Patterns of tobacco and e-cigarette use status in India: a cross-sectional survey of 3000 vapers in eight Indian cities

BACKGROUND: Tobacco smoking is one of the biggest and avoidable public health threats in the world, especially in low- and middle-income countries. India represents a highly complex public health environment due to the large number of smokers and complexities arising from tobacco use in different forms, including a variety of smokeless tobacco (SLT) products. Electronic cigarettes, an alternative nicotine delivery system with significantly less harmful emissions than smoke, could be an option for those who are unable to achieve smoking abstinence using other available means. This study, which we believe is the first of this kind in India, was conducted to obtain data on the characteristics and tobacco use profile of e-cigarette users (vapers) in India. METHODS: An interview-based survey was performed in the 8 largest metropolitan cities in India using a convenience sampling approach involving a total of 3000 subjects. Inclusion criteria were being a current e-cigarette user and aged 18 years or more. Interviewers were asked to continue recruitment until a total sample of 375 was reached in each target city. RESULTS: A total of 3000 vapers (81.4% males and 18.6% females, median age 29 years) participated to the study. The majority (80%) were first exposed to nicotine via tobacco smoking, SLT use, or both. Most of the subjects (79%) believed that e-cigarettes were less harmful than smoking. The vast majority of smokers (71.3%) reported smoking cessation (30.0%) or reduction in consumption (41.3%) with the help of e-cigarettes. Similar changes were observed in SLT users. Participants reported minimal side effects and some health benefits after e-cigarette use initiation. CONCLUSION: Indian vapers who participated to this study were predominantly smokers and SLT users before e-cigarette use initiation, with the majority subsequently quitting or reducing tobacco use. Minimal side effects of e-cigarette were experienced, while some health benefits were also reported.