Evidence that e-cigarette use is associated with increased susceptibility to smoking among 10-11 year-olds in the UK

E-cigarette enthusiasts, particularly from the UK, have consistently minimized the possibility that e-cigarette use was increasing among kids and that e-cigarette use would predict later smoking.
Graham Moore and colleagues recently published “E-cigarette use and intentions to smoke among 10-11-year-old never-smokers in Wales,” a carefully done survey of 1500 youth that found that

  • 6% of these kids had tried an e-cigarette, including 5% of never-cigarette smokers
  • As with cigarettes, kids of parents who smoked or used e-cigarettes were more likely to have used e-cigarettes (OR=3.4) compared to kids whose parents did not use nicotine
  • Having used an e-cigarette was associated with intentions to smoke (OR=3.21)
  • Children who had used an e-cigarette has increased susceptibility to smoke in the next 2 years

These results are similar to findings in the US among older adolescents.
While a cross-sectional study, susceptibility to smoking is a well-validated measure of future smoking, so the results support the a gateway effect.  Even if the kids do not go on to use cigarettes, however, introducing them to nicotine addiction is not a good thing.
This paper, together with the earlier work, emphasizes the importance of stopping marketing that reaches youth as well as the importance on both smokefree and e-cig free homes.
The full paper, published in Tobacco Control, is available here.
Here is the abstract:
Background:  E-cigarettes are seen by some as offering harm reduction potential, where used effectively as smoking cessation devices. However, there is emerging international evidence of growing use among young people, amid concerns that this may increase tobacco uptake. Few UK studies examine the prevalence of e-cigarette use in non-smoking children or associations with intentions to smoke.
Methods:  A cross-sectional survey of year 6 (10–11-year-old) children in Wales. Approximately 1500 children completed questions on e-cigarette use, parental and peer smoking, and intentions to smoke. Logistic regression analyses among never smoking children, adjusted for school-level clustering, examined associations of smoking norms with e-cigarette use, and of e-cigarette use with intentions to smoke tobacco within the next 2 years.
Results: Approximately 6% of year 6 children, including 5% of never smokers, reported having used an e-cigarette. By comparison to children whose parents neither smoked nor used e-cigarettes, children were most likely to have used an e-cigarette if parents used both tobacco and e-cigarettes (OR=3.40; 95% CI 1.73 to 6.69). Having used an e-cigarette was associated with intentions to smoke (OR=3.21; 95% CI 1.66 to 6.23). While few children reported that they would smoke in 2 years’ time, children who had used an e-cigarette were less likely to report that they definitely would not smoke tobacco in 2 years’ time and were more likely to say that they might.
Conclusions: E-cigarettes represent a new form of childhood experimentation with nicotine. Findings are consistent with a hypothesis that children use e-cigarettes to imitate parental and peer smoking behaviours, and that e-cigarette use is associated with weaker antismoking intentions.