# Analysis of the Dual Use of Electronic Cigarettes and Conventional Tobacco According to the Survey on Alcohol and Other Drugs in the General Population in Spain (EDADES 2022)

## TL;DR

This study examines the dual use of electronic cigarettes and conventional tobacco in Spain, finding that 1.55% of the population uses both.

## Contribution

The study provides new insights into dual use patterns and associated sociodemographic and health factors in Spain.

## Key findings

- Dual users were younger and had lower income compared to exclusive tobacco users.
- Dual users reported poorer self-perceived health than exclusive electronic cigarette users.
- Former electronic cigarette users mostly returned to conventional tobacco.

## Abstract

Introduction: Electronic nicotine delivery systems present emerging challenges for public health. This study describes the use of electronic cigarettes (ECs) and dual consumption patterns in the Spanish population. Material and Methods: A descriptive cross-sectional study was conducted using data from the 2022 Survey on Alcohol and Other Drugs in the General Population in Spain (EDADES), targeting individuals aged 15–64. Variables included sociodemographic characteristics, dual consumption (defined as use of both EC and conventional tobacco, daily and/or within the last 30 days), perceived health status, and self-perceived risk of ECs or tobacco consumption. Analysis included descriptive statistics and multinomial logistic regression. Results: The study included 26,337 participants, (51% men). The prevalence of dual users in the population was 1.55% (95%CI: 1.40–1.70). Each additional year of age was associated with increased odds of exclusive tobacco use (aOR: 1.04; IC95%: 1.02–1.05). Compared to dual users, individuals with monthly incomes of 1000–1499 and 1500–2499 had higher odds of exclusive tobacco use (aOR 1.56; 95%CI: 1.03–2.34 and 1.90; 95%CI: 1.28–2.82, respectively). Dual use was associated with a ‘fair’ perceived health compared to exclusive EC users (aOR: 0.28; 95%CI: 0.13–0.60) and exclusive tobacco users (aOR: 0.62; 95%CI: 0.47–0.83), and with ‘poor/very poor’ health compared to exclusive tobacco users (OR: 0.43; 95%CI: 0.24–0.79). Among former EC users, 71% reported exclusive conventional tobacco use in the past 30 days. Conclusion: The prevalence of dual use in Spain was 1.55%. Dual users were younger than conventional tobacco smokers and, had lower income levels and poorer self-perceived health status compared to exclusive EC users.