Have e-cigarettes renormalised or displaced youth smoking? Results of a segmented regression analysis of repeated cross sectional survey data in England, Scotland and Wales

Hallingberg, Britt; Maynard, Olivia; Bauld, Linda; Brown, Rachel; Gray, Linsay; Lowthian, Emily; MacKintosh, Anne Marie; Moore, Laurence; Munafò, Marcus R; Moore, Graham

doi:10.1136/tobaccocontrol-2018-054584

Cited by 44 publications

(51 citation statements)

References 24 publications

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“…For example, as most adult e-cigarette use is among adults who smoke or have recently given up [7][8][9]18,19], it logically follows that most children whose parents use e-cigarettes will come from families where they are currently, or have recently also been, exposed to tobacco cigarettes. Analyses of survey data from three UK nations found that experimentation with tobacco cigarettes declined during the emergence of e-cigarettes, while the decline in perceptions of acceptability of smoking accelerated [2]. Hence, this provides no evidence that smoking was becoming renormalised during this time and suggests that any gateway effects were not having a population level impact on smoking rates.…”

Section: Introductionmentioning

confidence: 87%

“…Having a parent figure who smokes is a well-established risk factor for smoking initiation in childhood and adolescence; a meta-analysis of 58 studies, for example, found that the odds of smoking uptake doubled where a parent figure smoked [1]. Smoking rates have declined substantially in recent years [2], with progressively comprehensive tobacco control strategies acting to de-normalise smoking [3]. However, many parents continue to smoke, with parental smoking particularly common among less affluent families [4].…”

Section: Introductionmentioning

confidence: 99%

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Associations of Socioeconomic Status, Parental Smoking and Parental E-Cigarette Use with 10–11-Year-Old Children’s Perceptions of Tobacco Cigarettes and E-Cigarettes: Cross Sectional Analysis of the CHETS Wales 3 Survey

Moore

Angel

Gray

et al. 2020

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Background: This study examines primary schoolchildren’s perceptions of e-cigarettes and tobacco cigarettes, and associations with parental smoking, vaping and socioeconomic status. Methods: Survey of 2218 10–11-year-old children in 73 schools in Wales. Results: Overall, 36% reported that a parent figure smoked compared to 21% for vaping, with parental smoking lower in affluent families (OR = 0.72; 95% CI = 0.68 to 0.76). Overall, 1% had tried a cigarette, while 5% had tried an e-cigarette. Most said they would not smoke or vape in 2 years’ time; susceptibility to vaping (20%) was higher than smoking (12%). Exposure to and perceptions of tobacco cigarettes were more positive for children of smokers. Having a parent who vaped was associated with exposure to and positive perceptions of e-cigarettes, but not smoking. Most children perceived e-cigarettes as used by adults to stop smoking (64%). Susceptibility to smoking (OR = 0.57; 95% CI = 0.41 to 0.79) and vaping (OR = 0.78; 95% CI = 0.62 to 0.99) were lower among children who perceived e-cigarettes as cessation aids. Conclusions: Parental smoking continues to be concentrated in poorer families. This study provides no evidence that parental vaping in the absence of smoking is associated with more positive perceptions of tobacco cigarettes. Communicating to children the role of e-cigarettes as cessation devices for smokers may help to limit their appeal to young people.

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Section: Introductionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Associations of Socioeconomic Status, Parental Smoking and Parental E-Cigarette Use with 10–11-Year-Old Children’s Perceptions of Tobacco Cigarettes and E-Cigarettes: Cross Sectional Analysis of the CHETS Wales 3 Survey

Moore

Angel

Gray

et al. 2020

IJERPH

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“…We were able to explain much of this association with a relatively limited set of measured confounders and the residual effect estimates could be at least partially explained by unmeasured confounding and/or reverse causation. Taken together with other evidence such as observed increases in youth smoking after implementation of e-cigarette sale restrictions [45][46][47] and continued declines in youth pro-smoking attitudes while youth vaping has been rising [48], it seems that even if there is an effect whereby vaping increases risk for smoking, it may not be the primary or dominant explanation for these associations.…”

Section: Discussionmentioning

confidence: 94%

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

Green¹,

Gray²,

Sweeting³

2020

Preprint

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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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“…We were able to explain much of this association with a relatively limited set of measured confounders and, as noted above, the residual effect estimates could be at least partially explained by unmeasured confounding and/or reverse causation. Taken together with other evidence such as observed increases in youth smoking after implementation of e-cigarette sale restrictions [37][38][39] and continued declines in youth prosmoking attitudes while youth vaping has been rising [40], it seems that even if there is an effect whereby vaping increases risk for smoking, it is unlikely to be the primary or dominant explanation for associations between the two, and ongoing concerns about such effects should be abated.…”

Section: Meaning and Implicationsmentioning

confidence: 98%

Youth vaping and smoking and parental vaping: a panel survey

Green

Gray

Sweeting

2020

Preprint

Self Cite

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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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Have e-cigarettes renormalised or displaced youth smoking? Results of a segmented regression analysis of repeated cross sectional survey data in England, Scotland and Wales

Cited by 44 publications

References 24 publications

Associations of Socioeconomic Status, Parental Smoking and Parental E-Cigarette Use with 10–11-Year-Old Children’s Perceptions of Tobacco Cigarettes and E-Cigarettes: Cross Sectional Analysis of the CHETS Wales 3 Survey

Associations of Socioeconomic Status, Parental Smoking and Parental E-Cigarette Use with 10–11-Year-Old Children’s Perceptions of Tobacco Cigarettes and E-Cigarettes: Cross Sectional Analysis of the CHETS Wales 3 Survey

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

Youth vaping and smoking and parental vaping: a panel survey

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