Use of tobacco and e-cigarettes among youth in Great Britain in 2022: analysis of a cross sectional survey

Am on g t he 1 8. 0% of th os e surve ye d wh o rep or t ed ev er ha vi ng s moked a c i gar et t e, 83.9% were n ot regula r (at lea st once pe r we ek) s moke r s a nd 16.1 % w ere (15. 1% and 2.9% o f t he t otal s a mp l e re spect ive l y). A mo ng t he 1 9.2% o f t ho se surv eye d wh o had ev er u s e d an e - c iga re tte, 7 9. 2% we re not re gula r user s, wh i le 2 0. 8 % wer e (15. 2% and 4. 0 % re s p e ctive ly . R egula r e-ci g arett e us e w as mo re c om m on t han regul a r t obacc o sm ok ing (4. 0% v s 2.9%). E -ci gar ette use was mo re c om mo n amon g tho se w ho a l so sm oked toba cco, with 9.0 % o f ne v e r e -ciga rett e use r s e ve r s m oking tobacc o, c o mpa red w ith 89. 4% of re gu la r e-ci g are t te us e r s. B oth sm ok ing a nd e- cigaret te u se w e re assoc iated w it h inc rea s in g age a nd us e b y othe r s wi t hi n th e ho me, but not with s oci al c lass. Use o f disp os a bl e e-c i gar ette s w a s re p orted by 53 .8% of t h os e w ho hav e e ve r us e d a n e - c igaret t e , a nd mo re c om m on a mon g g irl s tha n b oy s. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprintthis version posted July 26, 2022. ; https://doi.org/10.1101/2022.07.25.22277745doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. DISCU SSI O N Regula r e-ci gare tte u se is now mo re c o mm on than s mokin g i n chi ldren a nd you th, t houg h t he major ity of t h i s i s a mo ng th ose wh o h a v e a lso smoke d t obacc o. M easu re s to r ed uce t he a pp ea l of e- both e-c iga ret t e s a nd t obacc o t o chi ldre n and youn g p e o ple a r e warrant ed. INTRODU CTION The use of e-ciga ret te s a s a t ool for h arm r eduction a mo ng pe opl e wi t h t oba cco depend enc e ha s gain ed rece n t m o men tum in th e UK, an d in 20 21 t he Me dicine s a nd H ealt hcare Pr odu cts R eg ulat ory age ncy (M HR A ) an nounc ed t hat i t wo uld fac ilitat e t he pr oc e s s f or e-ci ga rette s t o bec om e li ce ns ed as m edic inal prod ucts , whic h woul d all o w them t o be market ed ex p lic it l y as s mo king c e s sa tio n a ids and pr e s c ribe d in s mokin g ce s s a t io n cli ni cs and e l sew her e (1 ) Alt houg h U K yout h s m oking rate s a re a t an a ll ti me l ow ( 2), t he re a re gr owin g c o nc ern s that e - ci garet t e u s e may be dev e lo ping a m ong tobacc o-naiv e y oung pe opl e, p art ic ular l y t h e s ug ge s t ion that e-ci ga rette use with in thi s p opul ati o n may act a s a gat ewa y to ci gar ette s m o ki ng. In th e U S a 201 8 r ep ort by th e Nati onal Academ ie s of Scie nc es, E ngi nee rin g, and M edi cine ( NAS EM) conc luded that t he re w as eviden ce fo r a causal ef f e ct of e-ci gare tt e u s e on you th trans iti on fro m non -s m oker to e v e r sm ok er, whil e th e Ce nte rs f or D i s ease Con tr ol and P r e v enti on (C DC ) de s c ri be you th e - ci garet t e u s e a s a se ri ous public heal th c once rn(3 , 4). Wi thin th e UK a 202 0 P H E r epo rt st a ted t h a t the maj o r i t y o f y outh ne v er s moke rs had als o ne ve r us ed an e -cigar ett e w ith onl y 0.8%-1.3% of tobacc o-naiv e y outh re po rti ng t he y wer e curre nt e -ciga r e t t e user s, c onc luding w ith a s tat em ent that e-ci ga rette p r e valen ce a m on g th e U K’s y oung p e o ple nee