Date post: | 14-Jul-2015 |
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Health & Medicine |
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Background
Public health concerns about children, young
people and e-cigarettes:
‘Gateway’ effect?
Marketing
Channels previously used for traditional cigarettes
Plus celebrity endorsements, online promotions and
social media
Growing number of e-cigarette product types, flavours
and product innovations
Investment in e-cigarette point-of-sale displays
‘Renormalisation’ of smoking?
Previous review
Review published by Public Health
England in May 2014
Identified 9 studies on use in
children (up to March 2014).
One UK study
In the studies we reviewed, with
the exception of one Polish survey,
ever use was reported by fewer
than one in ten children and was
concentrated in young people who
smoke
Update
Applied the same search
strategy in October 2014
to identify all published
peer-reviewed studies of
young people and e-
cigarettes
Also looked for ‘grey’
literature from the UK
We identified 23 new
studies/surveys, of
which 6 were grey
literature (i.e. not been or
unlikely to have been
peer-reviewed)
32 studies/surveys in all
These are English
language studies only.
Use in Great Britain
The only representative survey of young people
in the UK (GB only) is the work conducted by
YouGov for ASH in March 2013 and repeated
in March 2014
In 2013, 67% of 11-18 year olds had heard of
electronic cigarettes rising to 84% in 2014.
Of these, 5% had ever tried an e-cigarette in
2013 and 8% in 2014. Use was highly
concentrated in current smokers.
Which ONE of the following is closest to describing your experience of e-cigarettes?
Source: ASH (2014) YouGov survey, Base: All children aged 11 to 18 (2,068). Fieldwork dates: 21st
March to 1st April 2014
Don't want to say
I use them often (more than once a week)
I use them sometimes (more than once a month)
I have tried them once or twice
I have never used them
E-cigarette use by children in Great Britain
Not aware of e-cigarettes
Which comes first?
The GB survey asked
children about e-cig vs
tobacco cigarette
initiation
Source: ASH (2014) YouGov survey, Base: All children aged 11 to 18 who had heard of e-cigarettes
and tried them (n=157) Fieldwork dates: 21st March to 1st April 2014
I tried using an e-cigarette before I first tried smoking a real cigarette
I have never smoked a real cigarette but have tried an e-cigarette
I don't remember
I tried smoking a real cigarette before I first tried using an e-cigarette
What about other countries?
Data relating to ever use is available from 10
countries
Direct comparisons are very difficult with
published data because of:
Differences in age range (youngest in surveys=11,
oldest=19)
Differences in questions asked
Obtaining raw data from authors may allow for
some comparisons
Ever and current use
In surveys conducted between 2011 and 2014,
recorded ever use varied very significantly - from
5% to 62%
Amongst repeat cross sectional surveys there is a
consistent pattern of rising use between years
Except in one Polish study, rates of regular use
are much lower, commonly less than 10%.
Current use in never smokers also remains low
(the highest identified rate is 2%).
Survey comparisons
Some surveys reporting much lower levels of use amongst never smokers were excluded
from this table
Source: Dutra, K and Glanz, S (2014) High international electronic cigarette use among never
smoker adolescents, Journal of Adolescent Health, 595-597
E-cigarette/smoking by children: USA
Source: US CDC data from National Youth Tobacco Survey 2011 and 2012. Graph from Bates & Rodu
Repeat cross-sectional survey in Poland
Source: Goniewicz, M et al (2014) Rise in electronic cigarette use amongst adolescents in Poland, Journal of Adolescent Health, 55, 713-715
What about the ‘gateway’
Until we have reliable longitudinal data on
young people and e-cigarettes, theories about
these products being a ‘gateway’ to smoking are
just that – theories.
However we do need to recognise that a number
of young people in a range of countries are
exposed to nicotine for the first time by using an
e-cigarette.
Flavours
Concerns about E-liquid
flavours and youth appeal
have been raised
A number of studies and
consumer surveys have
looked at flavour preferences
in adult users.
As an example, a recent
survey of 800 vapers in
Germany, Austria and
Switzerland asked about
liquid flavour preferences. Source: PowerCigs (2014) www/powercigs-
shop.de. Online consumer survey October 2014.
