Evolution of nicotine product use in Ireland 2015-2023, and associations with quit intentions and attempts: an analysis of nationally representative repeated cross-sectional surveys.

Abstract

Nicotine product use (NPU; including combustible tobacco products and/or e-cigarettes) is changing rapidly worldwide. Aiming to inform an agile policy response, this study examined NPU trends, and associations with intentions and attempts to quit tobacco. Survey-weighted prevalences of NPU (tobacco and/or e-cigarette), tobacco, e-cigarette, and dual (tobacco and e-cigarette) use were estimated from 2015 to 2023 (excluding 2020 and 2021) using seven waves of the nationally representative Healthy Ireland survey (combined N = 52,167). Associations between sociodemographic factors and NPU, as well as between NPU and quit intentions and attempts, were examined using survey-weighted regression in the 2015 and 2023 waves. Between 2015 and 2023, decreases in NPU were non-significant (24·6% (1846/7502) to 22·9% (1688/7356), p_trend = 0·120), while tobacco use decreased (22·8% (1713/7502) to 17·7% (1303/7356), p_trend = 0·012), e-cigarette use increased (3·1% (230/7502) to 8·4% (614/7356), p_trend = 0·001) and dual use increased (1·3% (97/7502) to 3·1% (230/7356), p_trend = 0·006). Among those aged 15-24, NPU increased from 19·6% (214/1095) in 2015 to 30·0% (345/1149) in 2023. In 2015, dual use was strongly associated with higher odds of quit intentions and attempts to quit tobacco, compared to tobacco-only, but this was no longer the case in 2023. E-cigarette and dual use have more than doubled in Ireland, while tobacco declines have slowed. The most substantial changes occurred among 15-24-year-olds. Concurrently, the link between dual use and quit intentions and attempts attenuated. These findings underscore the need for stronger e-cigarette regulation and renewed policy efforts to achieve tobacco endgame in Ireland. None.