Harm Reduction or Harm Introduction? Prevalence and Correlates of E-Cigarette Use Among French Adolescents

doi:10.1016/j.jadohealth.2015.12.013

Journal of Adolescent Health

Volume 58, Issue 4, April 2016, Pages 440-445

https://doi.org/10.1016/j.jadohealth.2015.12.013 Get rights and content

Abstract

Purpose

Electronic cigarettes are marketed as a tool to give up or reduce cigarette smoking, and their use has risen sharply in recent years. There is concern that use is increasing particularly among adolescents and that they are not being used as a cessation tool but as a novel experience in their own right.

Methods

The present research assessed prevalence and sociodemographic correlates of e-cigarette use and standard cigarette use and also explored the extent to which e-cigarettes appear to be used as a cessation tool. This was assessed using a questionnaire administered to 1,486 French adolescents aged 16 years.

Results

Prevalence of e-cigarette experimentation was high (54%) and comparable to that for standard cigarettes (55%). Furthermore, 20% of those who had experimented with e-cigarettes had never tried standard cigarettes, and among regular smokers of standard cigarettes, intentions to quit were not associated with e-cigarette usage frequency. Experimentation with both e-cigarettes and standard cigarettes was significantly predicted by higher age, higher socioeconomic status, and parental smoking of standard cigarettes (in particular the father). Being male marginally predicted e-cigarette use, whereas being female significantly predicted standard cigarette use.

Conclusions

These findings give cause for concern: e-cigarette usage experimentation is extremely high, and is not associated with attempts to quit smoking standard cigarettes. Rather, it is exposing adolescents to a highly addictive drug (nicotine) and may pave the way for a future cigarette habit.

Section snippets

Participants

A total of 1,486 participants (709 females), attending seven different schools, took part in the study. Participants were all in their first year of “lycée” (mean age = 16.13 years, standard deviation = .71 years). All schools were located in the Hauts-de-Seine, a region of higher than French average (but lower than Parisian average) urban density and SES [29]. Each school serves neighborhoods of varying SES, in accordance with the French principle of social diversity (mixité sociale). See

Frequencies of electronic/standard cigarette usage

Because of technical difficulties with the online survey software, data on electronic/standard cigarette usage was missing for eight participants (<.01% of the sample), resulting in a sample size of 1,478. Just over half (54%) of the participants reported having experimented with e-cigarettes, and 55% reported having tried standard cigarettes, see Table 2. Of those who had ever tried e-cigarettes (N = 794), 157 adolescents (20%) had never tried standard cigarettes.

E-cigarette usage and cessation behaviors among regular smokers

A between-subjects analysis of

Discussion

The present research aimed to explore how French adolescents use e-cigarettes, to establish prevalence of use, to determine the sociodemographic variables predicting experimentation with e-cigarettes, and how this compares to the variables predicting standard cigarette experimentation. Experimentation with e-cigarettes was high in this sample, with 54% reporting having tried e-cigarettes. This is comparable with the percentage having tried standard cigarettes (55%). Of those who had tried

Funding Sources

This research was supported in full by a grant from La Comité des Hauts-de-Seine de la Ligue Nationale Contre le Cancer.

References (38)

C. Bullen et al.
Electronic cigarettes for smoking cessation: A randomised controlled trial
Lancet
(2013)
E.L. Sutfin et al.
Electronic cigarette use by college students
Drug Alcohol Depend
(2013)
S. Lee et al.
Electronic cigarette use among Korean adolescents: A cross-sectional study of market penetration, dual use, and relationship to quit attempts and former smoking
J Adolesc Health
(2014)
J.H. Cho et al.
Electronic-cigarette smoking experience among adolescents
J Adolesc Health
(2011)
J.K. Pepper et al.
Adolescent males' awareness of and willingness to try electronic cigarettes
J Adolesc Health
(2013)
D.R. Camenga et al.
Trends in use of electronic nicotine delivery systems by adolescents
Addict Behav
(2014)
S.E. Adkison et al.
Electronic nicotine delivery systems: International tobacco control four-country survey
Am J Prev Med
(2013)
A.J. Swerdlow et al.
Epidemiology of cancer
R. Doll
Mortality in relation to smoking: 50 years' observations on male British doctors
BMJ
(2004)
J. Ferguson et al.
The English smoking treatment services: One-year outcomes
Addiction
(2005)

N.L. Benowitz

Smokeless tobacco as a nicotine delivery device: Harm or harm reduction?