ds t o be cl o s el y m o nito red ( 5). Giv en the im po rtance of ob s e r v in g sm ok ing a nd e-ci ga ret t e use with in t he youn g er po p ulation and the ne ed fo r vi gi lanc e t o tr a ck d e vel op m e nts in t h e ma rket, w e re po rt data fr o m the 20 22 A SH /Y ouG ov S mok efre e G B -Y outh surv ey on y outh s mokin g and e-c iga ret t e u s e . METHO D S Da t a Data ca me fr om th e AS H /Y ouG ov S mok efre e GB-Y outh surv ey of 2,613 11 - 1 8 ye ar olds, c oll ect ed betwe en 1 st and 2 9 th March 20 22. Data w ere c oll ected by You Gov, a public li mit e d compa ny , fro m an onl ine pane l r ec ruited u sing p ro pri eta ry so ftware w h ich i s de t a iled e l s e whe re ( 6). Co ns ent wa s pro vide d by p art ic i pant s i f t hey w ere ag e d ove r 16 y ea rs , a nd by the i r pa ren ts if 15 year s or youn ge r . Meas u r e s E-ciga r e tte u s e was as s e s s e d usi ng th e q ue s ti on “ Which ONE of the following is closest to describing your experience of e-cigarettes?” We ca t e g ori sed t h is int o n eve r e -c igar ette use rs ( “I hav e ne v er us e d an e-ciga ret te”), n on- r e gular e -ci gar ette us e rs ( “I hav e only t ri e d an e - c iga ret te o nce o r twic e” ; “ I u s e d e - cig a re t t es i n t he p a st b u t n o l onge r do” ; “ I u s e e - c iga r et t es mo r e t h a n onc e a mo n th , b u t l e s s than on ce a we e k” ; “ I use e-ci ga re t t es so me t i me s , but n o mo re t han once a m o nth” ) , and r egula r use (“I use e-ci gar et te s mo re than o nce a we ek but n ot ev ery da y” ; “I us e e-ci gar e t te s ev er y day ” ). We al so c la ssifi e d re spon de nts w ho r epli e d that th ey ha d nev e r hea rd o f e -c igar e tt e s a s ne v er e- ci garet t e u s e rs. Tobac co u se was a s s e s sed us i n g th e sam e c ate go rie s. W e p re se nt r egr e s si on ana lyse s f or b oth re gu lar u se and eve r us e o f both toba cco and e -c iga rette s . All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprintthis version posted July 26, 2022. ; https://doi.org/10.1101/2022.07.25.22277745doi: medRxiv preprint Participa nts w h o rep or ted e ve r use o f e - ciga r e tte s we re al so asked a b out t h e ord er of pr oduc t us e. We re po rt the p e r c en tage o f toba cco sm oki ng a m ong th os e c h o os i n g t o s e lect “I tried s mokin g a real ci gare tte b ef ore I f ir s t t ried u sing a n e-ci ga rette” c o m pared w ith tho s e w ho s elec t e d “ I trie d using a n e-ci ga rette be for e I fir s t tri ed s mokin g a real ci ga re t te .”E ver e-c i gar ett e us e rs w e re al s o asked “ Have you EV ER us ed a dispo sabl e el ec t r onic ci ga ret t e (no n-re cha rgeabl e )?” whic h w a s cl as si fied i nto y es a nd n o . Other da t a incl uded w ere age gro up (11 to 13 , 14 t o 15, 16 to 1 7, a nd 18 yea rs old s ) , sex , social cla ss (based on the Reg is t rar G ene ral cla s s i f i c ation of occup at i on s and cl a s si fied a s AB C1 (hi g her ) v s. C2D E ( lowe r), a nd c ou nt r y o f G r eat Brita in ( Engla nd, Sc otland, Wal e s). We a sses s ed house h old us e of e-c iga ret t e s a nd t obacc o f ro m t he questi on s “D oe s an yo n e wh o curr entl y l iv e s in y ou r h om e us e an e-ciga ret te? (ye s vs. no ) ” a nd “ W h o i n your fa mily , if a ny o ne, s moke s tobacc o c iga rette s a t the mo men t?” Fo r toba cco use in th e h ou se hol d, we c reat