Association of psychological and behavioural economic factors with cigarette, water pipe, e-cigarette and heated tobacco use in Israel

Introduction
Identifying behavioural factors related to tobacco may provide a better understanding of what drives this behaviour and thus may inform more effective tobacco control programmes and policies. In this study, we explore associations between behavioural factors (time preferences, risk-taking, general self-efficacy and grit) and tobacco and e-cigarette use among adults.

Methods
4084 adults in the Smoking and Lifestyles in Israel study (2020) were examined. Multivariable logistic regression was used to estimate the association between behavioural factors and the following tobacco and e-cigarette use variables: factory-made cigarettes (FMC), roll-your-own (RYO) cigarettes, water pipes, e-cigarettes and heated tobacco products (HTPs). Dual use of combustible cigarettes and water pipes, combustible cigarettes and e-cigarettes, and combustible cigarettes and HTPs was also examined.

Results
Multivariable models revealed that impatient time preferences were significantly associated with higher odds of FMC, RYO and e-cigarette use (FMC: OR=1.68, 95% CI 1.32, 2.13; RYO: OR=1.40, 95% CI 1.00, 1.96; e-cigarettes: OR=1.93, 95% CI 1.14, 3.29) but not water pipes or HTPs. Higher risk-taking scores were associated with increased use of all tobacco products (eg, HTPs: OR=1.20; 95% CI 1.10, 1.32). Higher general self-efficacy was related to lower use of RYO (OR=0.82; 95% CI 0.69, 0.97), e-cigarettes (OR=0.46; 95% CI 0.35, 0.60) and HTPs (OR=0.32; 95% CI 0.24, 0.42). Increased general self-efficacy was also related to lower odds of dual use of all products, while impatience and higher risk-taking were associated with higher odds of dual use of all products. Grit was unrelated to the use of any product.

Conclusions
Risk-seeking and impatient preferences appear to increase the likelihood of using various tobacco products and e-cigarettes, whereas higher general self-efficacy appears as protective. These behavioural factors should be considered when designing interventions alongside evidence-based policies.