Electronic cigarette use and its association with smoking in Hong Kong Chinese adolescents

doi:10.1016/j.addbeh.2015.06.037

Addictive Behaviors

Volume 50, November 2015, Pages 124-127

https://doi.org/10.1016/j.addbeh.2015.06.037 Get rights and content

Highlights

•
E-cigarettes use is increasing in adolescents.
•
Association between e-cigarettes use and smoking in Chinese adolescents was less known.
•
E-cigarettes use was associated with smoking intention in never, experimental and ex-smokers.
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E-cigarette use was associated with nicotine addiction in current smokers.

Abstract

Background

Electronic cigarettes (e-cigarettes) are increasingly used in adolescents with unknown impacts on conventional cigarette smoking. We examined the associations of e-cigarette use with smoking intention, nicotine addiction and smoking cessation in Chinese adolescents.

Methods

A total of 45,128 students (age 14.6 ± 1.9; boys 51.4%) from 75 randomly selected schools in Hong Kong reported e-cigarette use (in the past 30 days), conventional cigarette use and socio-demographic characteristics in an anonymous questionnaire survey. Adjusted odds ratios (AORs) of intention to smoke, morning smoking urge, intention to quit and quit attempts; and beta-coefficient (β) of cigarette consumption per day were calculated in relation to e-cigarette use.

Results

E-cigarette use was associated with intention to smoke with an AOR (95% CI) of 1.74 (1.30–2.31) in all students, 2.18 (1.12–4.23) in never and 2.79 (2.05–3.79) in ever smokers (non-significant interaction by smoking status). The associations were also significant in experimental and former smokers but not in current smokers. In current smokers, e-cigarette use was significantly associated with heavier smoking (β 2.54, 95% CI 1.28–3.81) and morning smoking urge (AOR 2.54, 95% CI 1.50–3.11), and non-significantly associated with lower quit intention (0.76, 0.52–1.09) and attempts (0.80, 0.56–1.23).

Conclusions

E-cigarette use was associated with smoking intention in never, experimental and former smokers in Hong Kong Chinese adolescents. In current smokers, e-cigarette use was associated with nicotine addiction but not quit intention and attempts. Prospective studies with detailed measurements on e-cigarette use are warranted for further studies.

Introduction

Electronic cigarettes (e-cigarettes) are highly controversial. Apparently, e-cigarettes have less toxicants than conventional cigarettes (Goniewicz et al., 2014) but acute adverse effects on respiratory function have been reported (Vardavas et al., 2012) and long-term health effects and abuse liability are uncertain. E-cigarettes are advocated as smoking cessation aids, but conflicting findings have been reported by trials (Bullen et al., 2013, Caponnetto et al., 2013), longitudinal (Adkison et al., 2013, Grana et al., 2014) and cross-sectional (Brown, Beard, Kotz, Michie, & West, 2015) studies. Some had argued that popular use of e-cigarettes may undermine tobacco control policies and renormalizes smoking (Fairchild, Bayer, & Colgrove, 2014). Young people might be particularly vulnerable to e-cigarette use as it is relatively new and seemingly safe (Durmowicz, 2014).

The prevalence of current e-cigarette use has reached 13.0% in Hungary (children aged 13–15), 8.2% in Poland (high school students), 4.5% in Korea (children aged 13–18) and 1.1% in the US (middle school students). Among smokers, one-fourth (26%) of US and 75% of Korean adolescent smokers were currently using e-cigarettes (Dutra and Glantz, 2014, Lee et al., 2014). Cross-sectional studies among adolescents suggested that e-cigarette use was linked to heavier cigarette consumption and higher odds of smoking maintenance, but its associations with quit intention and attempts remain unclear (Dutra and Glantz, 2014, Lee et al., 2014, Lippert, in press). Some have advocated using e-cigarettes to lower smoking prevalence but the influence on smoking among never-smoking children is causing concern. Hong Kong, the most westernized and urbanized city of China with the strongest tobacco control measures and smoking denormalisation among Chinese cities, has the lowest smoking prevalence in the developed world (10.7% daily smoking in 2012–13) with decreasing smoking prevalence in adolescence (3.3% smoked in the past 30 days in 2012–13) (Mackay, Ritthiphakdee, & Reddy, 2013). We examined the associations of e-cigarette use with the intention to smoke, nicotine addiction and quitting in Hong Kong Chinese adolescents.

