Characterizing reasons for e-cigarette use among Filipino adults who smoke: A cross-sectional study

Introduction: There is a potential risk of increased dual use of e-cigarettes and cigarettes among people who currently smoke and use e-cigarettes. Limited data are available on why people who smoke in the Philippines use e-cigarettes, including reasons that relate to smoking cessation. The current study addresses this gap to inform e-cigarette regulatory strategy. Methods: Data were collected via an online self-administered cross-sectional survey in November 2023 from 611 Filipino adults who smoke and reported current e-cigarette use (i.e. dual users). Participants selected their primary reason for e-cigarette use from a pre-populated list of 15 reasons. We conducted separate logistic regression models of each top reason for e-cigarette use, controlling for demographic and tobacco-use variables. Results: The top primary reasons for e-cigarette use were to cut down smoking (26%), to help quit smoking (24%), to use when not allowed to smoke cigarettes (11.6%), vaping is less harmful than smoking to others around me (11.6%), and 'I enjoy the flavor' (8.5%). Men were more likely than women to select to help quit (adjusted odds ratio, AOR=1.84; p=0.003, 95% CI: 1.22-2.77). Those intending to quit smoking within the year were more likely to select to help quit (AOR=5.22; p<0.001, 95% CI: 2.30-11.9) and to cut down (AOR=2.84, p<0.001, 95% CI: 1.36-5.95), and less likely to select to use when not allowed to smoke (AOR=0.25, p<0.001, 95% CI: 0.13-0.50) and because 'I enjoy the flavor' (AOR=0.24, p<0.001, 95% CI: 0.12-0.49). Conclusions: Some people who smoke in the Philippines use e-cigarettes in order to support smoking cessation; however, there is a risk of prolonged dual use if strong regulations are not implemented to promote complete cessation. Further research should investigate causal factors for e-cigarette use to identify policy pathways for reducing dual use and supporting cessation efforts.