Educational gradients in the use of electronic cigarettes and heat-not-burn tobacco products in Japan

PLoS One. 2018 Jan 12;13(1):e0191008. doi: 10.1371/journal.pone.0191008. eCollection 2018.

Abstract

Objectives: In addition to electronic cigarettes (e-cigarettes), tobacco companies have recently begun to sell heat-not-burn tobacco products, Ploom and iQOS in Japan. Previous research has reported an inverse association between combustible cigarette smoking and educational attainment, but little is known about the association for e-cigarettes, especially heat-not-burn tobacco products. Our objective was to analyze the relationship between educational attainment and e-cigarette and heat-not-burn tobacco use.

Setting: An internet survey (randomly sampled research agency panelists) in Japan.

Participants: A total of 7338 respondents aged 18-69 years in 2015 (3632 men and 3706women).

Primary measures: Adjusted odds ratios (ORs) of educational attainment for current smoking (combustible cigarettes), e-cigarette ever-use, and heat-not-burn ever-use were calculated by multivariable logistic regression models using covariates including socio-demographic factors. Stratified analyses according to smoking status (combustible cigarettes) were additionally performed for e-cigarette ever-use and heat-not-burn tobacco product ever-use.

Results: Associations between educational attainment and e-cigarette ever-use or heat-not-burn tobacco ever-use are not straightforward, although these associations are not statistically significant except for one cell. For example, using "graduate school" education as a reference category, adjusted ORs for "high school" were 1.44 (95% confidence interval [CI]: 0.85-2.44) for e-cigarettes ever-use and 0.75 (95% CI:0.19-2.97) for heat-not-burn tobacco product ever-use. Among current smokers, compared with "graduate school" (reference), those with lower educational attainment showed 0.6 to 0.7 ORs for e-cigarette ever-use: e.g.,"4-year university"(OR = 0.54, 95% CI:0.24-1.24) and "high school" (OR = 0.69, 95% CI: 0.30-1.60). Among former smokers, lower education indicated higher ORs for both e-cigarettes and heat-not-burn tobacco ever-use.

Conclusions: This study provides baseline information on educational gradients of e-cigarette and heat-not-burn tobacco products, ever-use. As heat-not-burn tobacco products are increasing their market share in Japan, continuous monitoring of these products will be necessary.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Electronic Nicotine Delivery Systems*
  • Female
  • Health Education*
  • Hot Temperature
  • Humans
  • Internet
  • Japan
  • Male
  • Middle Aged
  • Surveys and Questionnaires
  • Tobacco Products*
  • Young Adult

Grants and funding

This study was supported by the Ministry of Health, Labour and Welfare (URL: http://www.mhlw.go.jp/stf/seisakunitsuite/bunya/hokabunya/kenkyujigyou/index.html): Comprehensive Research on Life-Style Related Diseases including Cardiovascular Diseases and Diabetes Mellitus (H28-008) and the Ministry of Education, Culture, Sports, Science, and Technology (URL: http://www.mext.go.jp/a_menu/shinkou/hojyo/main5_a5.htm): grant-in-aid for Young Scientists B: number 15K19256. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.