More than half of adolescent E-Cigarette users had never smoked a cigarette: Findings from a study of school children in the UK

Objectives
Electronic cigarettes (ECs) are known for their use as a smoking cessation aid; however, experimental use in adolescence is a growing international concern. The proportion of adolescent EC users who have never used tobacco is rising. EC use is associated with later tobacco initiation in young people. Understanding adolescent beliefs about ECs is needed to inform public health campaigns and school education regarding the EC and the associated risks.

Study design
A cross-sectional questionnaire-based design was used.

Methods
As part of a larger study, questionnaires to assess beliefs about ECs and current use were distributed to 499 school pupils aged 11–16 years in a county in England, UK.

Results
More than half of EC users had never used tobacco (52.6%), a substantially greater proportion than previously reported in the literature. Adolescents were aware that ECs were less harmful than tobacco but many were unaware that they contain nicotine and the subsequent risk of addiction could lead to later tobacco use.

Conclusions
Given the possible association of EC use and later smoking initiation, education in schools may warrant greater emphasis on ECs, the role of nicotine and the risk of addiction associated with experimentation. Young people who deem ECs as a ‘safe’ option, and may otherwise have never experimented with tobacco, could be at risk of later tobacco use.