime respiratory diseases. Compared to adults who had ever vaped without marijuana, adults who had ever vaped at least sometimes with marijuana had a significantly greater risk of having wheezing/whistling in the chest (adjusted odds ratio [aOR] = 1.21, 95% confidence interval [CI]: 1.01, 1.44), chest sounded wheezy during or after exercise (aOR = 1.59, 95% CI: 1.31, 1.93), and had a dry cough at night (aOR = 1.35, 95% CI: 1.16, 1.57), while adults who had ever vaped rarely with marijuana had a significantly greater risk of having wheezing/whistling in the chest (aOR = 1.31, 95% CI: 1.06, 1.61), chest sounded wheezy during or after exercise (aOR = 1.24, 95% CI: 1.01, 1.52), and had a dry cough at night (aOR = 1.24, 95% CI: 1.04, 1.47). Conclusions Lifetime e-cigarette use with marijuana is associated with self-reported past 12-month respiratory symptoms in adults. Implications The use of e-cigarettes with marijuana has become prevalent in recent years. Our cross-sectional study suggests that there may be respiratory health symptoms associated with ever vaping with marijuana that is independent of nicotine vaping, which should raise public awareness of potential health risks associated with the use of e-cigarettes with marijuana. Further longitudinal studies on the respiratory health effects of e-cigarette use with marijuana are warranted.

scholarly journals The Association of Sleep Duration and the Use of Electronic Cigarettes, NHANES, 2015-2016

2020 ◽  
Vol 2020 ◽  
pp. 1-12
Author(s):  
R. Constance Wiener ◽  
Christopher Waters ◽  
Ruchi Bhandari ◽  
Alcinda K. Trickett Shockey ◽  
Omayma Alshaarawy
Keyword(s):  
Sleep Duration ◽  
Electronic Cigarettes ◽  
Sleep Time ◽  
Potential Effect ◽  
Cross Sectional Study ◽  
Electronic Cigarette ◽  
Cigarette Use ◽  
Time Duration ◽  
Chi Square ◽  
Cross Sectional

Introduction. The unknown effects of electronic cigarettes are public health concerns. One potential effect of electronic cigarette fluid constituents, such as nicotine, may influence sleep. The purpose of this study is to determine if there is an association between sleep duration and electronic cigarette use. Methods. A retrospective, cross-sectional study was conducted using National Health and Nutrition Examination Survey (NHANES) 2015-2016. Variables of interest included responses to questions concerning electronic cigarette use, hours of sleep, and other variables associated with sleep. Data analyses were conducted with the Rao-Scott chi square test and logistic regression. Results. This study was conducted on 2889 participants, aged 18-65 years, of whom 50.7% were female. Using a bivariate analyses of electronic cigarette usage and sleep duration, participants who never used an electronic cigarette were more likely to have appropriate sleep durations as compared with participants who were currently using electronic cigarettes (P<0.0001). After adjusting for sociodemographic variables and cigarette smoking, current electronic cigarette use was associated with higher odds of less sleep duration (adjusted odds ratio=1.82; 95% CI: 1.18, 2.79; P=0.0075). Conclusions. Participants currently using electronic cigarettes are more likely to have less sleep as compared to participants who have never used electronic cigarettes. Implications. With sleep time duration being a major factor for proper body function and repair, this study can serve as confirmation that the use of electronic cigarettes is not a harmless health behavior.

scholarly journals Use of Flavored E-Cigarettes Among Adolescents, Young Adults, and Older Adults: Findings From the Population Assessment for Tobacco and Health Study

2019 ◽  
Vol 134 (3) ◽  
pp. 282-292 ◽  
Author(s):  
Samir S. Soneji ◽  
Kristin E. Knutzen ◽  
Andrea C. Villanti
Keyword(s):  
Older Adults ◽  
Young Adults ◽  
Electronic Cigarettes ◽  
Smoking Status ◽  
Health Study ◽  
Cigarette Use ◽  
Population Assessment ◽  
Logistic Regression Models ◽  
The Past ◽  
Concurrent Use

