E-cigarettes, a safer alternative for teenagers? A UK focus group study of teenagers' views

Hilton, Shona; Weishaar, Heide; Sweeting, Helen; Trevisan, Filippo; Katikireddi, Srinivasa Vittal

doi:10.1136/bmjopen-2016-013271

Cited by 55 publications

(105 citation statements)

References 35 publications

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“…Mounting evidence supports this view [2,[6][7][8] and that vaping may aid smoking cessation [2,[9][10][11]. Nevertheless, concerns remain [3,12], particularly around risks of vaping introducing youth to nicotine and cigarette use [13][14][15][16], though so far regular (at least weekly) vaping by youth in the UK has been rare [17,18].…”

Section: Introductionmentioning

confidence: 99%

Socioeconomic patterning of vaping by smoking status among UK adults and youth

et al. 2020

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Background:Smoking contributes significantly to socioeconomic health inequalities. Vaping has captured much interest as a less harmful alternative to smoking, but may be harmful relative to non-smoking. Examining inequalities in vaping by smoking status, may offer insights into potential impacts of vaping on socioeconomic inequalities in health. Methods: Data were from 3291 youth (aged 10-15) and 35,367 adults (aged 16+) from wave 7 (2015-17) of the UK Household Longitudinal Study. In order to adjust for biases that could be introduced by stratifying on smoking status, marginal structural models were used to estimate controlled direct effects of an index of socioeconomic disadvantage (incorporating household education, occupation and income) on vaping by smoking status (among adults and youth), adjusting for relevant confounders and for selection into smoking states. We also estimated controlled direct effects of socioeconomic disadvantage on being an ex-smoker by vaping status (among adult ever-smokers; n = 18,128). Results: Socioeconomic disadvantage was associated with vaping among never smoking youth (OR for a unit increase in the socioeconomic index: 1.17; 95%: 1.03-1.34), and among ex-smoking adults (OR: 1.17; 95% CI: 1.09-1.26), with little to no association among never smoking (OR: 0.98; 95% CI: 0.91-1.07) and current smoking (OR: 1.00; 95% CI: 0.93-1.07) adults. Socioeconomic disadvantage was also associated with reduced odds of being an exsmoker among adult ever-smokers, but this association was moderately weaker among those who vaped (OR: 0.88; 95% CI: 0.82-0.95) than those who did not (OR: 0.82; 95% CI: 0.80-0.84; p-value for difference = 0.081). Conclusions: Inequalities in vaping among never smoking youth and adult ex-smokers, suggest potential to widen health inequalities, while weaker inequalities in smoking cessation among adult vapers indicate e-cigarettes could help narrow inequalities. Further research is needed to understand the balance of these opposing potential impacts, and how any benefits can be maximised whilst protecting the vulnerable.

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Section: Introductionmentioning

confidence: 99%

Socioeconomic patterning of vaping by smoking status among UK adults and youth

et al. 2020

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“…Mounting evidence supports the view that e-cigarettes are substantially less harmful than traditional cigarettes [1,16,[42][43][44][45], and that they can aid successful smoking cessation [3,16,34,[46][47][48]. While potential public health bene ts of e-cigarettes should be weighed against possible detriments [25,49], we found little evidence to support concerns about negative impacts on youth smoking or vaping behaviour. While we could not rule out effects whereby youth vaping increases risk for smoking, associations were substantially attenuated by measured confounders, indicating support for common liabilities, and the residual associations observed could potentially be explained by reverse causation and/or strong unmeasured confounding.…”

Section: Discussionmentioning

confidence: 66%

Youth vaping and smoking and parental vaping: a panel survey

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2020

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Background: Concerns remain about potential negative impacts of e-cigarettes including possibilities that: youth e-cigarette use (vaping) increases risk of youth smoking; and vaping by parents may have impacts on their children’s vaping and smoking behaviour.Methods: With panel data from 3291 youth aged 10-15 years from the 7th wave of the UK Understanding Society Survey (2015-2017), we estimated effects of youth vaping on youth smoking (ever, current and past year initiation), and of parental vaping on youth smoking and vaping, and examined whether the latter differed by parental smoking status. Propensity weighting was used to adjust for measured confounders and estimate average effects of vaping for all youth, and among youth who vaped. E-values were calculated to assess the strength of unmeasured confounding influences needed to negate our estimates.Results: Associations between youth vaping and youth smoking were attenuated considerably by adjustment for measured confounders. Estimated average effects of youth vaping on youth smoking were stronger for all youth (e.g. OR for smoking initiation: 32.5; 95% CI: 9.8-107.1) than among youth who vaped (OR: 4.4; 0.6-30.9). Relatively strong unmeasured confounding would be needed to explain these effects. Associations between parental vaping and youth vaping were explained by measured confounders. Estimates indicated effects of parental vaping on youth smoking, especially for youth with ex-smoking parents (e.g. OR for smoking initiation: 11.3; 2.7-46.4) rather than youth with currently smoking parents (OR: 1.0; 0.2-6.4), but these could be explained by relatively weak unmeasured confounding.Conclusions: While measured confounding accounted for much of the associations between youth vaping and youth smoking, indicating support for underlying propensities, our estimates suggested residual effects that could only be explained away by considerable unmeasured confounding or by smoking leading to vaping. Estimated effects of youth vaping on youth smoking were stronger among the general youth population than among the small group of youth who actually vaped. Associations of parental vaping with youth smoking and vaping were either explained by measured confounding or could be relatively easily explained by unmeasured confounding.