ed a binar y var iable whi c h c at e go ri s ed all o f: “Mothe r ( or f e male c are r)” , “Fathe r ( or mal e c a r e r)”, “ Broth er o r s is t e r”, “ G randpa r e n t ” and “ O the r famil y m e mber( s ) ” as ye s. W e al s o asse s s ed ex po sure t o e-c i gar ett e p ro mo t i o n usin g th e que s ti on “For t he f oll ow ing que s ti on, by "bein g p r om oted", we m ean s o me thi ng tha t t ri es to in c rea se inter e st in o r de ma nd f or e-ci ga r e t te s.In wh ich, i f any, of t h e f oll ow ing plac e s d o you ev er s ee e- ci garet t e s bei n g pr om oted?” Partici pa nts c ould sel ec t mo r e than on e re spo ns e a nd we categ ori sed ex po s ure as s ele cti ng at least one of Billboards; shops; Online; On buses; On TV; In newspapers/ magazines; or “Somewhere else”. We did not have data on exposure to tobacco advertising. Ana lysi s De s c ri pt i ve stati s t ics a re pre sent ed aft e r acco unt i ng fo r s u r v ey w ei ghti ng to d e al w it h diff er ential non- re sp on s e. Log is t ic r egr e ss i on a naly s es a s s e sse d dif fer ence s i n ev er a nd r egul ar e - c i gar ette and tobacc o us e an d use o f di sp os a bl e e -c iga rette s a mo ng th o s e wh o rep o rted e ve r use of e - c i gare tte s .

The ma jor ity of par tici pan ts l ived in Eng l and (2281), wit h 2 06 in Sc ot l and and 126 in Wale s (Tabl e 1). Ther e w er e 1 756 part i ci pant s in A BC1 s o cia l cl ass and 75 5 in C2 DE . Th er e wer e 3 4 1 pa r tic ipan ts aged 18 year s old a nd t he maj o r i t y o f pa rticip a nt s (997 ) we re a ged 1 1 to 1 3 y ea rs . Eve r s m okin g t obacc o wa s r ep ort ed by 18.0 % of th e sam ple. 83.9% o f t h e se wer e non -re gul ar sm oke rs ( a bsolute pe rcenta ge 15.1 %) an d 16.1% were re gu lar s m o ke rs (a bsolute perce ntag e 2.9% ) (Table 2). A m ong th e 1 9.2% of t h os e sur veye d wh o had ev er u s e d an e - c iga ret te, 79 .2% we r e n ot regula r us e r s, whi l e 2 0.8 % were (15.2% a nd 4.0% re spec tiv ely ) . R egular e - c i gare tte use wa s mo re com mo n tha n r egula r t oba cco smoki n g ( 4.0% v s 2.9% ). E-ciga r e tte use was m or e co mmo n am on g tho s e who a lso s m ok ed t obacc o, w it h 9. 0% o f n e ve r e -c igar ette use rs e v e r sm ok i ng t obacc o, comp a red wi th 89. 4% of r egul ar e-ciga re t te u s e rs . Que s ti on s on orde rin g o f p roduct us e f o und t ha t re gular tobac co s moki ng was m ore co mm o n amon g tho se w ho re po rted u sin g t obac co b ef ore e -ciga r e t t es tha n t ho se wh o u sed e-ciga r e tte s f ir s t (20.2% v s 9.3%). Di ff e r e nces in e ve r and r e gula r us e o f e - c igare tte s a re s h own in Table 3. Ev e r use was m ore c o mm on as pa rtici pa nt s g ot o lde r ( p f or tr end <0 . 00 1). Partici pa nts a ge d 18 y ear s wer e co nside rably mo re lik ely t o re po rt e v er use tha n t ho se a ge d 11 t o 13 years (adjusted odds ra tio = 13.7 9, p< 0.0 01). Ev e r All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprintthis version posted July 26, 2022. ; https://doi.org/10.1101/2022.07.25.22277745doi: medRxiv preprint use w as m o r e co mm on a mo ng part ici pa nts re po rtin g r egu lar e-ci ga re t te us e in t hei r h o me ( A O R = 6.65, p <0. 001 ), alt houg h n o di ffe renc e s w ere det ec t e d by s ocia l cl a s s o r c ountry . Ass ociati on s we re si milar fo r regula r use, with use m or e co mm on a mo ng olde r p a r tic ipa nt s and t ho se re po rtin g e - ci garet t e u s e i nside t he ho me ( A O R = 2 0 .0 5, p<0. 