Tuberc Respir Dis.  2021 Apr;84(2):159-166. 10.4046/trd.2020.0166.

Nicotine Dependence and Stress Susceptibility in E-Cigarette Smokers: The Korea National Health and Nutrition Examination Survey 2013–2017

Affiliations
  • 1Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
  • 2Department of Internal Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
  • 3College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
  • 4Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
  • 5Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
  • 6Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
  • 7Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
  • 8Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
  • 9Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Republic of Korea
  • 10Department of Software Convergence, Seoul Women’s University College of Interdisciplinary Studies for Emerging Industries, Seoul, Republic of Korea
  • 11Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea

Abstract

Background
E-cigarettes are steadily gaining popularity in Korea. However, the characteristics of e-cigarette smokers, especially nicotine dependence and stress susceptibility, have not been evaluated in comparison to those of nonsmokers or combustible cigarette smokers in Korea.
Methods
In this study, 28,059 participants from the Korea National Health and Nutrition Examination Survey (2013–2017) were classified into the following three groups: non-smokers, smokers (current smokers and ex-smokers of combustible cigarettes only), and e-smokers (current smokers and ex-smokers of e-cigarettes regardless of combustible cigarette use).
Results
Among the participants, 16,980 (60.5%), 9,247 (33.0%), and 1,832 (6.4%) subjects were non-smokers, smokers, and e-smokers, respectively. E-smokers were younger, more educated, and had a higher household income than nonsmokers or smokers. The number of e-smokers who smoked within 5 minutes of waking up (31.5% vs. 19.8%, p<0.001) and who planned to quit smoking within 6 months (39.1% vs. 35.7%, p<0.05) was greater than that of smokers. E-smokers perceived stress as “very much” (7.0% vs. 4.4%, p<0.001) and “a lot” (29.1% vs. 20.5%, p<0.001) compared to non-smokers. Suicidal ideation (6.5% vs. 4.7%, p<0.001), plans (2.4% vs. 1.3%, p<0.001), and attempts (1.1% vs. 0.5%, p<0.001) were higher in e-smokers than in non-smokers. Depressive episodes in 1 year (14.2% vs. 11.4%, p<0.05) and suicidal plans (2.4% vs. 1.8%, p<0.05) were more frequent among e-smokers than among smokers.
Conclusion
E-smokers were younger, more educated, and had a higher income, but they were more dependent on nicotine and susceptible to stress than non-smokers and smokers. Smoking cessation counseling should be tailored according to the characteristics of e-smokers.

Keyword

E-cigarette; Nicotine Dependence; Stress Susceptibility
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