title: Elucidating challenges that electronic cigarettes pose to tobacco control in Asia: a population-based national survey in Taiwan.
abstract: This study investigated the prevalence and correlates of electronic cigarettes (e-cigarettes) use in Taiwan.
  
  
  
  We studied a nationally representative random sample in the 2015 Taiwan Adult Smoking Behavior Survey.
  
  
  
  This study included 26 021 participants aged 15 years or older (51% women, 79% non-smokers, 16% aged 15-24 years), after excluding 31 persons (0.1%) who had missing information on e-cigarette use.
  
  
  
  The prevalence of ever having used e-cigarettes was calculated in the overall sample and by smoking status (current, former and never) or age (15-24, 25-44 and ≥45 years). We performed multivariable log-binomial regression to assess correlates of ever having used e-cigarettes among all participants and separately for subgroups by smoking status and age.
  
  
  
  Approximately 3% of all participants had ever used e-cigarettes. The prevalence of ever having used e-cigarettes was high in current smokers (14%) and people aged 18-24 years (7%). E-cigarette use was particularly common in people aged 15-24 years who were current (49-52%) or former (22-39%) smokers. Ever having used e-cigarettes was positively associated with tobacco smoking (adjusted prevalence ratio (aPR): 21.5, 95% CI 15.4 to 29.8, current smokers; aPR: 8.3, 95% CI 15.2 to 13.1, former smokers), younger age and high socioeconomic status. Age remained a significant factor of ever having used e-cigarettes across smoking status groups. Among non-smokers, men had a 2.4-fold (95% CI 1.5 to 3.8) greater prevalence of e-cigarette use than women.
  
  
  
  E-cigarette use was uncommon in the general population in Taiwan, but prevalence was high among smokers and young people. This study highlights challenges that e-cigarettes pose to tobacco control, which warrant high priority action by policymakers and public health professionals. E-cigarette regulations should focus on young people.
authors.affiliation: Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Hui-Chin
authors.initials: HC
authors.lastname: Chang
authors.affiliation: Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Yi-Wen
authors.initials: YW
authors.lastname: Tsai
authors.affiliation: Faculty of Pharmacy, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Ming-Neng
authors.initials: MN
authors.lastname: Shiu
authors.affiliation: Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Ying-Ting
authors.initials: YT
authors.lastname: Wang
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA.
authors.forename: Po-Yin
authors.initials: PY
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D044466:Asian People; D003430:Cross-Sectional Studies; D066300:Electronic Nicotine Delivery Systems / Q000706:statistics & numerical data*; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D040541:Marketing / Q000379:methods; D011050:Policy Making; D015995:Prevalence; D011634:Public Health; D011640:Public Policy; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology; D016540:Smoking Cessation / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013624:Taiwan / Q000453:epidemiology; D014029:Tobacco Use Disorder / Q000453:epidemiology*; D055815:Young Adult
keywords: EPIDEMIOLOGY; Electronic cigarettes; PUBLIC HEALTH; Smoking and tobacco; Taiwan; Young adult