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“…Mounting evidence supports the view that e-cigarettes are substantially less harmful than traditional cigarettes [1,[5][6][7][8][9], and there is increasing evidence that they can aid successful smoking cessation [3,[9][10][11][12][13]. Nevertheless, potential public health benefits of e-cigarettes should be weighed against possible detriments [14,15]. Internationally, concerns have been raised, particularly relating to youth, that because the behaviours are similar and many (but not all) e-cigarettes contain nicotine, vaping behaviour could help establish and/or maintain smoking behaviour [16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

“…If there are effects of parental vaping, these could feasibly differ depending on parental smoking status. If e-cigarettes are viewed as an aid to smoking cessation [3,14] then parental use could make smoking seem less normative and reduce risk of smoking initiation, especially if parents completely switch from smoking to vaping. On the other hand, dual-use by parents could result in the behaviours appearing to youth as linked and complementary and increase risk for both.…”

Section: Introductionmentioning

confidence: 99%

Youth vaping and smoking and parental vaping: a cross-sectional survey

Green¹,

Gray²,

Sweeting³

2020

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Background: Concerns remain about potential negative impacts of e-cigarettes including possibilities that: youth e-cigarette use (vaping) increases risk of youth smoking; and vaping by parents may have impacts on their children’s vaping and smoking behaviour. Methods: With cross-sectional data from 3291 youth aged 10-15 years from the Understanding Society Survey, we estimated effects of youth vaping on youth smoking (ever, current and initiation in the past year), and of parental vaping on youth smoking and vaping, and examined whether the latter differed by parental smoking status. Propensity weighting was used to adjust for measured confounders and estimate effects of vaping under alternative scenarios of no vaping vs universal adoption, and vs observed vaping levels. E-values were calculated to assess the strength of unmeasured confounding influences needed to negate our estimates. Results: Associations between youth vaping and youth smoking were attenuated considerably by adjustment for measured confounders. Estimated effects of youth vaping on youth smoking were stronger comparing no use to universal adoption (e.g. OR for smoking initiation: 32.5; 95% CI: 9.8-107.1) than to observed levels of youth vaping (OR: 4.4; 0.6-30.9). Relatively strong unmeasured confounding would be needed to explain these effects. Associations between parental vaping and youth vaping were explained by measured confounders. However, estimates for parental vaping on youth smoking indicated effects, especially for youth with ex-smoking parents (e.g. OR for smoking initiation: 11.3; 2.7-46.4) rather than youth with currently smoking parents (OR: 1.0; 0.2-6.4). Relatively weak unmeasured confounding could explain these parental vaping effects. Conclusions: While results for youth vaping and youth smoking associations indicated support for underlying propensities, estimated effects still required considerable unmeasured confounding to be explained fully. However, these estimates from cross-sectional data could also be explained by smoking leading to vaping. Stronger estimates for universal vaping adoption vs observed usage, indicated that if youth vaping does increase risk of youth smoking, this effect may be stronger in the general population of youth, than among those youth who typically vape. Associations of parental vaping with youth smoking and vaping were either explained by measured confounding or could be relatively easily explained by unmeasured confounding.

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E-cigarettes, a safer alternative for teenagers? A UK focus group study of teenagers' views

Abstract: Objective: Concerns exist that e-cigarettes may be a gateway to traditional cigarettes and/or (re)normalise teenage smoking. This qualitative study explores how teenagers in the UK currently perceive e-cigarettes and how and why they do or do not use them.

Cited by 55 publications

References 35 publications

Socioeconomic patterning of vaping by smoking status among UK adults and youth

Socioeconomic patterning of vaping by smoking status among UK adults and youth

Youth vaping and smoking and parental vaping: a panel survey

Youth vaping and smoking and parental vaping: a cross-sectional survey

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