Understanding addiction in e-cigarette users – the EVAPE project

Abstract Background Electronic cigarettes (e-cigarettes) are often advertised as a healthier option to combustible cigarettes and as smoking cessation aid. However, e-cigarettes are a growing health concern and their addictive potential remains to be fully understood. Within the EValuation of the Addictive Potential of E-cigarettes (EVAPE) project, we studied subjective and objective measures of addiction in relation to e-cigarette use. Methods This cross-sectional analysis was based on 832 participants of the first wave (2016) of England from the ITC Four Country Smoking and Vaping (4CV) Survey, who were using e-cigarettes daily or weekly for at least four months. Perceived addiction to e-cigarettes was categorised as very vs. not/somewhat addicted, and perceived addictiveness of e-cigarettes relative to combustible cigarettes as equally/more addictive vs. less addictive. Objective measures of addiction included urge to vape, time to first vape after waking, frequency of use, and used nicotine strength. We examined associations between these objective and subjective measures of addiction using multivariate logistic regression, adjusted for age, gender, education, and cigarette smoking. Results 17.8% of participants reported feeling very addicted to e-cigarettes and 42.3% considered e-cigarettes equally/more addictive than combustible cigarettes. Those who felt very addicted had higher odds of regarding e-cigarettes as more addictive (OR 3.43 (95%-CI 2.29-5.19)). All objective measures of addiction were associated with higher perceived addiction, whereas only a shorter time to first vape was associated with perceived product addictiveness. Conclusions Subjective measures of addiction to e-cigarettes, in particular perceived addiction, correspond with objective measures. Understanding the addictive potential of e-cigarettes is the cornerstone for developing new strategies for prevention and treatment, and ultimately understanding their role from a public health perspective. Key messages Despite being promoted as healthier alternative to combustible cigarettes, electronic cigarettes are a growing health concern, also given their potential addictiveness. We found both subjective and objective indicators of addiction to be prevalent in a relevant proportion of electronic cigarette users, suggesting an addictive potential of electronic cigarettes.


Background:
Electronic cigarettes (e-cigarettes) are often advertised as a healthier option to combustible cigarettes and as smoking cessation aid.However, e-cigarettes are a growing health concern and their addictive potential remains to be fully understood.Within the EValuation of the Addictive Potential of E-cigarettes (EVAPE) project, we studied subjective and objective measures of addiction in relation to e-cigarette use.

Methods:
This cross-sectional analysis was based on 832 participants of the first wave (2016) of England from the ITC Four Country Smoking and Vaping (4CV) Survey, who were using ecigarettes daily or weekly for at least four months.Perceived addiction to e-cigarettes was categorised as very vs. not/ somewhat addicted, and perceived addictiveness of e-cigarettes relative to combustible cigarettes as equally/more addictive vs. less addictive.Objective measures of addiction included urge to vape, time to first vape after waking, frequency of use, and used nicotine strength.We examined associations between these objective and subjective measures of addiction using multivariate logistic regression, adjusted for age, gender, education, and cigarette smoking.Results: 17.8% of participants reported feeling very addicted to ecigarettes and 42.3% considered e-cigarettes equally/more addictive than combustible cigarettes.Those who felt very addicted had higher odds of regarding e-cigarettes as more addictive (OR 3.43 (95%-CI 2.29-5.19)).All objective measures of addiction were associated with higher perceived addiction, whereas only a shorter time to first vape was associated with perceived product addictiveness.

Conclusions:
Subjective measures of addiction to e-cigarettes, in particular perceived addiction, correspond with objective measures.Understanding the addictive potential of e-cigarettes is the Background: Characteristics of the place of residence have been proposed as a key determinant of physical and mental health, but so far, little experimental evidence exists.The quasi-random dispersal of refugees in Germany serves as a natural experiment to study the causal relationship between socio-economic deprivation and health as well as the impact of the social context on this relationship.

Methods:
Refugees subject to dispersal policy (n = 1723) were selected from the nation-wide German IAB-SOEP-BAMF Panel from 2016 to 2018.The effect of German Index of Socioeconomic Deprivation quintiles (Q1-Q5) on change between baseline (t0) and follow-up (t1) in mental (mcs) and physical (pcs) health component scales of SF-12 were analysed using multilevel linear regression.Social context variables were included in a mediation analysis.

Conclusions:
The quasi-random dispersal of refugees in Germany acts as a natural experiment to disentangle selection effects from the relationship between deprivation and health.Results suggest a negative effect of deprivation on physical health and a potential positive effect on mental health which can be partially explained by the social context.Limitations are the small sample sizes in deprived quintiles and short follow-up periods.This analysis can act as a magnifying glass for similar effects among other population groups, but causal paths need to be investigated further.

Key messages:
The quasi-random dispersal of refugees in Germany acts as a natural experiment to disentangle selection effects from the relationship between deprivation and health.
Results from a natural experiment suggest a negative effect of deprivation on physical health and a potential positive effect on mental health which can be partially explained by the social context.