Differences in Adolescent E-cigarette and Cigarette Prevalence in Two Policy Environments: South Korea and the United States.

Abstract

In the context of different regulatory environments, different patterns of e-cigarette use have emerged among adolescents worldwide. The United States and South Korea are two examples, the latter of which has maintained much more extensive regulation of e-cigarettes. This analysis compares the prevalence of e-cigarette and conventional cigarette use between 2011 and 2015 from the Korean Youth Risk Behavior Web-based Survey and the U.S. National Youth Tobacco Survey, both nationally representative samples of middle and high school students that use similar questions. E-cigarette prevalence (past 30 days) among South Korean adolescents decreased from 4.7% in 2011 (95% confidence interval [CI]: 4.4-5.0) to 4.0% (3.7-4.3) in 2015 but increased dramatically among US adolescents from 0.9% (0.7-1.2) to 11.2% (9.9-12.7). Cigarette prevalence (past 30 days) decreased in South Korea from 12.1% (11.6-12.7) to 7.8% (CI: 7.3-8.3) and in the United States from 11.1% (9.5-12.6) to 6.1% (5.1-7.3). Combined prevalence of cigarette and e-cigarette use (adjusting for dual users) decreased in South Korea from 13.2% (12.7-13.8) to 8.5% (8.0-9.1) but increased in the United States from 11.3% (9.7-12.9) to 14.0% (12.4-15.7). In South Korea, where e-cigarettes are extensively regulated, adolescent e-cigarette use remained stable at a low level, whereas in the United States, where e-cigarette regulation has been limited, e-cigarette use increased. Combined e-cigarette plus cigarette use declined in South Korea whereas it increased in the United States. The restrictive policies in South Korea likely contributed to lower overall product use. This paper compared the strength of regulation of South Korea and the United States with the prevalence of adolescents' e-cigarette and cigarette use and suggests that more restrictive policies likely to contribute to lower e-cigarette use and overall use of e-cigarette and cigarette.