Young people's use of e-cigarettes in Wales, England and Scotland before and after introduction of EU Tobacco Products Directive regulations: a mixed-method natural experimental evaluation

Graham Moore,Rachel Brown,Nicholas Page,Britt Hallingberg,Olivia Maynard,Jennifer Mckell,Linsay Gray,Anna Blackwell,Emily Lowthian,Marcus Munafò,Anne-Marie Mackintosh,Linda Bauld

doi:10.1016/j.drugpo.2020.102795

Abstract

BackgroundYoung people's experimentation with e-cigarettes has increased in recent years, although regular use remains limited. EU Tobacco Products Directive (TPD) regulations introduced packet warnings, advertising restrictions, and regulated nicotine strength from 2016, in part due to concerns regarding use by young people. This paper examines e-cigarette use trajectories before and after TPD. MethodsE-cigarette use data were obtained from School Health Research Network/Health Behaviour in School-aged Children surveys in Wales and Smoking Drinking and Drug Use surveys in England. Data from Wales were analysed using segmented logistic regression, with before and after regression analyses of English data. Semi-structured group interviews included young people aged 14-16 years in Wales, England and Scotland in 2017 and 2018. ResultsIn Wales, ever use of e-cigarettes increased over time, but under a range of assumptions, growth did not appear to continue post-TPD. A small and non-significant change in trend was observed post-implementation (OR=0.96; 95%CI=0.91 to 1.01), which increased in size and significance after adjusting for ever smoking (OR=0.93; 95%CI=0.88 to 0.98). There was little increase in regular e-cigarette use from 2015 to 2017 in Wales. However, ever and regular use increased from 2014 to 2016 in England. Young people in all nations described limited interactions with components of TPD, while describing e-cigarette use as a ‘fad’, which had begun to run its course. ConclusionsThis study provides preliminary evidence that young people's e-cigarette experimentation may be plateauing in UK nations. The extent to which this arises from regulatory changes, or due to a fad having begun to lose its appeal among young people in the UK countries, remains unclear. These trends contrast to those observed in North America, where newer products whose EU market entry and marketing have been impacted by TPD, have gained traction among young people. Long-term monitoring of e-cigarette use trends and perceptions among young people remain vital.

Highlights

Young people's experimentation with e-cigarettes has increased in recent years, regular use remains limited
Prevalence of ever use of e-cigarettes almost doubled over the time series: 17.6% of pupils sampled reported ever use of e-cigarettes in November 2013 compared to 34.0% in December 2017 (Supplementary Table 1)
For the whole sample and all subgroups, odds ratios for post-slope were in the anticipated direction of negative change in trend, indicating an approximately 4% reduction in odds of ever e-cigarette use each month beyond the Tobacco Products Directive (TPD) implementation date, relative to the secular baseline trend

Summary

Introduction

Young people's experimentation with e-cigarettes has increased in recent years, regular use remains limited. Young people in all nations described limited interactions with components of TPD, while describing e-cigarette use as a ‘fad’, which had begun to run its course. The extent to which this arises from regulatory changes, or due to a fad having begun to lose its appeal among young people in the UK countries, remains unclear. These trends contrast to those observed in North America, where newer products whose EU market entry and marketing have been impacted by TPD, have gained traction among young people. In more recent UK sur veys, the secular decline in smoking has begun to level off, mirroring trends across a broad range of adolescent risk behaviours (Hewitt, et al 2019; NHS Digital, 2018)

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