Experimental use of electronic cigarettes (e-cigarettes) is on the rise among children and teenagers in Wales and is more common than experimental use of conventional cigarettes in most 10- to 16-year-olds in that country, researchers report in an article published online April 15 in BMJ Open. Unlike the use of conventional tobacco products in this age group, however, sex, ethnic background, or family economic status are not significant contributing factors to e-cigarette use.
The findings of two cross-sectional studies indicate that 5.8% of 10- to 11-year-old Welsh children and 12.3% of 11- to 16-year-olds had tried e-cigarettes compared with 1.6% and 12.1%, respectively, who had tried tobacco, regardless of sex, ethnicity, or family economic status.
"Use of e-cigarettes at least once was more common than having smoked a conventional cigarette among all age groups, except the oldest [15-16 year olds]," writes Graham Moore, PhD, from the Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, School of Social Sciences at Cardiff University, United Kingdom, and colleagues in a news release.
In addition, although many experimental e-cigarette users reported never smoking a conventional cigarette, most regular e-cigarette users had also smoked tobacco, the authors write.
The researchers derived data for this investigation from the Child Exposure to Tobacco Smoke (CHETS) survey undertaken in Wales in 2014 and from the 2014 Welsh Health Behaviour in School-Aged Children (HBSC) Survey. The CHETS survey recruited a large nationally representative sample of primary school children aged 10 to 11 years, and the HBSC sample examined a large, nationally representative sample of secondary schoolchildren aged 11 to 16 years. In all, 1601 children aged 10 to 11 year- and 9055 children aged 11 to 16 year-oldse surveyed about their e-cigarette use.
Of the nearly 6% of primary school children in the CHETSil survey who reported ever using an e-cigarette, 3.7% reported that they only used them once, and 2.1% reported using them more than once. In addition, fewer than 2% of all the 10- to 11-year-olds reported having ever smoked conventional cigarettes, and less than 1% reported current smoking.
Within the HBSC sample, of the approximately 12% children who had ever tried e-cigarettes, 1.5% reported using them regularly (at least once a month). Of those secondary students who reported having ever smoked, 5.4% were current smokers. Lifetime prevalence of cannabis use in the group was 7.4%, the authors write.
At all ages, "tobacco use is substantially higher among children who have used e-cigarettes than among those who have not," the authors write. "By age 16 for example, while a minority of all young people have tried smoking, more than two-thirds of those who have used e-cigarettes report that they have also tried smoking."
In addition, the authors note, "The odds of e-cigarette use are more than 16 times greater for children aged 10–11 who had ever smoked tobacco, while among current smokers the odds of e-cigarette use were more than 17 times greater."
With respect to lifetime smoking in the older sample, nearly half (47.9%) of those who had tried smoking had also tried an e-cigarette compared with only 4.8% of those who have never tried tobacco.
In terms of relative risk ratio and absolute values, regular e-cigarette use was more likely among those who had smoked tobacco, "with 80% of regular e-cigarette users reporting having also smoked tobacco," the authors write, noting that current smoking was also strongly associated with e-cigarette use.
"However, 72.1% of young people who had used an e-cigarette a few times, and 43.2% of regular e-cigarette users, were from the larger group of young people who were not current smokers," they report, indicating that although current smoking is associated with a greater relative risk of e-cigarette use, "most young people who have used an e-cigarette are not smokers."
Lifetime cannabis use was also strongly associated with both experimental e-cigarette and regular e-cigarette use, the findings show.
The prevalence of experimental e-cigarette use across both study samples, which may reflect the fact that e-cigarettes are easier to obtain in these populations because of the lack of legal age restrictions, suggests e-cigarettes could become normalized "relatively quickly" among children and teenagers. However, the authors write, "there is a very low prevalence of regular use, which suggests that e-cigarettes are unlikely to be making a significant direct contribution to adolescent nicotine addiction."
Although the use of e-cigarettes as smoking cessation aids has been reported, the strong link between current smoking and e-cigarette use suggests children and teenagers are not using these products to help them quit smoking, the authors note.
Further research priorities included the collection of more detailed measures of e-cigarette use and longitudinal data to understand temporal relationships between e-cigarette and tobacco use, they conclude.
Both studies from which data are drawn were funded by the Public Health Division, Welsh Government. Dr Moore is supported by an MRC Population Health Scientist Fellowship. The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, a UK Clinical Research Collaboration Public Health Research Centre of Excellence, the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the Welsh Government, and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, provided funding support. The remaining authors have disclosed no relevant financial relationships.
BMJ Open. 2015;5:e007072. Full text
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