Relieving or aggravating the burden: Non-communicablediseases of dual users of electronic and conventional cigarettein Indonesia

NTRODUCTION Conventional (tobacco) and e-cigarette smoking prevalence is a growing concern in Indonesia. It has worsened as e-cigarettes complement conventional cigarettes, resulting in dual users, potentially causing an additional burden in terms of health.

METHODS Our study is a secondary data analysis of the 2018 National Basic Health (Riskesdas) Survey. The sample is limited to respondents aged 15–64 years who either only used e-cigarettes (e-cigarette single users), only used conventional cigarettes (conventional cigarette single users) or used both e-cigarettes and conventional cigarettes (dual users) in the last month. The sample size of the data was 174917 individuals. Our analysis utilized the logit and negative binomial regression to test whether the type of smoking behavior was associated with reporting to have a non-communicable diseases (NCDs) and multimorbidity, respectively.

RESULTS We found that: 1) dual users are positively associated to report having NCDs, such as liver failure (AOR=2.38; 95% CI: 2.32–2.44), diabetes (AOR=1.53; 95% CI: 1.50–1.57), hypertension (AOR=1.49; 95% CI: 1.48–1.51), and gum diseases (AOR=1.74; 95% CI: 1.73–1.74) compared to single users; and 2) e-cigarette single users are positively associated with reporting to have NCDs such as asthma (AOR=3.11; 95% CI: 3.01–3.22) and diabetes (AOR=16.01; 95% CI: 14.57–17.59), and dental problems such as broken teeth (AOR=1.04; 95% CI: 1.03–1.06), and they have disease multimorbidity compared to conventional cigarette single users.

CONCLUSIONS Simultaneous control of the consumption of e-cigarettes and conventional cigarettes is essential. In addition, it is important to promote policies to increase the price of e-cigarettes and conventional cigarettes to reduce smoking prevalence and prevent dual users. Moreover, as there are negative health consequences for conventional and e-cigarette single users or dual users, the most effective alternative is to stop smoking, not switching products

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