Clin Pharmacol Ther

(2011)

C. Bullen et al.

Effect of an electronic nicotine delivery device (e cigarette) on desire to smoke and withdrawal, user preferences and nicotine delivery: Randomised cross-over trial

Tob Control

(2010)

P. Caponnetto et al.

EffiCiency and safety of an eLectronic cigAreTte (ECLAT) as tobacco cigarettes substitute: A prospective 12-month randomized control design study

PloS One

(2013)

T.E. Sussan et al.

Exposure to electronic cigarettes impairs pulmonary anti-bacterial and anti-viral defenses in a mouse model

PloS One

(2015)

A.K. Regan et al.

Electronic nicotine delivery systems: Adult use and awareness of the “e-cigarette”in the USA

Tob Control

(2013)

K.A. Vickerman et al.

Use of electronic cigarettes among state tobacco cessation quitline callers

Nicotine Tob Res

(2013)

Z. Cahn et al.

Electronic cigarettes as a harm reduction strategy for tobacco control: A step forward or a repeat of past mistakes?

J Public Health Policy

(2011)

B. Dautzenberg et al.

E-cigarette: A new tobacco product for schoolchildren in Paris

Open J Respir Dis

(2013)

N.K. Cobb et al.

E-cigarette or drug-delivery device? Regulating novel nicotine products

N Engl J Med

(2011)

Cited by (32)

