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.