Primary pupils more likely to try e-cigarettes – but no evidence it’s a gateway to smoking

Trying is not the same as taking up. e-cig by Shutterstock

The tobacco industry kills about 5m smokers a year, plus another 600,000 non-smokers. With the health risks involved, it’s perhaps unsurprising that e-cigarettes that release nicotine in vapour form are increasingly being promoted as an alternative.

The great vape debate about the potential health benefits and harms has gathered pace and ferocity – particularly when it comes to whether e-cigarettes could act as a gateway for young people to take up smoking. However, the debate is highly polarised and lacks much research evidence.

The pro e-cigarette lobby argue that among the many cessation methods and products available, e-cigarettes are a more popular, convenient and low-cost method to help people stop smoking cigarettes, and could have potentially huge health benefits. Others argue that the unregulated use of e-cigarettes – partly fuelled by Big Tobacco’s growing financial backing of popular e-cigarette companies – could undermine the success of recent tobacco control policies and drive the recruitment of new smokers.

In new research published in BMJ Open, we set out to find out how many young people are using e-cigarettes and the potential harms and benefits. We based our work on surveys of more than 10,000 young people aged 10-16 in Wales.

Young people are using e-cigarettes

Lots of young people are using e-cigarettes who would probably not have otherwise been exposed to nicotine. Primary-school children in Wales were three times more likely to have used e-cigarettes (5.8%) than tobacco (1.6%). E-cigarette use is now more common than tobacco use until the age of 14 and by the age of 16 about one in ten “never smokers” have tried an e-cigarette.

Experimentation with e-cigarettes also appears to be becoming “normalised” within the youth population. Our surveys found no differences in the proportion of young people reporting e-cigarette use by gender, ethnicity or family affluence measures at secondary school age.

In an ideal scenario, the only people using e-cigarettes would be past smokers who have switched to e-cigarettes and no longer smoke tobacco. However we found that current smoking was as strongly associated with e-cigarette use as past smoking. In short, few young people seem to be switching from tobacco to e-cigarettes in a bid to stop smoking.

E-cigs not likely to contribute directly to nicotine addiction. Smoking by Shutterstock

However, there is some good news: the prevalence of regular e-cigarette use among school-aged young people is still very low. Less than 2% of the 11 to 16-year-olds surveyed in Wales reported using e-cigarette use at least once a month. This suggests that e-cigarettes are not likely to contribute directly to nicotine addiction for many, if any, young people at the moment.

In England, recent research involving a survey of more than 16,000 14-17 year-olds also found that many teenagers, even those who have never smoked, are now experimenting with e-cigarettes. One in five of those surveyed in that study had tried e-cigarettes, which led the researchers to dub them the “alcopops of the nicotine world” and suggest that they needed tougher controls.

Along with the number of primary school children trying e-cigarettes that we have identified, this does suggest that there is reason to be concerned and to monitor the situation regarding e-cigarette marketing and sales.

But there is still no evidence that e-cigarettes are a new gateway into tobacco smoking. Longer-term studies that follow young people over time are now needed before firmer conclusions can be drawn about the benefits and harms of e-cigarettes.

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