FUNDAMENTO GENERAL

Data on the use of non-tobacco nicotine among children are limited to e-cigarette use. Annual surveys by ASH of young people in the UK since 2013 demonstrate that awareness of e-cigarettes has grown substantially, such that, in 2015, only 7% of young people reported no knowledge of these products, and the proportion of young people who had tried e-cigarettes increased over these three surveys from 5% to 13% (Fig 7.10).⁸

However, of the 13% of young people who reported in 2015 ever having tried an e-cigarette, most (80%) had done so only once or twice.⁸Only 2.4% of all participants in the survey had used e-cigarettes once or more a month, and 0.5%

once or more a week. The Scottish SALSUS (Schools Adolescent and Lifestyle and Substance Use Survey) study⁵reported similar findings among 13- and

15-50 40 30 20 10 0

A disposable e-cigarette (non-rechargeable)

24

5

An e-cigarette kit that is rechargeable

with replaceable pre-filled cartridges

An e-cigarette that is rechargeable

and has a tank or reservoir that you fill

with liquids

Don’t know/

can’t remember

Percentage 41

28

7 26

2

Fig 7.9 Types of e-cigarette tried in the past and now.⁷(Adapted from ASH⁷ with permission under Open Government Licence.)

year-olds in 2013, with 7% and 17%, respectively, reporting ever having tried to use or used an e-cigarette, and only 1% in each age group using the product more than ‘once or a few times’. In 2014, the Welsh Health Behaviour in School-aged Children survey of 11- to 16-year-olds in Wales reported that 12.3% of participants had ever used an e-cigarette, and 1.5% were using e-cigarettes at least once a month.⁶The 2014 Smoking, Drinking and Drug Use survey of children aged 11–15 in England found that 22% of participating children had ever used an e-cigarette, but only 1% reported regular use.⁴Regular use of e-cigarettes among young people in the UK thus appears to be very rare. As in adults, it appears that it occurs predominantly among those who are using, or have used, tobacco cigarettes. In 2013 in the Scottish study, all of those who reported having used e-cigarettes more than a few times had been, or were still, smokers (Fig 7.11).⁵

The 2014 Welsh survey reports very similar findings, with young people aged 11–15 who had ever used an e-cigarette being over 20 times more likely than never-users to have ever smoked; those using e-cigarettes more than once a month were more than 100 times more likely to be smoking cigarettes at least once a week.⁶The 2015 ASH survey also reports a strong association between use of e-cigarettes and tobacco cigarettes (Fig 7.12), with almost all e-cigarette users either being current smokers, or having tried or been regular smokers in the past.⁸Regular e-cigarette use in the 2014 English Smoking, Drinking and Drug Use survey was exclusive to children who had at least tried smoking.⁴

Fig 7.10 Prevalence of awareness and frequency of use of e-cigarettes among young people aged 11–18, UK, 2013–15.⁸(Adapted from ASH⁸with permission under Open Government Licence.)

100 Once a month or more I have tried them once or twice Available but not tried them Not aware of e-cigs/don’t know

33%

100

80

60

40

20

0 Never smokers

Never used

Used to use but not now Tried once

Tried a few times Use <1/month Use >1/month <1/week Use >1/week

Tried smoking

once

Percentage

Former smokers

Occasional smokers

Regular smokers

Fig 7.11 Use of e-cigarettes, by smoking status, among 13- and 15-year-olds in Scotland in 2013.⁵(Adapted from NHS National Services Scotland⁵with permission under Open Government Licence.)

Fig 7.12 Young people aged 11–18 who have ever tried an e-cigarette, by smoking status, UK, 2015.⁸(Adapted from ASH⁸with permission under Open Government Licence.)

Never-smoker

Former smoker

Occasional smoker

Regular smoker

Tried smoking

0 10 20 30 40 50 60 70 80

Unweighted base: all 11–18 year olds (n = 2,291)

Percentage who have tried e-cigarettes 4%

34%

61%

77%

45%

7.4 Summary

> Use of e-cigarettes among adults in the UK was rare before 2010, but has since increased to the point that up to one in five smokers now uses an e-cigarette, more than twice as many as use NRT.

> The proportion of smokers using NRT has fallen by about half over this period, but the proportion using any non-tobacco nicotine product has increased to just under 30%.

> These trends are similar but more marked among recent ex-smokers, 40%

of whom use an e-cigarette.

> Use of e-cigarettes among adults who have never been regular smokers is very rare.

> There is a slightly greater likelihood that younger adult smokers will use e-cigarettes than NRT; in Scotland, younger men are more likely to use them.

> Adult regular e-cigarette users tend to use tank or other refillable devices, rather than first-generation ‘cigalikes’, and tobacco-, fruit- or menthol-flavoured nicotine.

> The proportion of young people in Britain aged <18 who have ever used an e-cigarette is increasing, but remains low.

> Most use among young people appears to be single or very occasional experimentation. Use more than once a month is relatively rare and more than once a week extremely rare.

> Regular use is almost exclusively limited to young people who are already either regular or occasional smokers, or have experimented with smoking in the past.

> Young regular users of e-cigarettes also favour later-generation devices, and fruit, tobacco or menthol flavours.

> In adults and young people in the UK, therefore, use of e-cigarettes is limited almost entirely to those who are already using, or have used, tobacco.

References

1 Smoking in England, www.smokinginengland.info [Accessed 29 March 2016].

2 Office for National Statistics. Adult smoking habits in Great Britain, 2013. London: ONS, 2014. www.ons.gov.uk/ons/dcp171778_386291.pdf [Accessed 25 February 2016].

3 The Scottish Government. The Scottish health survey 2014. Edinburgh: The Scottish Government, 2015. www.gov.scot/Topics/Statistics/Browse/Health/scottish-health-survey/

Publications#a1 [Accessed 25 February 2016].

4 Health and Social Care Information Centre. Smoking, drinking and drug use among young people in England in 2014. London: HSCIC, 2015. www.hscic.gov.uk/catalogue/PUB17879/

smok-drin-drug-youn-peop-eng-2014-rep.pdf [Accessed February 2016].

5 Scottish Schools Adolescent Lifestyle and Substance Use Survey. Smoking among 13 and 15 year olds in Scotland 2013. Edinburgh: NHS National Services Scotland, 2014.

www.isdscotland.org/Health-Topics/Public-Health/Publications/2014-11-25/SALSUS_

2013_Smoking_Report.pdf [Accessed February 2016].

6 Moore G, Hewitt G, Evans J et al. Electronic-cigarette use among young people in Wales:

evidence from two cross-sectional surveys. BMJ Open 2015;5:e007072.

7 Action on Smoking and Health. Use of electronic cigarettes (vapourisers) among adults in Great Britain. London: ASH, 2015. www.ash.org.uk/files/documents/ASH_891.pdf [Accessed February 2016].

8 Action on Smoking and Health. Use of electronic cigarettes among children in Great Britain.

London: ASH, 2015. www.ash.org.uk/files/documents/ASH_959.pdf [Accessed February 2016].

9 Smoking in England. Smoking Toolkit Study. Monthly tracking of key performance indicators, 2015 (online). www.smokinginengland.info/sts-documents/ [Accessed 25 February 2016].