Is socioeconomic status related to youth e-cigarette use? Examining family affluence and sexual identity
2023, Addictive Behaviors
There is limited evidence about the relationship between socioeconomic status (SES) and youth electronic cigarette use, particularly among sexual minorities. This study investigates whether family affluence is significantly associated with e-cigarette use among youth, including sexual minority youth. Data came from the 2021 National Youth Tobacco Survey (N = 10,515). The prevalence of e-cigarette use for all participants and sexual minority youth (N = 1376) by SES was calculated and ranked according to the Family Affluence Scale. A propensity score weighting method was used to address the imbalance in characteristics among SES groups. The associations of SES with current e-cigarette use and current flavored e-cigarette use were estimated using univariate survey logistic regression for all participants and self-identified sexual minority students. The prevalence of e-cigarette use was similar among socioeconomic groups for all participants and sexual minorities. The propensity score weighting analysis showed no significant association between SES and current e-cigarette use for all participants and sexual minority students. Equally, there was no significant association between SES and current flavored e-cigarette use. Findings suggest that other protective and risk factors might explain youth e-cigarette use more than SES (family affluence scale).
Longitudinal transitions in tobacco use in youth and young adults: A latent transition analysis of the population assessment of tobacco and health study from Wave 1 to 5
2023, Addictive Behaviors
Citation Excerpt :
Although e-cigarette use has shown a declining trend in recent years, its use among youths remains alarmingly high (Wang et al., 2020) and has become a significant public health concern. The prevalence of multiple tobacco product use (i.e., poly-tobacco use) has increased in recent years (Mattingly et al., 2021; Richardson et al., 2014; Sung et al., 2016). From 2020 to 2021, the prevalence of current poly-tobacco use increased from 1.3% to 4 % among middle school students and from 3.8% to 14.6% among high school students (Walensky et al., 2021).
Tobacco use by youth and young adults can lead to significant long-term health problems. We aim to understand transitions in tobacco use patterns among these groups and the factors that affect transition patterns.
Using the five waves of data from the nationally representative Population Assessment of Tobacco and Health (PATH) Study (2013–2019), we conducted latent class analysis and latent transition analysis to understand tobacco use classes and the longitudinal transitions between classes. We also adjusted for covariates, including demographics, individual behaviors, household environment, and psychosocial factors, to capture their effects on class transition probabilities.
Three tobacco use behaviors were identified: non-current user (C1), moderate e-cigarette user (C2), and poly-tobacco user (C3). At baseline (Wave 1), 94.4% of participants were classified as C1, 3.2% as C2, and 2.4% as C3, and the distribution shifted towards C2 and C3 over time. Progression to the next class represented the most common transitions (14.1% C2 to C3, 10.7% C1 to C2), while the direct progression from C1 to C3 was rare (0.6%). Being male, White, adult, living in smoking-allowed households, past-year alcohol use, drug use, internalizing problems, and social media follower of tobacco brands were associated with a faster progression to poly-tobacco use.
The transition patterns implied that e-cigarette use might be an intermediate progression from non-current use into poly-tobacco use. Individual behaviors, household environment, and psychosocial factors are associated with elevated risks of progression. The findings may inform tobacco prevention and cessation policies among youth and young adults.
Examining potential risk factors for early age of nicotine vaping initiation in a sample of Florida youth
2021, Addictive Behaviors
Citation Excerpt :
In contrast, studies among adolescents do not indicate that youths engage in vaping as an attempt to cease traditional cigarette smoking – and there is even evidence to suggest that a non-negligible portion (~12% − 20%) of adolescents who vape have never tried traditional cigarettes (Chapman & Wu, 2014; Corey et al., 2013; Rennie et al., 2016; Sutfin et al., 2013). Findings from this area of research indicate that male gender, conventional cigarette smoking, other forms of substance use (e.g., alcohol and marijuana), having peers who vape, and externalizing symptoms are the most salient risk factors for predicting adolescent vaping activity (Audrain-McGovern et al., 2020; Camenga et al., 2014; Cho et al., 2011; Fotiou et al., 2015; Goniewicz & Zielinska-Danch, 2012; Ramo et al., 2015; Rennie et al., 2016; Riehm, et al., 2019; Vogel et al., 2018; Westling et al., 2017). A study by Westling and colleagues (2017), for example, found that e-cigarette use in eighth grade was significantly correlated with the use of other substances such as conventional cigarettes, alcohol, and marijuana.
Previous research has examined risk factors for nicotine vaping in young adults and older adolescents. Even so, significantly less research has examined risk factors for initiating nicotine vaping in early adolescence. This paper addresses this gap in the literature by examining risk factors for initiating nicotine vaping in a sample of middle- and high-school students. In order to do so, we analyze data from the 2019 cohort of the Florida Youth Substance Abuse Survey (FYSAS). We employ multinomial logistic regression and logistic regression to examine potential risk factors for early age of nicotine vaping initiation. Our findings reveal that early age of nicotine vaping initiation is associated with cigarette use, alcohol use, having substance using peers, lifetime incidence of arrest, and lifetime incidence of school suspension. In conclusion, our findings reveal that early age of nicotine vaping initiation is associated with other forms of risky behavior in adolescence (i.e., substance use, misbehavior leading to arrest and/or school suspension). We discuss the implications of these findings for future research.
Use of electronic cigarette in France among adolescents aged 17: Results from the ESCAPAD 2017 survey
2019, Bulletin du Cancer
L’usage d’e-cigarette s’est développé en France depuis 2010, y compris chez les adolescents. Parmi eux, le rôle joué par l’e-cigarette par rapport au tabac n’est pas encore bien compris.
Les données proviennent d’ESCAPAD 2017, enquête transversale et nationale réalisée par l’Observatoire français des drogues et des toxicomanies (OFDT) lors de la Journée défense et citoyenneté (JDC), en partenariat avec la Direction du service national et de la jeunesse (39 115 répondants). Des analyses descriptives et des régressions multivariées ont été réalisées afin de caractériser l’usage récent d’e-cigarette à 17 ans.
L’e-cigarette a été expérimentée par 52,4 % des 17 ans, et utilisée dans le mois précédant l’enquête par 16,8 % d’entre eux, 1,9 % quotidiennement. La majorité des usagers récents étaient des fumeurs quotidiens (62,5 %), et seuls 7,6 % n’avaient jamais expérimenté de cigarettes. Seulement 13,3 % avaient expérimenté la vape avant les cigarettes. L’usage d’autres produits était fortement associé : tabagisme quotidien (risque relatif [RR] = 2,74), expérimentation de la chicha (RR = 2,31), cannabis dans l’année (RR = 1,60), alcool récent régulier (RR = 1,20), et expérimentation d’un autre produit illicite (RR = 1,11). Les doubles usagers présentaient un profil sociodémographique plus marqué et des consommations d’autres produits plus importantes.
Bien que l’expérimentation d’e-cigarette soit répandue à 17 ans, son usage récent reste limité et associé le plus souvent à un usage quotidien de cigarettes. Il convient de suivre l’évolution des usages, des parcours et des facteurs associés à l’e-cigarette et au tabagisme chez les adolescents français.
The use of electronic cigarettes has become relatively popular in France since 2010, including among adolescents. However, its use in relation to smoking and other factors is not well understood today.
The data come from the ESCAPAD 2017 survey, a nationally representative cross-sectional survey taking place at a 1-day session of civic and military information compulsory for all French nationals around 17 (39,115 respondents). Descriptive analyses and multivariate regressions were undertaken to describe the recent use of e-cigarette at 17 and its associated factors.
e-cigarettes were experimented by 52.4 % of 17 year-olds, and used by 16.8 % in the preceding month, 1.9 % daily. Most recent users were also daily smokers (62.5 %), and only 7.6 % had never experimented cigarettes before. Among those who experimented with both products, only 13.3 % tried e-cigarettes before cigarettes. The associated uses of other products were the most striking factors: daily smoking (relative risk [RR] = 2.73), ever use of hookah (RR = 2.31), cannabis use in the last year (RR = 1.60), regular alcohol drinking (RR = 1.20) and ever use of another illicit drug (RR = 1.11). Recent vapers that were also daily smokers had a more pronounced sociodemographic profile and a higher level of other drugs consumptions than recent vapers only.
Although a majority of French adolescents experiment with vaping, they are fewer to use it regularly and its current use is frequently associated with daily smoking. Future trends and the relationship between smoking and vaping among adolescents will have to be further investigated, including the motivations of its use.
More than half of adolescent E-Cigarette users had never smoked a cigarette: findings from a study of school children in the UK
2018, Public Health
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.
A cross-sectional questionnaire-based design was used.
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.
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.
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.
Socio-demographic Correlates of Electronic Cigarette and Cannabis Co-use Among Naïve and Tobacco Adolescent Users
2023, Journal of Prevention