Objectives: The use of flavored electronic cigarettes (e-cigarettes) is common among e-cigarette users, but little is known about the potential harms of flavorings, the extent to which the concurrent use of multiple flavor types occurs, and the correlates of flavor type use. The objective of this study was to assess the types of e-cigarette flavors used by adolescent (aged 12-17), young adult (aged 18-24), and older adult (aged ≥25) e-cigarette users. Methods: We assessed the prevalence of flavored e-cigarette use within the past month by flavor types and concurrent use of multiple flavor types among past-month e-cigarette users sampled during Wave 2 (2014-2015) of the Population Assessment for Tobacco and Health Study among 414 adolescents, 961 young adults, and 1711 older adults. We used weighted logistic regression models for the use of fruit-, candy-, mint/menthol–, tobacco-, or other-flavored e-cigarettes and concurrent use of multiple flavor types. Covariates included demographic characteristics, e-cigarette use frequency, cigarette smoking status, current use of other tobacco products, and reasons for e-cigarette use. Results: The leading e-cigarette flavor types among adolescents were fruit, candy, and other flavors; among young adults were fruit, candy, and mint/menthol; and among older adults were tobacco or other flavors, fruit, and mint/menthol. Compared with older adults, adolescents and young adults were more likely to use fruit-flavored e-cigarettes (adjusted odds ratio [aOR] = 3.35; 95% confidence interval [CI], 2.56-4.38; and aOR = 2.31; 95% CI, 1.77-3.01, respectively) and candy-flavored e-cigarettes (aOR = 3.81; 95% CI, 2.74-5.28; and aOR = 2.95; 95% CI, 2.29-3.80, respectively) and concurrently use multiple flavor types (aOR = 4.58; 95% CI, 3.39-6.17; and aOR = 2.28; 95% CI, 1.78-2.91, respectively). Conclusions: Regulation of sweet e-cigarette flavors (eg, fruit and candy) may help reduce the use of e-cigarettes among young persons without substantially burdening adult e-cigarette users.

Discordance between perceived and actual tobacco product use prevalence among US youth: a comparative analysis of electronic and regular cigarettes

2018 ◽  
Vol 28 (2) ◽  
pp. 212-219 ◽  
Author(s):  
Israel Terungwa Agaku ◽  
Satomi Odani ◽  
David Homa ◽  
Brian Armour ◽  
Rebecca Glover-Kudon
Keyword(s):  
Tobacco Use ◽  
Electronic Cigarettes ◽  
Statistical Significance ◽  
Tobacco Product ◽  
Cigarette Use ◽  
Cross Sectional ◽  
Media Messages ◽  
School Based ◽  
Nationally Representative ◽  
Actual Prevalence

ImportanceTwo components of social norms—descriptive (estimated prevalence) and injunctive (perceived acceptability)—can influence youth tobacco use.ObjectiveTo investigate electronic cigarettes (e-cigarette) and cigarette descriptive norms and measure the associations between overestimation of e-cigarette and cigarette prevalence and tobacco-related attitudes and behaviours.DesignCross-sectional.SettingSchool-based, using paper-and-pencil questionnaires.ParticipantsUS 6th-12th graders participating in the 2015 (n=17 711) and 2016 (n=20 675) National Youth Tobacco Survey.ExposureStudents estimated the percent of their grade-mates who they thought used e-cigarettes and cigarettes; the discordance between perceived versus grade-specific actual prevalence was used to categorise students as overestimating (1) neither product, (2) e-cigarettes only, (3) cigarettes only or (4) both products.OutcomesProduct-specific outcomes were curiosity and susceptibility (never users), as well as ever and current use (all students). Descriptive and multivariable logistic regression analyses were performed. Statistical significance was at P<0.05. Data were weighted to be nationally representative.ResultsMore students overestimated cigarette (74.0%) than e-cigarette prevalence (61.0%; P<0.05). However, the associations between e-cigarette-only overestimation and e-cigarette curiosity (adjusted OR (AOR)=3.29), susceptibility (AOR=2.59), ever use (AOR=5.86) and current use (AOR=8.15) were each significantly larger than the corresponding associations between cigarette-only overestimation and cigarette curiosity (AOR=1.50), susceptibility (AOR=1.54), ever use (AOR=2.04) and current use (AOR=2.52). Despite significant declines in actual e-cigarette use prevalence within each high school grade level during 2015–2016, perceived prevalence increased (11th and 12th grades) or remained unchanged (9th and 10th grades).ConclusionsFour of five US students overestimated peer e-cigarette or cigarette use. Counter-tobacco mass media messages can help denormalise tobacco use.

