Use of electronic cigarettes and heated tobacco products during the Covid-19 pandemic

Only a few studies investigated changes in electronic cigarette (e-cigarette) and heated tobacco product (HTP) use during pandemic restrictions. We conducted a web-based cross-sectional study of a representative sample of 6,003 Italian adults during the strictest phase of the Covid-19 lockdown (April–May 2020). Participants were asked to report changes in e-cigarette and HTP use compared to before the pandemic. E-cigarette users increased from 8.1% to 9.1% and HTP users from 4.0% to 4.5%. Among e-cigarette non-users before lockdown, 1.8% started using e-cigarettes during lockdown. New users were more frequently younger (p for trend 0.001), men (odds ratio, OR 1.56; 95% confidence interval, CI: 1.03–2.34), cannabis users (OR 2.35; 95% CI: 1.33–4.13), gamblers (OR 3.34; 95% CI: 2.18–5.11) and individuals with anxiety symptoms (OR 1.58; 95% CI: 1.00–2.52). 1.0% of HTP non-users started using it during lockdown. New users were less frequently current than never cigarette smokers (OR 0.19; 95% CI: 0.06–0.61) and more frequently gamblers (OR 2.23; 95% CI: 1.22–4.07). E-cigarettes and HTPs played little role as smoking cessation tools for hardcore smokers but rather provided opportunities for young never smokers to engage in socially acceptable activities, perhaps reflecting the obstacles they faced in obtaining other addictive substances during confinement.

Trends and correlates of hardcore smoking in India: findings from the Global Adult Tobacco Surveys 1 & 2

Background: Data on prevalence of hardcore smoking (HCS) among different socioeconomic status (SES) groups in low- and middle-income countries are limited. We looked at the prevalence and pattern of HCS in India with the following objectives: 1) to analyse the association between SES and HCS, 2) to find trends in HCS in different SES groups and 3) to find state-wide variations in hardcore smoking. Methods: Data of individuals aged ≥25 years from the Global Adult Tobacco Survey (GATS) India 2009-10 (N= 9223) and 2016-17 (N= 7647) were used for this study. If an individual met all the following criteria: (1) current smoker, (2) smokes 10 or more cigarettes/day, (3) smokes first puff within 30 minutes after waking up, (4) no quit attempt in last 12 months, (5) no intention to quit at all or in the next 12 months, (6) lack of knowledge of harmful effect of smoking, s/he was identified as a hardcore smoker. Multiple regression analysis was done to find the factors associated with HCS. Results: Prevalence of HCS deceased from 2.5% in GATS 1 to 1.9% in GATS 2: males from 6.2% to 3.9% and females from 0.3% to 0.2%. Compared to the richest group the poorest, poor and those who belonged to the middle-income group were more likely to report HCS in GATS 1 and 2. However, only in the poorest SES group there was an increase in the proportion of hardcore smokers in GATS 2 compared to GATS 1. Other factors that were significantly associated with HCS in both surveys were male gender, working adults, those with lower education, early initiation of smoking and households without any rules for smoking inside the home. Conclusions: Tobacco control and cessation efforts need to focus on individuals of poor SES groups particularly in the high prevalence Indian states.

Factors Associated with Attempt for Smoking Cessation among Hardcore Smokers in Taiwan

Background: Tobacco control activities have mostly influenced those smokers who found it easier to quit and, thus, remaining smokers are those who are less likely to stop smoking. This phenomenon is called “hardening hypothesis,” which individuals unwilling or unable to quit smoking and likely to remain so. The aim of this study was to identify the factors correlated with smoking cessation among hardcore smokers. Methods: A cross-sectional descriptive correlational research design was employed. Hardcore smokers from communities in Taiwan were recruited to participate in the study (N = 187). Self-report questionnaires were used to collect demographic data as well as data on nicotine dependence, quitting self-efficacy, social smoking motives, attitudes towards the Tobacco Hazards Prevention Act (THPA), and smoking cessation. Logistic regression analysis was used to examine the factors that were related to quit smoking. Results: About 30.3% (n = 54) reported having experienced quitting smoking over 7 days in the past year. Logistic regression analysis indicated that attitudes towards the THPA was identified as a particularly important factor contributing to the increase in smoking cessation among hardcore smokers. Conclusions: Nurses should cooperate with smoking cessation coaches to facilitate the improvement of attitudes towards the THPA as a key means through which to increase the smoking cessation rate among hardcore smokers.

Characteristics of Hardcore Male Smokers in Taiwan: A Qualitative Study

Objectives: The purpose of this study was to explore the characteristics of hardcore smokers who were previously hospitalized. Study design: A descriptive qualitative design was used to investigate a sample of 29 male Taiwanese smokers. Methods: Male hardcore smokers were recruited at a hospital in southern Taiwan and their smoking behaviors and attitudes were explored in semistructured interviews. Inclusion criteria were: (1) smoking at least weekly or daily during the past year, (2) 100 cigarettes during the lifetime, (3) persistent smoking, or (4) at least one hospitalization. Audio-recorded interview data were analyzed using content categorization of the responses. Results: Four main themes emerged to describe characteristics of Taiwanese hardcore smokers: (1) physiological and psychological dependence, (2) no motivation to quit despite knowledge of negative health consequences, (3) social interaction and cultural norms, and (4) negative attitudes toward, but compliance with, smoking-free policies. Conclusions: The results can inform public health nurses of characteristics of Taiwanese hardcore smokers, which in turn may develop effective smoking cessation program to increase smoking cessation rate among Taiwanese hardcore smokers.

Are smokers “hardening” or rather “softening”? An ecological and multilevel analysis across 28 European Union countries

BackgroundTobacco control policies can reduce smoking prevalence. These measures may be less effective where smoking prevalence has significantly declined, as the remaining smokers have “hardened”. Our aim was to empirically evaluate the “hardening hypothesis” at the population level in the European Union (EU) and explore factors associated with hardcore smoking.MethodsWe conducted two separate analyses in the EU using data on smoking from the Eurobarometer surveys (2009–2017, n=112 745). 1) A panel-data fixed-effects linear regression to investigate changes over time in the percentage of hardcore smokers in relation to standardised smoking prevalence at the country level. 2) A multilevel logistic regression analysis with hardcore (daily smokers, ≥15 cigarettes per day who have not attempted to quit in the last 12 months) or light (<5 cigarettes per day) smoking as the dependent variable and time as the main independent variable, controlling for individual and ecological variables.ResultsWe studied 29 010 current smokers (43.8% hardcore smokers and 14.7% light smokers). The prevalence of hardcore smoking among adult smokers increased by 0.55 (95% CI 0.14–0.96) percentage points per each additional percentage point in the overall smoking prevalence. The odds of being a hardcore smoker increased over time and were higher in middle-aged males and people with financial difficulties, while the odds of being a light smoker significantly declined among females.ConclusionThis study does not support the “hardening hypothesis” in the EU between 2009 and 2017, but suggests a softening of the smoking population. Existing tobacco control policies are likely to be suitable to further decrease smoking prevalence in Europe.