December 5, 2022Open Access
Electronic cigarettes use and ‘dual use’ among the youth in 75 countries: estimates from Global Youth Tobacco Surveys (2014–2019)
Key Result
Youth in countries with the most restrictive e-cigarette regulations had significantly lower odds of being current e-cigarette users compared to those in countries with no regulatory policies (aOR 0.6).
Study Design
Type
Cross-Sectional (n=264,490)
Multicenter
Yes
Structured PICO
P
Population
264,490 school-going youth from 75 countries were surveyed between 2014 and 2019 to estimate the prevalence and determinants of e-cigarette use and dual use.
E
Exposure
E-cigarette regulatory status and country income level
C
Comparator
No restrictive policies (NRP) and lower-middle income countries (lMIC)
O
Outcome
Prevalence of awareness, ever use, current use, and dual use of e-cigarettespatient reported
Most restrictive policies, such as bans on e-cigarettes, appear to reduce e-cigarette use among youth globally.
Main Result
Odds Ratio: 0.6 (95% CI 0.6–0.7)
Absolute Event Rate: 5.6% vs 6.8%
p-value: p=<0.001
Limitations
- Self-reported behaviors are subject to reporting bias
- Did not distinguish between electronic nicotine delivery systems (ENDS) and electronic non-nicotine delivery systems (ENNDS)
- Estimates for 2014 to 2019 are not very up-to-date because e-cigarette use patterns among youth are evolving rapidly
- Unable to examine the distribution of e-cigarette use by youth's income status
Abstract
We report the country-level prevalence of awareness about electronic cigarette use, and 'dual use' and its association with age, sex, country income, and e-cigarette regulatory status. We analyzed the most recent Global Youth Tobacco Surveys done on nationally representative samples of school-going youth aged 13-15 years in 75 countries/territories. The weighted prevalence of 'awareness' (heard about e-cigarettes), 'ever use' (even tried a few puffs), 'current use' (during the last 30 days), and 'dual use' (e-cigarette use and cigarette smoking during the last 30 days) were estimated. Awareness was > 80% in 13 countries mostly from Europe Poland being the highest at 95.8% (95% CI 94.8- 96.6). In seven countries, 30-50% of the youth had ever used an e-cigarette, Italy was the highest at 55.1% (95%CI 51-3,58.9). In 30 countries, current e-cigarette use was > 10%, the highest of 35.1% (95%CI 32.4-38.0) in Guam. Awareness and use were highest in the European region (74.6% and 34.5%) and HIC (83.6% and 39.4%). Youth from HIC (compared to lMIC) and countries having restrictive e-cigarette regulations (compared to NRP) had 2.4 times (aOR 2.2.4, 95% CI 2.2, 2.7) and 1.8 times (aOR 1.8, 95% CI 1.6, 2.0) higher odds of being current e-cigarette users respectively. Youth in countries with the most restrictive e-cigarette regulations (compared to NRP) had 0.6 times lower odds of being current e-cigarette users (aOR 0.6, 95% CI 0.6, 0.7). Awareness and e-cigarette use varied by sex, country income level, and region. Continued global surveillance of youth e-cigarette use is needed for the formulation of e-cigarette regulatory policy. Awareness and use of e-cigarettes were higher among boys, in countries in Europe and America regions, and among those with higher income and restrictive policies, whereas it was lower in countries having the most restrictive policies. Higher awareness is strongly correlated with a trial and current use of e-cigarettes. E-cigarette marketing should be restricted, and continued surveillance of e-cigarette use is needed. Most restrictive policies such as the ban on e-cigarettes appear to reduce e-cigarette use among the youth.