Report on location-based promotions of less healthy food in supermarkets

As part of Cancer Research UK’s Tobacco Advisory Group funding stream, the Scottish Centre for Social Research (ScotCen) was funded to conduct a qualitative study, to explore the dual use of e-cigarettes and tobacco in those aged 45-64 in Scotland, in order to examine why levels of dual use are highest in this age group.
This research study explored the following questions:
The factors related to stopping the use of tobacco were:
Two individuals of the 21 interviewees had managed to quit both tobacco and e-cigarettes. Five participants claimed that they had used both tobacco and e-cigarettes, but never simultaneously, and did not necessarily consider themselves as dual users even if their use of these products overlapped.
Of those participants who were dual using, the most common reason for using e-cigarettes appeared to be circumventing tobacco restrictions, at work (e.g. on a building site) or in social settings. One individual did report that e-cigarettes were being used to reduce tobacco consumption.
The factors related to continue smoking tobacco only were:
The factors related to continue smoking e-cigarettes only were:
The factors relating to the participants’ future plans were:
Why is dual use prevalence higher in those aged 45-64?:
The qualitative interviews would suggest that this age group is quite a dynamic group, with relatively frequent changes in the trajectories of tobacco/e-cigarette use status reported. In addition, five of the 21 interviewees said that they did not dual use – they switched between tobacco and e-cigarette use (even if there was overlap, they did not consider it dual use). Still, at the time of interview, ten participants were no longer smoking tobacco. Four were dual using and eight were using e-cigarettes only, with only two quitting both tobacco and e-cigarettes. The fact that 10 of 21 interviewees have quit tobacco may be a positive result, although further support may be needed in order that e-cigarette use also decreases – those who only use e-cigarettes did not seem to have great motivation to reduce or stop using them. Those who had reverted to tobacco only, or were still dual using, may be more dependent smokers, and may need the assistance of smoking cessation services. The crucial role of tobacco control is also evident in that smokers had used e-cigarettes to circumvent tobacco restrictions, the cost of tobacco had resulted in quit attempts, reduced tobacco consumption and dual use.
Tables 1 and 2 below show that dual use was 3% in the whole adult population of Scotland in 2016-2019, but 16% among current smokers.
Dual use was still significantly higher in those aged 45-64 compared with other age groups combined (see Table 2).
Multiple logistic regression was conducted which demonstrated that the factors associated with dual use were:
Secondary analysis of the Scottish Health Survey sweeps 2016-2019 was conducted. Multiple logistic regression was conducted on the entire adult population, those aged 45-64, and those aged 16-44 and 65 and above. Factors associated with dual use in the different age groups were then identified.
Scottish Health Survey (SHeS) participants from the 2016-2019 sweeps who had given their consent to be recontacted were invited to take part in a qualitative interview. The purposive sampling was based on including dual users with:
We interviewed 21 SHeS dual users between 19th October 2021 and 23rd February 2022 by telephone or online, due to the pandemic. Interviews took an average of 75 minutes to complete. The topic guide incorporated a grid for completion as a joint endeavour between the interviewer and interviewee, focusing on the period when dual use had started. The topic guide also covered smoking and vaping profiles, views of tobacco and e-cigarette use, participant quit attempts (both tobacco and/or e-cigarettes), changes in dual use status over time, factors which made use of tobacco and/or e-cigarettes more and less likely, and future plans for tobacco and/or e-cig use.
We would like to thank Cancer Research UK for funding the research grant, and emphasise that the views expressed belong to the authors alone, and not Cancer Research UK. We also want to express our thanks to Dr Garth Reid at Public Health Scotland, Sheila Duffy at ASH Scotland and Morris Fraser and Jules Goodlet-Rowley at the Scottish Government.
Disclaimer: this report presents the findings from independent research conducted by the Scottish Centre of Social Research on behalf of Cancer Research UK. Unless stated to the contrary, the findings, suggestions, and recommendations presented in the report are grounded in the data collected for the research during a specific period of time, and do not represent the personal or professional views of the author(s) or the official view of the Scottish Centre for Social Research. Neither the author(s) nor the Scottish Centre for Social Research accept responsibility or any liability for how the findings might be interpreted or used by any other party other than Cancer Research UK. We reserve the right to issue a public correction for any misuse or misrepresentation of the research that is brought to our attention. Prior written consent must be sought from the copyright holder for the reproduction or distribution of the report and any of its findings in part or in full and include this disclaimer.
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