Elsevier

Public Health

Volume 129, Issue 9, September 2015, Pages 1150-1156
Public Health

Original Research
Electronic cigarette use in young people in Great Britain 2013–2014

https://doi.org/10.1016/j.puhe.2015.07.009Get rights and content

Highlights

  • E-cigarette use by youth is increasing, but largely confined to those who smoke.

  • A growing proportion of youth in GB deem e-cigarettes to be as harmful as smoking.

  • Regular use of e-cigarettes in those who have never smoked remains around 0.2%.

  • Ever use increased to 8.2% of youth, 80% of whom have used the product once or twice.

  • Smoking came prior to e-cigarettes for 70% in 2014, but for 8% e-cigarettes came first.

Abstract

Objectives

The recent growth in the market for electronic cigarettes (e-cigarettes) has led to concerns over their use by young people. It is therefore important to examine trends in the perception and use of e-cigarettes and conventional cigarettes in this group.

Study design

Two-wave cross-sectional survey design.

Methods

Young people aged 11–18 in Great Britain were surveyed online by YouGov in 2013 and 2014. Use of e-cigarettes, together with perceived health harms and intention to use were assessed and compared in relation to cigarette smoking history, age and gender.

Results

Ever-use of e-cigarettes increased significantly from 4.6% (95% CI 3.8–5.7) in 2013 to 8.2% (95% CI 7.0–9.6) in 2014. Monthly or more use of e-cigarettes increased from 0.9% (95% CI 0.5–1.5) to 1.7 (1.2–2.4), but remained rare in never-smokers at under 0.2%. The proportion of young people who perceived e-cigarettes to be less harmful to users than cigarettes fell from 73.4% (95% CI 71.0–75.8) to 66.9% (95% CI 64.5–69.2), while the proportion who considered e-cigarettes to cause similar levels of harm increased from 11.8% (95% CI 10.0–13.5) to 18.2% (95% CI 16.3–20.1). Of the 8.2% of e-cigarette ever-users in 2014, 69.8% (95% CI 62.2%–77.3%) had smoked a cigarette prior to using an e-cigarette, while 8.2% (95% CI 4.1%–12.2%) first smoked a cigarette after e-cigarette use.

Conclusions

A growing proportion of young people in Great Britain believe e-cigarettes are as harmful as smoking tobacco. Use of e-cigarettes by young people is increasing, but is largely confined to those who smoke.

Introduction

Electronic devices to deliver nicotine vapour without combustion (here referred to as e-cigarettes, but also termed electronic cigarettes or e-shisha) were invented as recently as 2003, and have been available in Europe since 2006.1 In Great Britain, an estimated 2.6 million individuals use e-cigarettes.2 The e-cigarette market has been estimated to be worth $3bn globally,3 and forecast to reach $50bn by the year 2025.4

This rapid rise in availability has been accompanied by controversy. Proponents1, 5, 6 argue that e-cigarettes could be a disruptive technology with the potential to significantly reduce the global total of six million deaths per year attributable to conventional cigarette smoking,7 as well as to reduce harm to non-using bystanders.8, 9 A recent Cochrane review found evidence that e-cigarettes help smokers to stop smoking long-term and make substantial reductions in cigarette consumption, compared with placebo e-cigarettes (and in one randomised controlled trial, nicotine patches) although the small number of studies and other limitations indicated that further research was necessary to substantiate the findings.10 Opponents, on the other hand, point out that there is relatively little research on the safety of e-cigarettes, their efficacy as cessation aids, the effects of second hand vapour, the long term health effects, quality standards in production, the adequacy and consistency of nicotine delivery, whether they introduce never smokers to nicotine or subsequent cigarette smoking or renormalize smoking.11, 12

There is a limited, albeit growing, body of research on the prevalence of e-cigarette use in young people. Although the methods used to sample the population and to define e-cigarette use vary substantially, available evidence suggests that there is a wide variation in estimated prevalence of current use of e-cigarettes, ranging from 4.7% in Korea13 to 29.9% in Poland.14 In the United States the prevalence of past 30-day e-cigarette use among adolescents increased from 0.9% in 2010 to 2.3% in 2011.15 Use of e-cigarettes appears, however, to be largely concentrated in those already smoking conventional cigarettes. Across Europe, 1.1% of never-smokers aged 15 and above had ever tried an e-cigarette.16

This study investigates the prevalence of use, perception of harm of e-cigarettes, and intentions to use e-cigarettes and conventional cigarettes in two national samples of 11–18 year olds in Great Britain in 2013 and 2014. Great Britain is an important jurisdiction to study within the international context, as there are currently few restrictions on the marketing and sale of e-cigarettes. Given the rapid evolution of the e-cigarette landscape, we chose to use internet surveys rather than schools or household based surveys which take considerable time to implement and gather data. To ascertain the level of sustained use of these products we asked about both occasional and regular use.

Section snippets

Methods

The charity Action on Smoking and Health (ASH) commissioned YouGov PLC to conduct a national survey of 11–18 year olds in Great Britain in 2013 and again in 2014 from their panel of over 400,000 individuals aged 16 and over in Britain. Panel members have been recruited from various online and offline sources, including standard advertising and strategic partnerships with a broad range of websites. Panel members disclose sociodemographic information when initially registered and this information

Results

A total of 2177 11–18 year olds were recruited in 2013, and 2068 in 2014. As 231 individuals from the 2013 sample were again sampled in 2014, half were randomly assigned to 2013 (n = 115) and half randomly assigned to 2014 (n = 116), resulting in a final cohort of 2062 individuals recruited in 2013 and 1952 individuals recruited in 2014 (Table 1). There were no significant differences in gender, age, region or smoking status between 2013 and 2014. There was, however, a significant difference in

Discussion

This study demonstrates a substantial increase in awareness and use of e-cigarettes in young people in the UK between 2013 and 2014. Ever use almost doubled to 8.2% of young people, though 80% of this use comprised individuals using the product once or twice. Monthly or more e-cigarette use also doubled, to 1.7%, and the change was statistically significant in the logistic modelling. Smokers were much more likely than non-smokers to use or intend to use e-cigarettes: monthly or more use of

Ethical approval

The body responsible for collecting the data (YouGov) adhere to the code of conduct set out by the Market Research Society (https://www.mrs.org.uk/pdf/mrs%20code%20of%20conduct%202014.pdf). Informed consent to take part in the online survey was provided either by the parents of those aged 11–15, or by those individuals aged 16–18.

Funding

Action on Smoking and Health commission and fund the annual youth survey, which is conducted by YouGov. Public Health England provided the analytical resources for

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