Far more non-smoking US students are trying e-cigarettes, figures show

BMJ 2014; 349 doi: (Published 29 August 2014) Cite this as: BMJ 2014;349:g5353
  1. Michael McCarthy
  1. 1Seattle

The number of middle and high school students in the United States who have tried electronic cigarettes (e-cigarettes) despite never using regular cigarettes increased threefold from 2011 to 2013, a new report has found.

The study by the US Centers for Disease Control and Prevention,1 published online on 20 August in the journal Nicotine and Tobacco Research, reported that 263 000 non-smoking students tried e-cigarettes in 2013, compared with just 79 000 in 2011.

It comes after a World Health Organization report2 called for strict e-cigarette regulations worldwide, including restrictions on e-cigarette advertising, promotions and sponsorships that target young people, bans on flavored e-cigarette products that appeal to children and young people, and bans on e-cigarette use in indoor public spaces and workplaces.

Researchers in the CDC study—led by Rebecca Bunnell, associate director for science at CDC’s Office on Smoking and Health—analyzed data from the nationally representative National Youth Tobacco Surveys of school students in grades 6-12, which were conducted in 2011, 2012, and 2013.

They found that non-smoking students who had tried e-cigarettes were twice as likely to say that they intended to smoke conventional cigarettes within the next year as were those who had never used e-cigarettes (44% v 22%). Students who had never smoked cigarettes were more likely to say that they intended to smoke if they had been exposed to advertisements promoting cigarettes, and those who were exposed to advertisements from a wider variety of sources such as online, print, and broadcast were at higher risk, the researchers reported.

Compared with those who had no exposure to e-cigarette advertising, in students who reported 1-2 sources of exposure the adjusted odds ratio for intending to smoke was 1.68 (95% confidence interval 1.45 to 1.95; P<0.001), while in those who reported 3-4 sources it was 2.30 (1.97 to 2.68; P<0.001), the researchers found. They wrote, “Interventions to prevent youth access and exposure to [electronic nicotine delivery systems] marketing on the internet, television, and elsewhere could help reduce product appeal and use.”

The study also found that students who reported use of other combustible products, such as cigars, cigarillos, pipes, and hookahs, were also more likely to report an intention to smoke cigarettes in the coming year. It concluded, “These findings highlight the importance of enhanced efforts to prevent all forms of tobacco use among youth, including e-cigarettes.”


Cite this as: BMJ 2014;349:g5353


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