Association between stages of change for smoking cessation and electronic cigarette use among adult smokers: A nationwide cross-sectional study in Korea

This study aimed to investigate whether smokers who are ready to quit are more likely to use electronic cigarette (e-cigarette) than those who are not. The association between the ever and current use of e-cigarettes with the stages of change (SOC) model was examined, which reflects the readiness to quit smoking. Current smokers were categorized based on the SOC (precontemplation, contemplation, and preparation). We investigated the associations between quit attempts, intention to quit, and stage of change with e-cigarette use in the general population and different age groups. We used data from the Korea Community Health Survey that was conducted nationwide in 2014, and 45,378 current smokers were included in the study. Adult smokers were more likely to use e-cigarettes simultaneously in the preparation and contemplation stages than in the precontemplation stage (adjusted odds ratio [AOR] of preparation stage: 2.88 and 95% confidence interval [CI]: 2.26–3.66; AOR of contemplation stage: 1.93 and 95% CI: 1.67–2.24). Ever use of e-cigarette was significantly associated with the contemplation stage in smokers younger than 50 years, while current e-cigarette use was greater in the contemplation stage than in the precontemplation stage at all ages. Both ever and current use of e-cigarettes were significantly related with the preparation stage among all age groups except 50–59 years. Because the use of e-cigarette among smokers may continually increase, public health guidance must be provided to different types of dual users. Previous studies on the association between e-cigarette use and the cognitive and behavioral aspects of smokers have conflicting results. This study highlights whether the use of e-cigarettes can be used as an indicator for the readiness to quit smoking. Thus, counselors can encourage smoking cessation and provide tailored interventions.