Use of e-cigarettes by young people in Great Britain before and after Tobacco Products Directive

Abstract

Abstract Background Young people’s experimentation with e-cigarettes has increased in recent years, although regular use remains rare. In May 2016, the EU Tobacco Products Directive (TPD) introduced regulations aimed in part at preventing use by young people. It imposed warnings on e-cigarette packets, banned many forms of advertising, and restricted nicotine strength. This paper examines change in young people’s e-cigarette use after TPD, as well as complementary and alternative causal explanations for change, from young people’s perspectives. Methods Quantitative data sources were 2013, 2015 and 2017 School Health Research Network/Health Behaviour in School-aged Children surveys in Wales and 2014 and 2016 Smoking Drinking and Drug Use surveys in England. Data were analysed using segmented binary logistic regression in Wales, with simpler before and after analyses in England. Results were considered alongside qualitative interview data from young people aged 14-15 years in England, Wales and Scotland, collected in 2017 and 2018. Results Ever-use of e-cigarettes almost doubled from 2013-15, though subsequent increases were smaller. In Wales, where pre-legislation time series data were available, under a range of assumptions, prior growth in e-cigarette ever-use did not continue post-TPD. Change in trend post-TPD did not reach significance (OR = 0.96; 95%CI=0.91 to 1.01), but became significant after adjusting for change in smoking rates across the time-series (OR = 0.93; 95%CI=0.88 to 0.98). Regular use did not increase significantly from 2015 to 2017 in Wales, although ever and regular use in England both increased from 2014 to 2016. Young people described limited interactions with core components of TPD, while commonly describing e-cigarette use as a fad which was beginning to run its course. Conclusions Growth in youth experimentation with e-cigarettes may be slowing. Qualitative data from young people provide a range of explanations which appear largely unrelated to TPD itself. Key messages Survey data provide preliminary evidence that use of e-cigarettes may be plateauing among young people in the UK after a rapid initial increase in experimentation. Explanations position e-cigarettes as a passing fad which is beginning to lose its appeal in UK youth. Longer term monitoring of trends and perceptions remain vital.