Research Underway
Youth Tobacco Policy Survey (YTPS) funded by Cancer
Research UK
Monitors youth response to tobacco marketing and
tobacco control since 1999
2014, 7th wave
New e-cigarette questions
Survey is currently in the field
To develop questions we conducted 6 focus groups with
11-16 year olds in central Scotland (n=34) in April and
May 2014 (ethics approval and parental consent obtained).
Findings Initial discussions
E-cigarettes seen as a distinct product type but
Lack of terminology and language surrounding them
This poses problems for the survey
Knowledge often came from a
family member who had used
e-cigarettes to try to stop smoking
For adult smokers who
want to stop smoking
For situations where smoking prohibited
“at football games
you’re not allowed to
smoke real ones, you
see people with the
e-ones” (boy, 13-14)
“fake cigarettes”
“vapour stuff”
“electric type ones”
“adults”
“parents”
“people that smoke”
“Nobody young does
them”
Views on marketing
E-cigarette marketing
Some awareness of e-cig marketing but
Lack of engagement
Little brand awareness
Some. I’ve only heard it
once or twice, erm, a little
while ago, and it just says,
like I think there’s one
about nicotine as well (girl,
11-12) Sometimes you get like
adverts, is it SKYCIG or
something like that? It’s like
the fake cigarette, for er,
people to stop smoking (girl, 11-12)
Sports Sponsorship
E-cigarette companies sponsoring sports events, have you come across that at all?
- No
- No
- Erm
- None
No, you haven’t come across that. Would you expect these companies to be
sponsoring things like that?
- No, I wouldn’t expect it
- Not yet
- Not sporting events
- Because sport, like its not frowned upon but it’s like you don’t see an athlete
that smokes
- I don’t know if they’re allowed to sponsor anyway (boys, 15-16)
Sports Sponsorship, cont.
- I have seen them a lot
- Yeah, they sponsor something
- I think they do
The SKYCIG?
- Yeah
- I think at the football you see them
- And the packets
OK, and you thought you’d seen that one before as well, can you remember
where?
- I think I just seen it (sighs) I can’t remember, I think that’s one that’s always
at the tills, I’m not sure though
Packaging and Flavours
Once exposed to different product/pack styles:
Younger participants surprised by the range of flavours
Some e-cigarettes shown did seem to increase appeal for
participants:
Sweet and fruity flavours
Bright colours
‘Pen’-type devices
Rated by some as ‘fun’, ‘cool’, ‘stylish’, ‘for people who have
never smoked’, ‘for someone like me’, ‘tempted to try’.
They might want to try it if
they want to smoke….
like your friends smoke,
you wouldn’t want to start
(smoking) because they
can be more addictive than
these can be (girl, 11-12)
For fun or something… for
somebody that’s kind of
like starting but they don’t
want to like get really
addicted (boy, 11-12)
Who are e-cigarettes for?
None of them are meant for us are they? (laughing)
Not really
We’re not smokers
They’re not designed for us, they’re designed for people that need help to
stop smoking
But then candyfloss might be for them (never smoker)
The candyfloss could be used by people…
The candyfloss and the chocolate one
They might be for people who have never smoked
For fun
They’d have a different taste
They might think it tastes good
Yeah, they might want to try cigarettes but don’t want to (smoke)
Findings
Imagery
Unlike previous work conducted with tobacco packaging/products, little
consistent imagery with e-cigs
Those resembling traditional cigarettes associated with older smokers who
want to quit – reinforced by POS
Some positive imagery from packaging of SKYCIG and VYPE, nightclubs,
fashion, young males, discreet
Pink ‘shisha’ pen associated with positive imagery for some of the girls
“Cos it’s not like
actually smoking, it’s
more attractive”
“The doctor
recommended ones,
the boring ones” (boy, 11-12,)
“Does it come out
pink smoke?”
“cool”
Next steps
Continuing to follow studies with young people
that report on e-cigarette use in any country
Work with others on age of sale introduction
and enforcement (good examples already exist)
Making the case for well designed studies that
will help us understand how these products are
perceived and used by youth
YTPS will report next Spring
Future longitudinal addition to YTPS
Thank you
Acknowledgements:
Kathryn Angus, Maciej Goniewicz,
Deborah Arnott, Allison Ford
& Anne-Marie Mackintosh