Social norms for e-cigarettes and smoking: associations with initiation of e-cigarette use, intentions to quit smoking and quit attempts: findings from the EUREST-PLUS ITC Europe Surveys
Authors: McDermott Máirtín S , East Katherine A , Hitchman Sara C , McNeill Ann , Tountas Yannis , Demjén Tibor , Fernández Esteve , Mons Ute , Trofor Antigona C , Herbeć Aleksandra , Janik-Koncewicz Kinga , Fong Geoffrey T , Vardavas Constantine I ,   the EUREST-PLUS Consortium, Vardavas Constantine I , Glahn Andrea , Kyriakos Christina N , Nguyen Dominick , Nikitara Katerina , Radu-Loghin Cornel , Starchenko Polina , Tsatsakis Aristidis , Girvalaki Charis , Igoumenaki Chryssi , Papadakis Sophia , Papathanasaki Aikaterini , Tzatzarakis Manolis , Vardavas Alexander I , Bécuwe Nicolas , Deaconu Lavinia , Goudet Sophie , Hanley Christopher , Rivière Oscar , Demjén Tibor , Kiss Judit , Kovacs Anna Piroska , Fernández Esteve , Castellano Yolanda , Fu Marcela , Nogueira Sarah O , Tigova Olena , McNeill Ann , East Katherine , Hitchman Sara C , Mons Ute , Kahnert Sarah , Tountas Yannis , Behrakis Panagiotis , Filippidis Filippos T , Gratziou Christina , Katsaounou Paraskevi , Peleki Theodosia , Petroulia Ioanna , Tzavara Chara , Trofor Antigona Carmen , Eremia Marius , Lotrean Lucia , Mihaltan Florin , Rohde Gernot , Asano Tamaki , Cichon Claudia , Far Amy , Genton Céline , Jessner Melanie , Hedman Linnea , Janson Christer , Lindberg Ann , Maguire Beth , Ravara Sofia , Vaccaro Valérie , Ward Brian , Willemsen Marc , de Vries Hein , Hummel Karin , Nagelhout Gera E , Zatoński Witold A , Herbeć Aleksandra , Janik-Koncewicz Kinga , Przewoźniak Krzysztof , Zatoński Mateusz , Fong Geoffrey T , Agar Thomas K , Driezen Pete , Gravely Shannon , Quah Anne C K , Thompson Mary E 
Published: April 2020

Abstract

Background
Social norms have received little attention in relation to electronic cigarettes (EC). The current study examine social norms for EC use and smoking tobacco, and their associations with (i) initiation of EC use, (ii) intention to quit smoking and (iii) attempts to quit smoking.

Methods
Cross-sectional and longitudinal data analysis from Waves 1 and 2 of the ITC 6 European Country Survey and corresponding waves from England (the ITC Four Country Smoking and Vaping Survey). Current smokers at baseline, who heard of ECs and provided data at both waves were included (n = 3702). Complex samples logistic regression examined associations between the outcomes and descriptive (seeing EC use in public, close friends using ECs/smoking) and injunctive (public approves of ECs/smoking) norms, adjusting for country, demographics, EC use and heaviness of smoking.

Results
In longitudinal analyses, seeing EC use in public at least some days was the only social norm that predicted initiation of EC use between waves (OR = 1.66, 95%CI = 1.08–2.56). In the cross-sectional analysis, having an intention to quit was associated with seeing EC use in public (OR = 1.37, 95%CI = 1.04–1.81) and reporting fewer than three close friends smoke (OR = 0.59, 95%CI = 0.44–0.80). There was no association between any social norm and making a quit attempt between waves.

Conclusions
Initiation of EC use is predicted by seeing EC use in public, which was also associated with greater intention to quit smoking. Friends’ smoking was associated with lower intention to quit. These findings may allay concerns that increased visibility of ECs is renormalizing smoking amongst current smokers.