School-level electronic cigarette use prevalence and student-level tobacco use intention and behaviours

Jianjiu Chen,Man Ping Wang,Tai Hing Lam,Lok Tung Leung,Sai Yin Ho

doi:10.1038/s41598-018-38266-z

Abstract

Prevalent electronic cigarette (e-cigarette) use in schools may undermine tobacco denormalisation, and thus increase tobacco use in students. We investigated the associations of school-level e-cigarette use prevalence with student-level intention and behaviours related to e-cigarettes, cigarettes, and other tobacco products. In a 2014-15 school-based cross-sectional survey of 41035 secondary school students (grade 7–12; age 11–18 years) in Hong Kong, information was collected on the use of e-cigarettes, cigarettes, and non-cigarette tobacco products (NCTPs), susceptibility to e-cigarette and cigarette use, intention to quit cigarette smoking, and sociodemographic characteristics. The adjusted odds ratio (AOR) of e-cigarette use susceptibility in relation to high (vs low) school-level e-cigarette use prevalence was 1.40 (95% CI 1.05–1.87) in never e-cigarette users. The AORs of cigarette smoking susceptibility in relation to medium and high (vs low) school-level e-cigarette use prevalence were 1.24 (1.01–1.52) and 1.34 (1.02–1.75), respectively, in never cigarette smokers. School-level e-cigarette use prevalence was associated with ever and past 30-day cigarette smoking, but not with intention to quit (in past 30-day cigarette smokers) or past 30-day NCTP use. The findings highlight the importance of strictly banning e-cigarettes in schools, and add to the evidence that prevalent e-cigarette use in adolescents may increase cigarette smoking prevalence.

Highlights

Prevalent electronic cigarette (e-cigarette) use in schools may undermine tobacco denormalisation, and increase tobacco use in students
In never e-cigarette users, 10.3% were susceptible to e-cigarette use; in never cigarette smokers, 10.1% were susceptible to cigarette smoking
After covariate adjustment, school-level e-cigarette use was strongly and linearly associated with e-cigarette use susceptibility in never e-cigarette users, and with cigarette smoking susceptibility in never cigarette smokers

Summary

Introduction

Prevalent electronic cigarette (e-cigarette) use in schools may undermine tobacco denormalisation, and increase tobacco use in students. We investigated the associations of school-level e-cigarette use prevalence with student-level intention and behaviours related to e-cigarettes, cigarettes, and other tobacco products. As adolescents spend a large amount of time in schools, a school environment with prevalent e-cigarette use may encourage e-cigarette uptake in never e-cigarette users This was explored in only one cross-sectional study in the US8. It is possible that e-cigarettes’ popularity in schools can undermine the denormalisation of tobacco in general and even increase the use of conventional tobacco products, including cigarettes. It is necessary to investigate the association of school-level e-cigarette use prevalence with student-level intention and behaviours related to cigarettes and other tobacco products. E-cigarettes’ reversal of tobacco denormalisation is believed to have a role in the gateway effect, along with other mechanisms[10]

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Results

Conclusion