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Vol. 53. Num. 11.November 2017Pages 603-658
Vol. 53. Num. 11.November 2017Pages 603-658
Scientific Letter
DOI: 10.1016/j.arbr.2017.03.022
Perceptions and Use of the e-Cigarette Among University Students
Percepciones y uso del cigarrillo electrónico en estudiantes universitarios
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Eden Rodriguez
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erm789@inlumine.ual.es

Corresponding author.
, Tesifón Parrón, Raquel Alarcón
Áreas Médicas, Facultad de Ciencias de la Salud, Universidad de Almería, Almería, Spain
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Table 1. Sociodemographic Characteristics and Perceptions About the e-Cigarette and its Use.
Table 2. Logistic regression model of factors associated with the use of the e-cigarette.*
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The long-term effects of use of electronic cigarettes (e-cigarette) to control smoking has generated both debate and concern in the public health arena.1 The prevalence of this device varies among the various European countries.2 In general, however, it appears to be more widely used by individuals aged between 15 and 24 years,3 and e-cigarette use is positively associated with being a student.4 Nevertheless, little is known about the use of e-cigarettes and how they are perceived among young people in Spain. This study, then, was conducted in this setting, with the aim of determining the perceptions of university students of e-cigarettes and how they use these devices.

This was a cross-sectional study conducted in a reference population of undergraduate students enrolled in the 2015–2016 academic year in the Universidad de Almeria, with a calculated sample size of 373 students. Data were collected using a self-administered online questionnaire consisting of a total of 14 items ranging from sociodemographic variables, smoking habit, physical activity, and awareness, use and perception of the e-cigarette. For study purposes, an invitation to participate with a link to the questionnaire was sent to the emails of the 10897 students enrolled in the university. In total, 771 students answered the questionnaire; 745 of these were correctly completed.

Mean age of respondents was 21.9±3.9 years, 31.9% were smokers, 60.9% were non-smokers, and 7.1% were former smokers. In total, 22.6% of the participants had used an e-cigarette at some time, and 1.7% used it on a daily basis (Table 1). The logistic regression analysis showed that smokers (OR=9.41) and former smokers (OR=3.82) were more likely to use the device than non-smokers (Table 2).

Table 1.

Sociodemographic Characteristics and Perceptions About the e-Cigarette and its Use.

  Use of the e-Cigarette 
  No (577)Yes (168)P-value 
  No.  Percentage  No.  Percentage   
Age (mean±SD)  21.8±4.0    22.3±3.8    .06* 
Sex          .07** 
Men  241  74.4  83  25.6   
Women  336  79.8  85  20.2   
Faculty          .02** 
Engineering  93  78.8  25  21.2   
Education  115  83.9  22  16.1   
Health sciences  58  72.5  22  27.5   
Economic sciences  100  82  22  18   
Experimental sciences  42  72.4  16  27.6   
Law  48  67.6  23  32.4   
Humanities  49  80.3  12  19.7   
Psychology  56  80  14  20   
Social work  16  57.1  12  42.9   
Year of study          .35** 
First  168  75.3  55  24.7   
Second  132  75.4  43  24.6   
Third  106  76.8  32  23.2   
Fourth  171  81.8  38  18.2   
Smoking habit          <.01** 
Smoker  125  52.5  113  47.5   
Former smoker  38  71.7  15  28.3   
Never smoker  414  91.2  40  8.8   
Physical activity          .16** 
No  196  74.5  67  25.5   
Yes, <3 times/week  187  76.6  57  23.4   
Yes, ≥3 times/week  194  81.5  44  18.5   
Religion          .11** 
Christian  286  79.9  72  20.1   
Muslim  88.9  11.1   
Atheist/agnostic  259  74.9  87  25.1   
Other  24  75  25   
Perception of harmfulness          .61** 
It is less harmful  283  77.7  81  22.3   
It is equally harmful  169  78.6  46  21.4   
It is more harmful  34  63  20  37   
It is not harmful  20  83.3  16.7   
Don’t know  71  80.7  17  19.3   
Perception of effectiveness for quitting smoking          <.01** 
It is not effective  338  76.1  106  23.9   
It is effective  132  72.9  49  27.1   
Don’t know  107  89.2  13  10.8   
Perception of potential for addiction          <.01** 
It is less addictive  190  72  74  28   
It is equally addictive  289  82.3  62  17.7   
It is more addictive  18  47.4  20  52.6   
Don’t know  80  87  12  13   
Frequency of use of e-cigarette; n=745           
Daily use  13  1.7       
Occasional use  0.8       
Used it to try it  149  20       
Never used it  577  77.4       
The most important reason to start using the e-cigarette; n=168           
To stop smoking  27  16.1       
To reduce tobacco consumption  20  11.9       
Out of curiosity  111  66.1       
On the recommendation of friends  2.4       
Because it can be used in places where conventional cigarettes are banned  3.6       
*

P-value obtained by the Mann–Whitney U test.