0 01). Ex p o s ure to e-ciga ret te pr om oti on w as link ed to g reat er l i keli ho od o f e ve r us e o f e-ci ga rette s (AOR = 1 .61, p< 0 .001) wit h a weake r assoc iati on w it h r egular e - c i gare tte use ( AOR = 1 .52 , p =0.0 97). Di ff e r e nces in e ve r and r e gula r t obac co s mokin g ar e sh own i n Tabl e 4 . Th es e p re s ent a si mila r pic t ure t o t h at fo r e-ciga rett e us e. Ev er u s e was m or e c o m mon am on g older pa r ti c ipants ( e .g. AOR for 18 yea r ol ds v s. 11 to 13 y ear old s = 10 .79 , p< 0.0 01 ) as we ll a s t ho s e with c i gare tte sm okin g i n th e famil y ( A O R = 2.4 2 , p <0. 00 1). R egula r smoki n g was m ore co mm on a mo n g olde r pa r tic i pant s (p fo r trend <0. 00 1) and tho s e re p o r ti ng ci gare tte sm okin g in th e fa mil y ( AOR = 3 . 87, p <0.0 01. W e did n ot detec t dif f e r e nce s by sex o r s oc ial clas s fo r eit her ev e r or re gular tobac co s mokin g. Di ff e r e nces in u s e o f di s p o sable e-ciga r e tte s am on g ev er e-c i gare tt e u s e r s are sh ow n in Ta ble 5. Use of di sp o sable p roduc ts w as mo r e c om m on a mon g g irl s (AOR = 1.69, p = 0. 010), 18 ye ar old s ( AOR = 2.7 8, p = 0.0 20), a nd t ho s e re po rt i n g e -ci ga r e tte u s e i n t he ho me ( A O R = 2.60 , p< 0.001 ). DISCU SSI O N Youth tobac co s mokin g a nd e-ci ga rette us ag e re main ed low in 202 2 , h owe v er e- ci garet t e u s a ge in thi s p opulati on is now sli ghtl y h ig her tha n re gu lar t obacc o sm oking . Co m pared to d ata f ro m 2 02 0 - 21 the l ow sm ok ing pr eva le nce i s uncha n ged an d r egular e - c i gar ette use is als o si milar (4 .0% vs 4.3 %,(7) . M os t e-ci gar ette use r s re p or t t hat t hey hav e exp e ri m ented wi th or a re r egula r toba cco user s a l ong side th eir e-c i gar ett e us e . 9.3% of th o s e wh o rep o rted tha t they us ed e-ci ga rette s be fo re s mokin g to bacc o were al so re gular tobacc o sm oker s . De spit e t hi s l ow pe rce ntage it i s st il l a c ause f or c on ce rn and h as bee n p r e v ious ly demo nst r a t e d ac ro s s t he W e s t . A 201 7 U S meta-a na ly s i s c onclu ded t hat ado le s c e nts w h o rep o rted any vapi ng exp e r i e nce (b ot h re gular an d inter mit t en t), i ncrea sed t he ir odds of su bsequent c igar ette sm oking by a t hird (8 ). D ata fr om ou r s ur vey de mo ns tr a tes an inc rea se i n y oung p eop le tryi n g e- ci garet t e s f ir st , i n 201 8 18. 3% o f y out h re por t e d th ey tr ied e - c igar ette s be fo re s m ok ing (7), t hi s ha s now incr ea sed t o 37.5 %. D e s pi te y outh s mokin g ra te s bein g at an all tim e l ow, th es e i ncr eas e s in e- ci garet t e u s e wit hout pr ev i ous toba cco smoki n g ar e a pot entia l c ause fo r co n cer n . W hil e it may b e the c a s e that th er e i s co mm on s u scept ibil ity t o b oth tobac co a n d e-ci ga r e t te u s e, t he r e is a ne e d f or r e g u l at io n an d enf or ce me n t t o e ns u r e l owe r l e v e ls of e - c i g a r et te us e am o ng c h i ldr e n . C u rr e nt regula t i on in t he U K p ro hibit s t he sale o f n icoti ne c ontain ing e-ci gare tte s t o t ho se under the a ge o f 18 (9). W hile we di d no t as s e s s wh eth er e-c iga rette s u s ed by s t udy re s p o nde nts c ontain ed nicot ine, pre vi ou s a naly se s of th is data f ound that 7 6% o f p a r tic i pant s re p orted tha t the i r e -ciga re t te s alw ay s o r so me t im es c on t a i n ed n i c o ti n e.