Summary
Introduction: Little is known about patterns of dual use of tobacco and electronic cigarettes (e-cigarettes), especially regarding the factors that
lead people to choose either product in particular situations. Identifying contextual factors that are associated with product use would enhance
understanding of the maintenance of dual product use.
Methods: Individuals who dual use (N = 102) completed ecological momentary assessment surveys via text message regarding the recent use
of tobacco and e-cigarettes for 2 weeks. Product legality, availability, craving, the presence of other people who smoke/vape, and social disapproval
were assessed. Data were analyzed using hierarchical logistic regression to identify factors associated with the likelihood of tobacco
versus e-cigarette use.
Results: Contexts associated with increased likelihood of using tobacco rather than e-cigarettes included being in the presence of other people
who smoke (odds ratio [OR] = 3.50, p < .0001) and experiencing elevated tobacco cigarette craving (OR = 3.51, p < .0001). Decreased likelihood
of tobacco over e-cigarette use was associated with smoking restrictions (OR = 0.26, p = .003), the presence of other people who vape
(OR = 0.38, p < .001), and experiencing elevated e-cigarette craving (OR = 0.23, p < .0001). The legality of e-cigarettes, social disapproval, and
the availability of the alternative product were not significantly associated with the use of one product over the other. An individual difference
score of relative tobacco (vs. e-cigarette) use pattern did not significantly moderate these effects.
Conclusions: This study provided essential information regarding behavioral patterns of dual use, which informs our understanding of people
who dual use. Contexts such as smoking restrictions, craving, and social context significantly differentiated between the use of tobacco and
e-cigarettes. This suggests product-specific motivations for dual use of tobacco and e-cigarettes in people who use both.
Implications: This study assessed the relationship between momentary contextual factors and dual use in a nationally recruited sample of
people who dual use. Assessments of dual use in daily life provided novel information regarding patterns of dual use as well as differential usemotivations
for each product. This information will be essential to build a theoretical framework of dual use of tobacco and e-cigarettes.
Citation
Betts JM. An Evaluation of the Contextual and Motivational Factors Associated with the Choice to Use Either Tobacco or Electronic Cigarettes in Dual Users. Ph.D. State University of New York at Buffalo; 2022.
