Electronic cigarettes use and ‘dual-use’ among the youth in 75 countries- Estimates from Global Youth Tobacco Surveys (2014-2019)

Background We report the country-level prevalence of awareness about and electronic cigarette use, and ‘dual use’ and its associations with age, sex, and country income,e and e-cigarette regulatory status. Methods 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. 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. Results Awareness was > 80% in 13 countries mostly from Europe, Poland being the highest at 95.8% (95% CI94.8- 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%, 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 and countries having restrictive e-cigarette regulations had 1.1 times (aOR 1.03, 95% CI 1.03, 1.24) and 1.8 times (aOR 1.81, 95% CI 1.63, 2.01) higher odds of being current e-cigarette users. Youth in countries with the most restrictive e-cigarette regulations had 0.6 times lower odds of being current e-cigarette users (aOR 0.64, 95% CI 0.56, 0.72). Conclusion Awareness and e-cigarette use varied by sex, country income level, and region. Continued global surveillance of youth e-cigarette use to assist in the formulation of e-cigarette regulatory policy. Implications Awareness and use of e-cigarettes including dual-use were higher among boys, in countries in Europe and America regions, and those with higher income and restrictive policies, whereas lower in most restrictive policies. Higher awareness 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.