Transition from experimentation with tobacco and nicotine products to regular smoking in Europe

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.