Changes in childhood experimentation with, and exposure to, tobacco and e-cigarettes and perceived smoking norms: a repeated cross-sectional study of 10–11 year olds’ in Wales

Abstract

Background Today’s primary school children have grown up in a climate of strong smoking restrictions, decreasing tobacco use, and the emergence of e-cigarettes. Children’s exposure to tobacco declined substantially in years following the introduction of smoke-free legislation, with smoking uptake and perceived smoking norms declining. There is debate regarding whether emergence of e-cigarettes may interrupt trends in children’s smoking perceptions, or offer a means for adults to limit children’s exposure to tobacco. This study examines change in children’s tobacco and e-cigarettes experimentation (ever use), exposure to secondhand smoking and vaping, and perceived smoking norms. Methods Data from four, repeat cross-sectional surveys of Year 6 primary school pupils (age 10–11 years) in Wales in 2007, 2008, 2014 and 2019 (n = 6741) were combined. E-cigarette use and perceptions were included in 2014 and 2019 surveys. Analyses used binary logistic regression analyses, adjusted for school-level clustering. Results Child tobacco experimentation and most indicators of exposure to tobacco smoke indicated a graded decreasing trend over time from 2007 to 2019. Exposure to e-cigarettes increased from 2014 to 2019, as did pupil awareness of e-cigarettes (OR = 2.56, 95%CI = 2.12–3.10), and parental use (OR = 1.26, 95%CI = 1.00–1.57). A decrease in child e-cigarette experimentation was not significant (OR = 0.80, 95%CI = 0.57–1.13). Children’s normative perceptions for smoking by adults and children indicated a graded decrease over time (OR = 0.66, 95%CI = 0.54–0.80; OR = 0.69, 95%CI = 0.55–0.86; respectively from 2014 to 2019). However, fewer reported disapproval of people smoking around them in 2019 relative to 2014 (OR = 0.68, 95%CI = 0.53–0.88). Higher exposure to tobacco cigarettes and e-cigarettes in public places, cars and households were associated with favourable normative perceptions for tobacco smoking; however in models adjusted for exposure to both associations of e-cigarette exposure were attenuated. Conclusion Children’s experimentation with and exposure to tobacco, and their perceptions of smoking as a normative behaviour, have continued to decline alongside growth in exposure to e-cigarettes. Although a large majority of pupils reported they minded people smoking around them, there was some evidence of diminishing disapproval of secondhand smoke since 2007. Further research is needed to understand whether use of e-cigarettes in cars and homes is displacing prior smoking or being introduced into environments where smoking had been eliminated.

Impacts of EU Tobacco Products Directive regulations on use of e-cigarettes in adolescents in Great Britain: a natural experiment evaluation

“…However, today's young people are also the first generation to have grown up in a time when e-cigarettes have become a major presence in UK society. 33 The growing presence of e-cigarettes has led to some concerns that e-cigarettes might lead to a new generation of tobacco-naive young people addicted to nicotine. Some concerns were expressed early in the emergence of e-cigarettes that marketing for e-cigarettes used approaches that mirror those used by the tobacco industry, targeting young people as potential new consumers.…”

Socio-temporal contextual and community factors associated with daily exclusive ENDS use and dual use with tobacco cigarettes among adolescent vapers: an ecological momentary assessment study

“…Research indicates that environments favorable of ENDS use influence susceptibility to and use of tobacco cigarettes [8,10,[17][18][19][20]. Studies further show that certain socio-ecological factors may be driving dual use behaviors among adolescents.…”

Contextual and community factors associated with daily exclusive ENDS use and dual use with tobacco cigarettes among adolescent vapers: an ecological momentary assessment study

“…Research indicates that environments favorable of ENDS use in uence susceptibility to and use of tobacco cigarettes (8,10,(17)(18)(19)(20). Studies further show that certain socio-ecological factors may be driving dual use behaviors among adolescents.…”