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Tuberc Respir Dis > Accepted Articles
DOI: https://doi.org/10.4046/trd.2020.0166    [Accepted]
Published online January 6, 2021.
Nicotine Dependence and Stress Susceptibility in E-cigarette smokers: The Korea National Health and Nutrition Examination Survey 2013-2017
Jae Yeol Kim, 1, Hye Seon Kang, 2, Jae-Woo Jung, 1, Sun Young Jung, 3, Hye Jung Park, 4, Jong Sook Park, 5, Joo Hun Park, 6, Sang Haak Lee, 7, Eun Mi Chun, 8, Dong Il Park, 9, Jisook Park, 10, Hye Sook Choi, 11, on behalf of the Korean Smoking Cessation Study Group,
1Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
2Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
3College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
4Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Republic of Korea
5Department of Internal Medicine, College of Medicine, Soonchunhyang University, Bucheon, Republic of Korea
6Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
7Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
8Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
9Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Republic of Korea
10Department of Software Convergence, Seoul Women’s University College of Interdisciplinary Studies for Emerging Industries, Seoul, Republic of Korea
11Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
Correspondence:  Hye Sook Choi, Tel: +82-2-958-2824, Fax: +82-2-968-1848, 
Email: maxymus72@hanmail.net
Received: 24 December 2020   • Revised: 25 December 2020   • Accepted: 2 January 2021
Abstract
Background
E-cigarettes are steadily gaining popularity in Korea. However, the characteristics of e-cigarette smokers, especially their nicotine dependence and stress susceptibility have not been evaluated in comparison to those of non-smokers or combustible cigarettes smokers in Korea.
Methods
In this study, 28,059 participants from the Korea National Health and Nutrition Examination Survey (2013-2017) were classified into three groups: non-smokers, smokers (current- and ex-smokers of combustible cigarettes only), and e-smokers (current- and ex-smokers of e-cigarettes regardless of combustible cigarette use).
Results
Among the participants, 16,980 (60.5%), 9,247 (33.0%), and 1,832 (6.4%) were non-smokers, smokers, and e-smokers, respectively. E-smokers were younger, more educated, and had a higher household income than non-smokers or smokers. The number of e-smokers smoking within 5 minutes of waking up (31.5% vs 19.8%, P<0.001) and planning to quit smoking within 6 months (39.1% vs 35.7%, P<0.05) was greater than that of smokers. E-smokers perceived stress as “very much” (7.0% vs 4.4%, P<0.001) and “a lot” (29.1% vs 20.5%, P<0.001) more than non-smokers. Suicidal ideation (6.5% vs 4.7%, P<0.001), plans (2.4% vs 1.3%, P<0.001) and attempts (1.1% vs 0.5%, P<0.001) were higher in e-smokers than in non-smokers. Depressive episode in 1 year (14.2% vs 11.4%, P<0.05) and suicidal plans (2.4% vs 1.8%, P<0.05) were more frequent among e-smokers than among smokers.
Conclusion
E-smokers were younger, more educated, and had a higher income, but were more nicotine-dependent and susceptible to stress than non-smokers and smokers. Smoking cessation counseling should be tailored to the characteristics of e-smokers.
Key Words: e-cigarette, nicotine dependence, stress susceptibility


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