Prevalence, demographic, socio-economic, and lifestyle factors associated with cigarette, e-cigarette, and dual use: evidence from the 2017–2021 Scottish Health Survey

Internal and Emergency Medicine https://doi.org/10.1007/s11739-024-03716-2 IM - ORIGINAL Prevalence, demographic, socio‑economic, and lifestyle factors associated with cigarette, e‑cigarette, and dual use: evidence from the 2017–2021 Scottish Health Survey Yusuff Adebayo Adebisi1 · Duaa Abdullah Bafail2 · Oluwatobi Ebenezer Oni3 Received: 21 May 2024 / Accepted: 10 July 2024 © The Author(s) 2024 Abstract Understanding the correlation between demographic, socio-economic, and lifestyle factors with e-cigarette use, cigarette smoking, and dual use is essential for targeted public health interventions. This study examines the prevalence of these behaviors in Scotland and identifies the associated factors. We conducted a repeated cross-sectional analysis of the Scottish Health Survey data from 2017 to 2021, leveraging data from 12,644 participants aged 16 and older: 2271 cigarette smokers, 687 e-cigarette users, 428 dual users, and 9258 never users. Weighted prevalences were calculated by age group, sex, and survey year, followed by weighted multinomial logistic regression to explore associated factors. The overall prevalences were 72.0% (95% CI 70.9–73.1) for never users, 18.9% (95% CI 17.9–19.9) for cigarette smokers, 5.5% (95% CI 5.0–6.1) for e-cigarette users, and 3.6% (95% CI 3.2–4.0) for dual users. From 2017 to 2021, cigarette smoking declined from 21.7% (95% CI 19.6–23.9) to 13.1% (95% CI 11.5–15.0), e-cigarette use from 6.5% (95% CI 5.4–7.8) to 4.8% (95% CI 3.6–6.4), and dual use from 3.7% (95% CI 2.9–4.6) to 2.7% (95% CI 1.9–3.7). Age was a critical factor, with the 25–34 age group more likely to use e-cigarettes (p = 0.007) and the 35–44 age group more likely to engage in dual use (p = 0.006) compared to the 16–24 age group. Males had higher odds of e-cigarette use than females (p = 0.031). White individuals had higher odds of using e-cigarettes (p = 0.023) and being dual users (p = 0.017) compared to non-whites. Previously married individuals had higher odds of dual use than singles (p = 0.031). Larger household sizes were linked to reduced odds of all three behaviors (p = 0.001). Rural residents were less likely to use e-cigarettes compared to urban residents (p = 0.025). Higher education correlated with lower odds of all three behaviors (p = 0.001). Manual occupation increased the likelihood of dual use (p = 0.042). Lower income and higher deprivation significantly increased the odds of all three behaviors (p < 0.001). Excessive alcohol consumption was associated with increased odds of the three behaviors (p < 0.001). Poor sleep quality correlated with increased odds of dual use (p = 0.002) and cigarette smoking (p < 0.001). Adherence to physical activity guidelines was associated with reduced odds of all three behaviors (cigarette smoking p < 0.001, e-cigarette use p = 0.031, dual use p = 0.016). In conclusion, this study showed a decline in the prevalence of cigarette smoking, e-cigarette use, and dual usage from 2017 to 2021 in Scotland. Significant associations with demographic, socio-economic, and lifestyle factors highlight the need for targeted public health interventions. Keywords Smoking · Demographic · Socio-economic · Lifestyle factors · Electronic cigarette · Scotland Introduction * Yusuff Adebayo Adebisi 1 College of Social Sciences, University of Glasgow, Glasgow, UK 2 Department of Clinical Pharmacology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia 3 School of Health and Well‑Being, University of Glasgow, Glasgow, UK Recent years have witnessed a significant transformation in the global tobacco landscape, notably marked by the advent and escalating popularity of e-cigarettes. An established consumer product, e-cigarettes impact behaviors and are now being used by over 80 million individuals worldwide as of 2021 [1]. This development has ignited debate within public health communities, particularly regarding their role in smoking cessation as well as long-term safety [2]. In the Vol.:(0123456789) Internal and Emergency Medicine United Kingdom and across Scotland in particular, e-cigarettes are reshaping traditional tobacco consumption trends [3, 4] and have even been recommended by the government as a safer option to tobacco smoking [5, 6]. Traditional cigarette smoking, responsible for over 8 million global deaths annually [7], now coexists with e-cigarette usage, introducing complex dynamics in smoking behaviors. According to the National Records of Scotland, there were an estimated 685,256 adult smokers in Scotland in 2022, with the Office for National Statistics reporting a smoking prevalence of 13.9%, down from 15.4% in 2019 [3]. Approximately, 10–13% of the adult population in Scotland use e-cigarettes, though usage by never-smokers remains rare at around 2.5%, according to the recent data from Smoking Toolkit Study [4]. E-cigarettes, initially received with scepticism, are now critically evaluated for their potential public health impacts [8]. For example, a recent Cochrane review provides highcertainty evidence that e-cigarettes with nicotine are more effective in quitting smoking than nicotine replacement therapies and e-cigarettes without nicotine [9]. This evidentiary base sets the stage for an examination of smoking habits, particularly in a Scottish context where specific trends and public health policies may uniquely influence these behaviors. Notably, a significant policy development is the proposed ban on the sale and supply of single-use e-cigarettes, set to take effect on 1 April 2025 [10]. Such policies underline the dynamic nature of public health interventions in Scotland, poised to distinctly impact smoking and vaping trends. The phenomenon of "dual use" involving both traditional cigarettes and e-cigarettes, presents new challenges and opportunities for public health strategies. It necessitates the need for clear understanding of the evolving tobacco use patterns, influenced by individual lifestyle choices, socioeconomic conditions, and demographic contexts. Scholarly opinions diverge on the phenomenon of dual use; some researchers view it as a transitional stage where smokers gradually switch to exclusive e-cigarette use, thereby refuting the gateway theory (which posits that the initial use of a less harmful drug can lead to later use of more harmful substances) [11–13]. Meanwhile, others interpret this co-use as indicative of the gateway effect of e-cigarettes, potentially leading to sustained nicotine addiction [14–17]. Public health efforts must navigate the challenge of minimizing e-cigarette risks, particularly among youth and non-smokers, while considering their benefits for smoking cessation. In Scotland, understanding the prevalence and factors related to dual use of e-cigarettes is important for informed policymaking, given the country's distinct health landscape and smoking patterns. Limited research, in peer-reviewed journals, has specifically focused on the Scottish popul (...truncated)