Section snippets

Study design and participants

A cross-sectional Youth Smoking Survey was conducted in 2012–13 in Secondary 1 (US grade 7) to 6 students (student response rate 96%) from 75 randomly selected schools (school response rate 20%). School sampling was stratified by district, mixed/single sex education, financial support, and school type. School non-responses were typically due to time and administrative issues, and the included schools were similar to all Hong Kong schools in district (Cohen's effect size 0.44), mixed/single sex

Results

Among 45,128 students, 51.4% were boys, mean age was 14.6 (± 1.9), 30.4% perceived family affluence as below average and 19.8% had paternal education below secondary school (data not shown in tables). The prevalence of e-cigarette use (past 30 days) was low overall (1.1%, 95% CI 1.0%–1.2%), but increased sharply with cigarette smoking status: never smokers 0.13%, experimenters 2.02%, former smokers 9.60% and current smokers 9.62% (Table 1). E-cigarette use was also more prevalent in students who

Discussion

Although not directly comparable, the prevalence of current e-cigarette use in Hong Kong adolescents (1.1%) was similar to that observed in the US (1.1%) but much lower than that in Korea, Poland and Hungary (4.5%–13.0%) (Durmowicz, 2014). E-cigarettes have been marketed as smoking cessation aids and were subject to regulation for therapeutic purposes in many countries but only few have totally banned e-cigarette sales or marketing (WHO Study Group on Tobacco Product Regulation, 2009). In Hong

Role of funding sources

This study was supported by the Food and Health Bureau, Hong Kong SAR Government. The funder has no role in study design, collection, analysis, or interpretation of data, writing the manuscript, and the decision to submit the manuscript for publication.

Contributors

MPW, SYH, and THL designed the study. MPW, SYH, and LTL collected and analysed the data. MPW, SYH, LTL, and THL drafted and agreed with the final version of the manuscript.

Conflict of interest

All authors declare that they have no conflicts of interest.

Acknowledgements

We thank students who participated in the survey, and the Food and Health Bureau (Hong Kong Special Administrative Region) for funding this study.

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China produces the majority of the world's electronic cigarettes (e-cigarettes) and e-cigarettes have become popular in the country, especially among young people. However, little is known about the characteristics of e-cigarette use in China and how it is associated with smoking cessation behavior. This study focuses on the adolescent group in China and examines their perception and use of e-cigarettes and the association with smoking abstinence.
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Citation Excerpt :
For example, 40%–93% of adolescent cigarette smokers in the U.S., the U.K., and Poland were lifetime e-cigarette users and 14%–58% were current dual users (Dutra & Glantz, 2014; Eastwood et al., 2015; Goniewicz et al., 2015). In addition, 35% and 10% of current cigarette smokers were dual users among Canadian and Hong Kong adolescents, respectively (Czoli, Hammond, Reid, Cole, & Leatherdale, 2015; Wang, Ho, Leung, & Lam, 2015). We found significant associations between demographics and e-cigarette use, which are consistent with what the literature suggests.
Despite a rapid increase in electronic cigarette (e-cigarette) use and substantial dual use of cigarettes and e-cigarettes among adolescents, little is currently known about adolescent e-cigarette use. Thus, this study aimed to investigate (a) rates of e-cigarette use and (b) significant factors associated with e-cigarette use among current cigarette users in adolescence.
We analyzed secondary data collected from a nationally representative sample of Korean adolescents. Our study sample included 6307 current smokers. Our dependent variable was e-cigarette use and consisted of three categories (nonuse, former use, and current use); independent variables included demographics, perceived stress, parental and friends' smoking, three characteristics of cigarette smoking, and other health risk behaviors. Descriptive statistics was used for the first aim; multinomial logistic regression analysis was performed for the second aim.
Of current cigarette users, 20% smoked e-cigarettes in their lifetime but not within the past 30 days (former users), and 42% smoked e-cigarettes in their lifetime and within the past 30 days (current users). Both former and current e-cigarette use were significantly associated with male gender, higher grades, higher weekly allowance, residence in urban areas, friends' smoking, daily smoking, a higher number of cigarettes smoked, and quit attempts. In addition, current e-cigarette use was significantly associated with at-risk drinking, lifetime drug use, and lifetime sexual intercourse.
E-cigarette use should be included in intervention strategies for smoking prevention and cessation. Strict regulations should be implemented in order to prohibit easy access to e-cigarettes and forbid advertising of e-cigarettes as well.

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Short CommunicationElectronic cigarette use and its association with smoking in Hong Kong Chinese adolescents

Highlights

Abstract

Background

Methods

Results

Conclusions

Introduction

Section snippets

Study design and participants

Results

Discussion

Role of funding sources

Contributors

Conflict of interest

Acknowledgements

American Journal of Preventive Medicine

Lancet

Journal of Adolescent Health

American Journal of Preventive Medicine

Journal of Adolescent Health

Drug and Alcohol Dependence

Chest

Addictive Behaviors

Time to first cigarette in the morning as an index of ability to quit smoking: Implication for nicotine dependence

Nicotine & Tobacco Research

Real-world effectiveness of e-cigarettes when used to aid smoking cessation: A cross-sectional population study

Addiction

Intentions to smoke cigarettes among never-smoking US middle and high school electronic cigarette users: National Youth Tobacco Survey, 2011–2013

Nicotine and Tobacco Research

EffiCiency and Safety of an eLectronic cigAreTte (ECLAT) as tobacco cigarettes substitute: A prospective 12-month randomized control design study

PLoS One

A systematic review of longitudinal population-based studies on the predictors of smoking cessation in adolescent and young adult smokers

Tobacco Control

Short Communication
Electronic cigarette use and its association with smoking in Hong Kong Chinese adolescents