Adolescents who recall seeing e-cigarettes in shops are more likely to have tried them in the past and are more likely to intend to try them in the future, according to a study published in the open access journal BMC Public Health.
The cross-sectional collaborative study led by researchers from the University of Stirling, UK, which involved 3,808 Scottish adolescents, is the first to examine the relationship between adolescents' recollection of e-cigarette displays at point of sale (POS) and their self-reported past use and future intention to use e-cigarettes.
Young people who had tried e-cigarettes in the past were found to be more likely to intend to use them again. The researchers also found that young people were more likely to try e-cigarettes if they had previously smoked tobacco. Young people who had never smoked tobacco were much less likely to have tried e-cigarettes or intend to do so in the future. Most adolescents in the study who reported using e-cigarettes had only tried them once or twice and were not regular users.
It was previously known that exposure to cigarette POS displays influences smoking behavior and intentions in young people and that increased availability of cigarettes -- for example through a high number of shops selling tobacco near a person's home -- is associated with higher consumption and uptake. However, to date there has been no evidence regarding the relationship between e-cigarette POS display exposure and e-cigarette use in young people. As cigarette brands are far more established and more instantly recognizable than e-cigarettes, the association between tobacco POS exposure and smoking behavior in young people could not necessarily be assumed to be the same for e-cigarettes, according to the researchers.
To examine a potential relationship between exposure to POS displays and e-cigarette use in adolescents, the researchers conducted a survey in four high schools in Scotland which involved 3,808 students between 11 and 18 years of age. The data collected was part of an ongoing 6-year study designed to assess the impact of Scottish legislation banning tobacco POS displays on young people's smoking behavior and their attitudes towards smoking. Additional information on e-cigarette advertising exposure, e-cigarette use and smoking status was gathered through a school-based survey conducted in early 2015.
Respondents were asked whether they had heard of e-cigarettes, whether they had ever used them, and whether they intended to try them in the next 6 months. They were also asked if they had ever smoked cigarettes and if they intended to do so in the next year.
A strong association between recall of e-cigarette displays at point of sale and use of e-cigarettes and intention to use in the future was found in this study. However, it used a cross-sectional design and so no causal relationship between POS recall and e-cigarette use or intention to use could be established. Therefore, it is unclear whether young people who plan to try e-cigarettes do so because they notice e-cigarettes at POS or whether they notice e-cigarettes because they intend to try them in the future.
The sample used in this study was not randomly selected and is not necessarily representative of the Scottish population, and there was a 13% non-response rate to the survey which relied on recall and self-reporting. The researchers note that collection of additional longitudinal data is needed to establish causality.
Catherine Best, the corresponding author, said: "Given that our study found an association between POS exposure to e-cigarettes and both their use and intention to use in young people, policy makers in the EU and elsewhere need to consider very carefully how to balance the promotion of e-cigarettes to adult smokers as an aid to help them quit, while at the same time minimizing their uptake by young people."
As of May 20th 2016 EU member states will be required to have legislation that restricts the advertising of e-cigarettes.
Sally Haw, lead author of the study, said: "We have seen considerable investment in e-cigarette advertising by the tobacco industry. While these new restrictions on e-cigarette advertising through broadcast and print media, sponsorship and product placement are very much welcomed, they are more limited than those that apply to tobacco advertising. However, individual jurisdictions will be able to extend their restrictions to include e-cigarette advertising on bill boards and at point of sale. This requires careful consideration. "
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Notes to editor:
1. Relationship between e-cigarette point of sale recall and e-cigarette use in secondary school children: a cross-sectional study Catherine Susan Best, Farhana Haseen, Winfried van der Sluijs, Gozde Ozakinci, Dorothy Currie, Martine Stead, Anne Marie MacKintosh, Jamie R Pearce, Catherine Tisch, Andy MacGregor, Amanda Amos, John Frank, Sally J Haw
BMC Public Health 2016
DOI: 10.1186/s12889-016-2968-2
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