View all citing articles on Scopus

View full text

Original articleHarm Reduction or Harm Introduction? Prevalence and Correlates of E-Cigarette Use Among French Adolescents

Abstract

Purpose

Methods

Results

Conclusions

Section snippets

Participants

Frequencies of electronic/standard cigarette usage

E-cigarette usage and cessation behaviors among regular smokers

Discussion

Funding Sources

Lancet

Drug Alcohol Depend

J Adolesc Health

J Adolesc Health

J Adolesc Health

Addict Behav

Am J Prev Med

Epidemiology of cancer

Mortality in relation to smoking: 50 years' observations on male British doctors

BMJ

The English smoking treatment services: One-year outcomes

Addiction

Smokeless tobacco as a nicotine delivery device: Harm or harm reduction?

Clin Pharmacol Ther

Effect of an electronic nicotine delivery device (e cigarette) on desire to smoke and withdrawal, user preferences and nicotine delivery: Randomised cross-over trial

Tob Control

EffiCiency and safety of an eLectronic cigAreTte (ECLAT) as tobacco cigarettes substitute: A prospective 12-month randomized control design study

PloS One

Exposure to electronic cigarettes impairs pulmonary anti-bacterial and anti-viral defenses in a mouse model

PloS One

Electronic nicotine delivery systems: Adult use and awareness of the “e-cigarette”in the USA

Tob Control

Use of electronic cigarettes among state tobacco cessation quitline callers

Nicotine Tob Res

Electronic cigarettes as a harm reduction strategy for tobacco control: A step forward or a repeat of past mistakes?

J Public Health Policy

E-cigarette: A new tobacco product for schoolchildren in Paris

Open J Respir Dis

E-cigarette or drug-delivery device? Regulating novel nicotine products

N Engl J Med

Original article
Harm Reduction or Harm Introduction? Prevalence and Correlates of E-Cigarette Use Among French Adolescents