E-Cigarette Uptake Amongst UK Youth: Experimentation, but Little or No Regular Use in Nonsmokers

Electronic cigarette (e-cigarette) use is now common in many countries, particularly in the developed world. Even in countries that don’t permit the sale of nicotine containing e-cigarettes, use has risen in recent years. 1 Along with this has come a rise in concern about uptake amongst young people, particularly in jurisdictions where youth tobacco smoking rates have fallen to low levels. The reasons for this concern are many and varied, but some of this relates to a perception that e-cigarettes may result in a new generation of adults who are dependent on nicotine. 2 To date we have identified at least 24 published, peer reviewed journal articles on e-cigarette use in youth, with at least as many again published survey reports. The majority of these only describe recent or ever use of these products and don’t differentiate experimentation from regular use. 3 An exception is in studies from the countries of the United Kingdom, where four recent surveys conducted in a 12-month period from 2013 to 2014 shed some light on ever and regular use amongst smoking and nonsmoking young people. Figure 1 summarizes results from these four surveys, each of which has yielded very similar findings. Prevalence of electronic cigarette (e-cigarette) use in teenagers, UK surveys. Notes: (1) Youth Tobacco Policy Survey, United Kingdom, n = 1205; (2) ASH/YouGov survey n = 1731 children who had heard of e-cigarettes; (3) health behavior in school children in Wales, n = 9055; (4) Scottish Schools Adolescent Lifestyle and Substance Use Survey, n = 33 685. What these surveys show is that a significant proportion of teenagers have tried e-cigarettes—8% in one survey across Great Britain, 4 and 12% in a representative UK-wide survey and national surveys in Wales 5 and Scotland. 6 A very small proportion (ranging from 0.4% in Scotland to 2% in the UK survey) report use more than monthly and even fewer (1% in the United Kingdom and 0.7% in Great Britain, respectively) more than weekly. On closer examination, however, this more regular use is found only in young people who have also smoked tobacco. Three of these surveys found no evidence at all of never smoking young people regularly using e-cigarettes. The fourth, a large survey in Wales of 9055 11–16 year olds, identified 54 never smoking young people who reported using e-cigarettes at least monthly. Rates of experimentation (or ever use) in never smoking young people were also low in all surveys, from 2% to 5%. What do these data tell us? They suggest that at the moment, regular use of e-cigarettes is almost entirely concentrated in young people who already smoke. As studies in other countries have also shown, never smokers are trying these devices (which may or may not contain nicotine—the surveys did not ask this). However, in the United Kingdom at least the data suggests that they are not progressing to habitual use. Given the size, representativeness and similar time period in which these studies were conducted, we can be relatively confident that they accurately capture the situation in a country that has at least 2.6 million adults who use e-cigarettes, and 10 million who smoke. 7 It is imperative that future studies of e-cigarettes and young people differentiate different patterns of consumption and do not use evidence of ever use as a proxy for continued use. Teenagers experiment, and for some smoking teenagers, e-cigarettes may well be a route out of tobacco. Surveillance of the kind reported here is important as patterns may well change in the future. Continued research is needed, particularly longitudinal studies, in order to capture new and emerging trends and inform policy and practice.