The sharp increase in the use of e-cigarettes has not led more British children to take up cigarettes or regard smoking as normal, the first study of its kind has shown, writes Steven Morris for The Guardian.
Some health experts and anti-smoking groups have expressed concern that the growth of e-cigarettes might normalise the idea of smoking for young people.
But the study led by Cardiff University researchers suggests the number of teenagers who said they had tried smoking or thought it was acceptable to smoke has continued to fall despite the rise in e-cigarette use.
The study, published in the journal Tobacco Control, examined data from England, Wales and Scotland, and found that from 1998 to 2015 the percentage of children aged between 13 and 15 who had smoked decreased from 60% to 19%, while regular smokers in the same age group fell from 19% to 5%.
It also reported that the percentage of young people who reported that trying a cigarette was “OK” declined from 70% in 1999 to 27% in 2015.
The report also points out that in the same period there was a fall in cannabis and alcohol use.
The analysis, funded by the National Institute for Health Research and conducted in collaboration with academics from Edinburgh, Stirling, Glasgow and Bristol, focused on three national surveys canvassing the views of almost 250,000 young people.
Dr Graham Moore, based at the Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, said: “These findings suggest that fears over a resurgence in youth tobacco smoking because of the rise in e-cigarette use are largely unfounded to date.
“The nature of e-cigarettes, and the landscape in which they are sold and used, continue to change rapidly, and we need to continue to keep a close eye on how they affect young people. However, this study demonstrates the success of public health efforts in reducing smoking among young people in the last 20 years and provides no evidence that e-cigarettes are reversing this.”
E-cigarette experimentation is becoming more popular among young people who have not previously used tobacco, although regular use of e-cigarettes by young people remains rare, the report says.
Professor Linda Bauld, from the University of Edinburgh, added: “Teenagers across Great Britain were trying e-cigarettes during the period when they were unregulated, and recent data suggests that these trends have continued up to the present day. But the findings of this study show that youth tobacco smoking has nevertheless continued to decline.”
The Welsh government was so concerned about the idea of e-cigarettes normalising smoking that in 2016 it tried to bring in legislation banning them from enclosed public places where children are likely to be present. Opponents claimed a ban could discourage smokers from switching to vaping to try to kick the habit, and the ban did not come into force.
The group’s CEO, Suzanne Cass, said: “We welcome the results of the study and hope this will strengthen the case for e-cigarettes to be considered a highly effective smoking cessation tool and a far safer alternative to smoking tobacco, rather than the first step to becoming a smoker.”
Simon Clark, the director of the smokers’ group Forest, said: “The study shows there is nothing to fear from the growth of vaping.
“The results support our view that government should ease restrictions on e-cigarette advertising. It’s time too for local authorities to lead by example and lift restrictions on the use of e-cigarettes in the workplace and other public areas.
“Young people’s negative views on smoking also suggest the health risks are very well understood. Now they need to be taught about choice and personal responsibility so when they are adults they can make informed decisions without unnecessary state intervention.”
Have e-cigarettes renormalised or displaced youth smoking? Results of a segmented regression analysis of repeated cross sectional survey data in England, Scotland and Wales
Britt Hallingberg, Olivia M Maynard, Linda Bauld, Rachel Brown, Linsay Gray, Emily Lowthian, Anne-Marie MacKintosh, Laurence Moore, Marcus R Munafoand Graham Moore.
To examine whether during a period of limited e-cigarette regulation and rapid growth in their use, smoking began to become renormalised among young people.
Design Interrupted time-series analysis of repeated cross-sectional time-series data.
248 324 young people aged approximately 13 and 15 years, from three national surveys during the years 1998–2015.
Unregulated growth of e-cigarette use (following the year 2010, until 2015).
Outcome measures Primary outcomes were prevalence of self-reported ever smoking and regular smoking. Secondary outcomes were attitudes towards smoking. Tertiary outcomes were ever use of cannabis and alcohol.
In final models, no significant change was detected in the pre-existing trend for ever smoking (OR 1.01, CI 0.99 to 1.03). There was a marginally significant slowing in the rate of decline for regular smoking (OR 1.04, CI 1.00 to 1.08), accompanied by a larger slowing in the rate of decline of cannabis use (OR 1.21, CI 1.18 to 1.25) and alcohol use (OR 1.17, CI 1.14 to 1.19). In all models and subgroup analyses for smoking attitudes, an increased rate of decline was observed after 2010 (OR 0.88, CI 0.86 to 0.90). Models were robust to sensitivity analyses.
There was a marginal slowing in the decline in regular smoking during the period following 2010, when e-cigarettes were emerging but relatively unregulated. However, these patterns were not unique to tobacco use and the decline in the acceptability of smoking behaviour among youth accelerated during this time. These analyses provide little evidence that renormalisation of youth smoking was occurring during a period of rapid growth and limited regulation of e-cigarettes from 2011 to 2015.
[link url="https://www.theguardian.com/society/2019/apr/01/e-cigarettes-do-not-normalise-smoking-for-young-people-study"]E-cigarettes do not normalise smoking for young people – study[/link]
[link url="http://dx.doi.org/10.1136/tobaccocontrol-2018-054584"]Have e-cigarettes renormalised or displaced youth smoking? Results of a segmented regression analysis of repeated cross sectional survey data in England, Scotland and Wales[/link]