scholarly journals Smokers Are More Likely to Smoke More after the COVID-19 California Lockdown Order

2021 ◽  
Vol 18 (5) ◽  
pp. 2582
Author(s):  
Mariaelena Gonzalez ◽  
Anna E. Epperson ◽  
Bonnie Halpern-Felsher ◽  
Deanna M. Halliday ◽  
Anna V. Song
Keyword(s):  
Negative Binomial ◽  
Electronic Cigarettes ◽  
Negative Binomial Regression ◽  
Electronic Cigarette ◽  
Cigarette Consumption ◽  
Cigarette Use ◽  
Central California ◽  
The Past ◽  
Before And After ◽  
Consumption Rates

To determine if cigarette smoking, electronic cigarette use, and rate of consumption of these products differed before and after a pandemic lockdown order, two convenience samples of adults in Central California were recruited and surveyed before (March 2020) and after (May 2020) COVID-19 lockdown orders were implemented in California (n = 2571). Multivariable logistic and negative binomial regression models tested the association between adults recruited pre- or post-California lockdown and past month cigarette use, past month electronic cigarette use, past month cigarette consumption, and past month e-cigarette consumption among current users, controlling for demographic differences. Adults pre- and post-lockdown had equal odds of using cigarettes during the past month. Cigarette users who responded post-lockdown had higher cigarette consumption rates compared to cigarette users who responded pre-lockdown (IRR = 1.13, 95% CI = 1.15, 1.23). Adults who responded post-lockdown had lower odds of using electronic cigarettes during the past month compared to participants surveyed before the order (OR = 0.66, 95% CI: 0.55, 0.78). Cigarette users may be using more cigarettes during the state mandated lockdown. Possible causes for this increase in cigarette use may include increased stress, the change in workplace smokefree protections coverage, and increased opportunities for smoking or vaping.

scholarly journals Nicotine dependence of cigarette and heated tobacco users in Japan, 2019: a cross-sectional analysis of the JASTIS Study

2021 ◽  
pp. tobaccocontrol-2020-056237
Author(s):  
Yan Kwan Lau ◽  
Sumiyo Okawa ◽  
Rafael Meza ◽  
Kota Katanoda ◽  
Takahiro Tabuchi
Keyword(s):  
Nicotine Dependence ◽  
Tobacco Use ◽  
Cross Sectional ◽  
The Public ◽  
The Past ◽  
Cross Sectional Analysis ◽  
Binomial Regression ◽  
Sectional Analysis ◽  
Prevalence Ratios ◽  
Min Cut

ObjectivesJapan is currently the biggest market of heated tobacco products (HTPs) in the world. Little is known about nicotine dependence among HTP users. Thus, the objective was to assess the association of type of tobacco use and time-to-first-use, a marker of nicotine dependence.MethodsA cross-sectional analysis of the 2019 data from an internet cohort study was conducted. The analytical sample consisted of 2147 current (≥1 day use in the past 30 days) HTP and/or conventional cigarette users, aged 25+ years. Marginal structural binomial regression was used to estimate nicotine dependence prevalence ratios (PRs) for each category of tobacco use (exclusive daily cigarette, exclusive HTP (≥1 day), dual HTP+daily cigarette, dual HTP+non-daily cigarette), relative to exclusive, non-daily cigarette smoking.ResultsUsing a 5 min cut-off for time-to-first-use, the prevalence of nicotine dependence was higher among dual users of HTP and daily cigarettes (PR=1.38; 95% CI: 1.05 to 1.82) and exclusive, daily cigarette users (PR=1.48; 95% CI: 1.15 to 1.91), relative to exclusive, non-daily cigarette users. However, nicotine dependence among exclusive HTP users, and dual HTP+non-daily cigarette users, did not differ from that of exclusive, non-daily cigarette users. When using 15 and 30 min cut-offs, all types of users, including exclusive HTP, had higher levels of nicotine dependence relative to exclusive, non-daily cigarette users.ConclusionsRegardless of HTP use, daily cigarette users had higher prevalence of nicotine dependence compared with non-daily cigarette users. Exclusive HTP users had similar (or potentially higher) dependence compared with exclusive, non-daily cigarette users. Longitudinal studies are needed to interrogate the public health implications of growing HTP use worldwide.

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