**

P-value obtained by Chi-square test.

Table 2.

Logistic regression model of factors associated with the use of the e-cigarette.*

Factors  OR  95% CI  P-value 
Smoking habit
Never smoker  Ref.     
Former smoker  3.82  1.72–8.46  <.05 
Smoker  9.41  5.82–15.23  <.05 
Sex
Men  Ref.     
Women  0.60  0.37–0.95  <.05 
Perception of addiction
Less addictive  Ref.     
Equally addictive  0.47  0.29–0.76  <.05 
More addictive  2.26  0.96–5.29  >.05 

Independent variables specified in the model: age, sex (1: male; 2: female); religion (1: Christian; 2: Muslim; 3: atheist/agnostic; 4: other); smoking habit (0: never smoker; 1: former smoker; 2: smoker); physical activity (0: no; 1: yes); perception of harmfulness (0: it is not harmful; 1: it is less harmful; 2: it is equally harmful; 3: it is more harmful); perception of effectiveness for quitting smoking (0: no; 1: yes); perception of addiction (0: less addictive; 1: equally addictive; 2: more addictive).

*

Hosmer and Lemeshow test (sig. 0.998).

In our study, most respondents (59.6%) thought that the e-cigarette was not an effective aid for quitting smoking. This coincides with the findings of Valero-Juan and Suárez del Arco,5 and differs from those of Choi and Forster,6 who reported a significant percentage of respondents (44.5%) who thought that the device could help stop smoking. However, advertising for this product which suggested, among other messages, that the device is useful for stopping smoking,7 has been regulated in Spain since 2014. In line with these regulations, it is forbidden to attribute any efficacy to the device that has not been recognized by a competent body.8 The high perception of lack of efficacy of the e-cigarette found in our study may be associated with the regulations imposed on the advertising of these devices.

Our study also shows that most students (47.1%) believe that the e-cigarette is just as addictive as the conventional cigarette. The prevalence of this view may be due, among other factors, to certain features of the e-cigarette, such as its ability to release nicotine and the similarity of its appearance and use to the conventional cigarette. With regard to the perception of harmful effects, most students (48.9%) responded that the e-cigarette is less harmful than the conventional cigarette, in line with the findings of Choi and Forster.6

Most respondents (66.1%) started to use the device out of curiosity. This may be because the marketing techniques of manufacturers of these devices are aimed at making them attractive to young people,9 or because the e-cigarette is perceived to be sophisticated or modern among the young.9 These factors may make individuals curious to use the device or to experience the sensation that it might produce. Biener et al.10 also reported that the most common reason among participants for trying the devices was curiosity, while Tavolacci et al.11 found that the most common reason was to give up smoking.

In our study, most e-cigarette users were smokers (67.3%). This suggests the existence of dual use, i.e. students who use conventional cigarettes along with e-cigarettes.12 This was also reported in other studies.6,12,13 The significant association between the consumption of tobacco and the use of the e-cigarette found in our study is consistent with other studies in students.14,15 The relationship between the use of the e-cigarette and being a former smoker may be due to the fact that former smokers may be attracted by the device, prompting them to resume smoking6 and leading them to try the device or to use it more frequently.

The level of use of the e-cigarette in our study is almost the same as that reported by Tavolacci et al.,11 in which 23% of students used it, and somewhat higher than the 19% reported by Goniewicz and Zielinska-Danch.14 Choi and Forster6 found a level of use of 7%, while Sutfin et al.13 reported that less than 5% of respondents had used it. The high percentage obtained in our study suggests a growing interest in the device among students.

Finally, to conclude, we found that most students believe that the e-cigarette is not effective as a smoking cessation aid, and that it is just as addictive as the conventional cigarette. The most common reason for using the e-cigarette among students is curiosity, and tobacco consumption is related to the use of e-cigarette.

References
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Please cite this article as: Rodriguez E, Parrón T, Alarcón R. Percepciones y uso del cigarrillo electrónico en estudiantes universitarios. Arch Bronconeumol. 2017;53:650–652.

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