Tobacco and Nicotine Products Use Study

In Estonia, the most common tobacco and nicotine products are cigarettes, e-cigarettes (including disposable and nicotine-free), nicotine pads, snuff and heated tobacco. This study focused on the three products most consumed in Estonia: regular cigarettes, e-cigarettes and nicotine patches. While the consumption of regular cigarettes has decreased, the use of new alternative tobacco and nicotine products (e.g. e-cigarettes) has increased.

Although there have been many studies on tobacco and nicotine products in Estonia, they have not examined the use of these products in such depth. To better understand the use of alternative nicotine products, which are becoming increasingly popular among youth, this study provided an overview. It explored what these products are, how much they are used, and why. The study also investigated where these products are obtained and what attitudes and beliefs are associated with their use. Furthermore, the study described and analyzed the profile of tobacco and nicotine product users. It included personality traits, reasons for quitting, and activities that could prevent or reduce the use of tobacco and nicotine products. 

The results showed that 23% of the general population surveyed and 7% of the students use tobacco and nicotine products every day or almost every day. The general population most commonly uses cigarettes, while students most commonly use e-cigarettes. Overall, women are less likely to use the products, with 48% of women have never used them. 

Key Findings

• The highest proportion of occasional users (monthly users) is among those aged 34 and under. If a person does not know someone who uses tobacco and nicotine products, they are less likely to start using products themselves. 87% of the general population and 80% of students have thought about quitting.
• People consider cigarettes and snuff as the most harmful tobacco and nicotine products. E-cigarettes are considered harmful by 77% of students and 79% of the population. Hookah is regarded as the safest product by students.
• 57% of the general population and 67% of students choose tobacco and nicotine products based on taste. The general population prefers menthol-flavored products. Students, on the other hand, prefer sweet-flavoured products. Price is a choice factor for 61% of the population and around half of the students. However, there is no correlation between the respondent’s income level and the price of purchased products. 17% of the population and 14% of students consider availability as a factor. It is particularly important for young people living in rural areas of Estonia. 
• Pupils mainly buy products from friends (61%), a dealer (38%) or someone else (43%). Notably, around a third of 14–15-year-olds obtain products from a kiosk, petrol station, or ordinary consumer shop. This is despite Estonia’s Tobacco Act, which makes it illegal to sell tobacco and nicotine products to minors under 18 years old.
• Respondents aged 16–64 most commonly tried cigarettes as their first tobacco and nicotine product. About half of the population who first started smoking cigarettes had tried hookah as the next product, followed by about a third who had tried e-cigarettes. Similarly to the general population, students started using cigarettes as the first tobacco and nicotine product. The second most commonly tried products among students were e-cigarettes and nicotine pads.
• Among tobacco and nicotine product users, around 40% of the population and 68% of students have used more than one product at a time. Among the 16–64-year-old polydrug users, 34% prefer cigarettes, 29% e-cigarettes and 15% nicotine cartridges. 
• Significant proportion of the population and students prefer to use tobacco and nicotine products alone or with friends. Among young people who use tobacco and nicotine products, 44% rate their use experience as pleasurable and 35% as relaxing. Surveyed population are most likely to use the products because of habit (60%) and already developed dependence (44%).

Recommendations

Effective intervention and prevention measures include several strategies. These strategies are: strengthening alcohol and tobacco policies, improving the school environment for young people, developing parental skills among parents, and enhancing life skills among young people. Additionally, media campaigns, workplace-based preventions, and short interventions are also important. Short interventions include using online applications or websites to promote quitting nicotine and tobacco products.

Following the example of other countries, a holistic approach should be taken to regulate tobacco and nicotine products. It is important to harmonize regulations between different products. This helps reduce the risk of cross-use or switching to alternative products. Furthermore, it is essential to introduce restrictions that can adapt to new product developments and availability. The impact of various intervention and prevention measures may vary. The results, therefore, depend on each measure’s objective and target group. Implementation of possible intervention and prevention measures needs more research to ensure their applicability in Estonia.