Abstract
BackgroundPublic health concerns regarding e-cigarettes and debate on appropriate regulatory responses are focusing on the need to prevent child access to these devices. However, little is currently known about the characteristics of those young people that are accessing e-cigarettes.MethodsUsing a cross-sectional survey of 14-17 year old school students in North West England (n = 16,193) we examined associations between e-cigarette access and demographics, conventional smoking behaviours, alcohol consumption, and methods of accessing cigarettes and alcohol. Access to e-cigarettes was identified through a question asking students if they had ever tried or purchased e-cigarettes.ResultsOne in five participants reported having accessed e-cigarettes (19.2%). Prevalence was highest among smokers (rising to 75.8% in those smoking >5 per day), although 15.8% of teenagers that had accessed e-cigarettes had never smoked conventional cigarettes (v.13.6% being ex-smokers). E-cigarette access was independently associated with male gender, having parents/guardians that smoke and students’ alcohol use. Compared with non-drinkers, teenagers that drank alcohol at least weekly and binge drank were more likely to have accessed e-cigarettes (adjusted odds ratio [AOR] 1.89, P < 0.001), with this association particularly strong among never-smokers (AOR 4.59, P < 0.001). Among drinkers, e-cigarette access was related to: drinking to get drunk, alcohol-related violence, consumption of spirits; self-purchase of alcohol from shops or supermarkets; and accessing alcohol by recruiting adult proxy purchasers outside shops.ConclusionsThere is an urgent need for controls on the promotion and sale of e-cigarettes to children. Findings suggest that e-cigarettes are being accessed by teenagers more for experimentation than smoking cessation. Those most likely to access e-cigarettes may already be familiar with illicit methods of accessing age-restricted substances.
Highlights
Public health concerns regarding e-cigarettes and debate on appropriate regulatory responses are focusing on the need to prevent child access to these devices
Research on e-cigarette use in children is only just emerging, yet studies in several countries are showing their rapid penetration into adolescent markets
E-cigarette access showed a strong relationship with alcohol use
Summary
Public health concerns regarding e-cigarettes and debate on appropriate regulatory responses are focusing on the need to prevent child access to these devices. Rapid growth in the marketing and use of e-cigarettes is generating widespread public health debate across the globe. Unlike many nicotine replacement therapies, e-cigarettes are often marketed to smokers as Hughes et al BMC Public Health (2015) 15:244 that an addictive drug can be promoted to, and cheaply accessed by, children [7]. Research on e-cigarette use in children is only just emerging, yet studies in several countries are showing their rapid penetration into adolescent markets. In the USA, studies show that lifetime e-cigarette use in grades 6-12 school students (~age 11-18) more than doubled from 3.3% in 2011 to 6.8% in 2012 [1]. In France, a 2012 study of Parisian school students aged 1219 years found that 8.1% had tried e-cigarettes, with prevalence ranging from 4.4% of non-smokers up to 33.4% of regular smokers [8]. In Korea, prevalence of ever using e-cigarettes in 13-18 year olds was found to have increased almost 20-fold between 2008 and 2011, from 0.5% to 9.4%, with 1.4% of e-cigarette users in 2011 having never smoked cigarettes [9]
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