E‐cigarette use and conventional cigarette smoking among European students: findings from the 2019 ESPAD survey

Abstract

Background and Aims: Representative data on e-cigarette use among European adolescents are scant. This study reports current vaping and tobacco smoking individual and country-specific correlates among European students. Design: Cross-sectional survey: 2019 European School Survey Project on Alcohol and Other Drugs (ESPAD) collecting data on risk behaviours on a representative sample of 16-year-old students. Setting: A total of 35 European countries, 25-30 with Tobacco Control Scale (TCS) and TCS components Participants: A total of 99 648 students (49.1% males) turning 16 years in the survey year.Measurements: Data on current cigarette and e-cigarette use were gathered through a self-administered questionnaire which also collected socio-demographics and individual and family characteristics. ESPAD data were integrated with country-level data on TCS and selected TCS parameters to assess their association with the prevalence of current cigarette and e-cigarette use.

Exclusive and dual use of electronic cigarettes among European youth in 32 countries with different regulatory landscapes

“…Altogether, 13.3% had ever used cigarettes, 10.6% e-cigarettes and 27.3% both; and 13.0% currently used cigarettes, 6.0% e-cigarettes and 6.4% both. Country prevalence of e-cigarette use and smoking has been detailed in the ESPAD Report 2019 and by Cerrai and colleagues 4 21. Majority of adolescents (64.6%) had at least one parent in the family with some college or university-level education.…”

“…To our knowledge, this is the first cross-country study to address the role of e-cigarette-specific regulations in the prevention of e-cigarette use among adolescents. Findings from previous studies on tobacco product regulations in connection to youth e-cigarette use were inconsistent,20 21 highlighting the need to address product-specific regulations and their effectiveness with more countries adopting them. Some country examples already indicate the importance of adopting and implementing comprehensive regulations to prevent youth e-cigarette use.…”

“…Chan et al 20 linked the WHO MPOWER implementation and e-cigarette use among 13-15 year-olds in 44 countries, finding that higher tax on combustible tobacco products was associated with higher adolescent e-cigarette use. Cerrai et al 21 linked the Tobacco Control Scale with data from 15 to 16 year-olds in up to 30 European countries and concluded e-cigarette use had been associated with weaker tobacco control measures, especially on tobacco price, advertising and promotion. For smoking, there is robust evidence that higher level of implementation of key tobacco control policies is associated with lower smoking prevalence among adults [22][23][24] and youth.…”

An International Systematic Review of Prevalence, Risk, and Protective Factors Associated with Young People’s E-Cigarette Use

“…In European countries, the prevalence of having ever used e-cigarettes varied by 17–62% [ 1 , 5 , 11 ]. Vapers in many European countries were previously cigarette users or started smoking at a young age, and some of these nations even reported a higher prevalence of e-cigarette use than traditional cigarette use (e.g., Iceland, Monaco, Lithuania, Poland, Ireland, Germany, Czechia, Hungary, France, and Norway) [ 12 ]. After the implementation of the EU Tobacco Products Directive regulations, e-cigarette use among young people in European nations, including the UK, is slowing down [ 13 , 14 ].…”

Commentary on Keller‐Hamilton et al. : Oral nicotine pouches provide a less controversial route for tobacco harm reduction than electronic cigarettes

“…For example, in 2019, 27.5% (4.1 million) of high school students and 10.5% (1.2 million) of middle school students in the United States had used e-cigarettes in the past 30 days [10]. In that same year, 12.4% of 16-year-olds in Europe reported using e-cigarettes in the past 30 days, ranging from 5.5% in Serbia to 41.4% in Monaco [11]. More recently, in 2023, 10.0% of US high school students and 4.6% of US middle school students had used e-cigarettes in the past 30 days [12], a noticeable decline from 2019.…”