( 1 0 ) T he se h igh l e vels of u s e s t ro ng l y s u gg e s t tha t c u r r e nt l aw s ar e po orl y en fo rced a nd unde rsc ore r ec ent r ecom me nda t i on s fo r i n crea sed i nv e s t m ent in loca l sm okef re e e nf orc e me nt acti on s (1 1). Ag e i s al so a sig ni ficant fac to r r e ga rding e-c iga rette and sm okin g beha vi our. A s dem on strate d in pre vi ou s (7 ) and by our c urren t s ur vey da ta, 1 8-yea r- olds a re si gni fic antly m or e l ik ely t o rep or t e ver sm oking a nd e -ciga re t t e use co mpa red w ith low e r ag e g r ou p s . W e f o und t hat us e o f e -c igar ette s by oth er s wit hin t he h om e w as a ssocia ted with e - c i gar ett e use am ong yout h, and the s a m e wa s true for tobacc o s moki ng. T hi s i s n ot sur pri s i ng and i s a wel l - k nown ri sk fac t or f o r s m okin g b ehav i our i n youn g pe opl e , obse r v ed in b ot h t h e UK a nd Ge rma ny (1 2, 13 ). We al so found tha t r e p orting All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprintthis version posted July 26, 2022. ; https://doi.org/10.1101/2022.07.25.22277745doi: medRxiv preprint e xp os u r e t o pr om ot i on of e- c i g a r et te s w as li n ke d t o eve r us e o f t he se pr o du ct s. Th i s f i n din g undersc ore s the ne e d to stre ngt hen en f or c e men t of t he r ul e s o n adve r ti sin g, pr o mot ion a nd enf orce me nt , and rev i ew whet he r t hey n eed furt he r st r en gth eni n g. Di s p o sable e -ciga rett e us e i n th e U S and U K is gr owing , r ecent d a t a fro m a c ros s s ec ti onal surv ey of adults in Great Britai n c onc luded that disp osabl e e - c igar ett e us e g rew s ig n ificant ly in 20 22, predomi na nt l y in 18 ye ar olds (14 ). We fo und that, am ong ev er e-c iga ret t e u se r s , use of d ispo sable s wa s re po rted b y m or e t han ha lf of re sp o ndents, m o r e c om mo nl y a mo ng gir ls a n d 18 year o ld s . Mor e r es earc h i s n eeded to under s ta nd the rea s on s a n d ri s k fact or s f o r di spo sabl e e-ci gar ette use amon g y oung er po p ulatio ns. Limitati on s of t he c urre nt s tudy inclu de t he surv ey s tudy de s ig n m eanin g th at we cannot i n f e r ca us al ity. T hi s m ean s t hat w e ar e u nable to de t e rmi n e t r a jecto rie s of tobac co s m oking, e-ci gare tte use and quitti ng of pr oduc t s.It i s plau sibl e t h a t so me e-ciga ret te u se i n th is p o pul ation is a m on g tobacc o sm oker s at t e mp t i ng to quit , o r may rep lac e t ryin g sm oking , and fur th er re s e arc h in t o t he s e is s ue s is ne e ded. Howev er, th e st udy sa mpl e w as de si gned t o be re pr e s entat iv e of th e G r eat B ritain popul ati on and t h e se re sults add to the on g oin g survei ll ance of sm ok ing and e-ci garet te u se a mo n g the U K’s y ounge r p op ulati on, w hich i s v i tal f or unde rs tanding a nd inf or mi ng t ob ac co c ont r o l p olic y. In c oncl usion, rate s o f e - c igar ett e us e a mon g y oung pe opl e a r e n ow hi gh er than s mokin g , t houg h the v as t ma j or i ty o f regula r e - c igar ett e use rs a lso s m oke or hav e do ne i n t he past . Mea sure s ar e nee ded t o reduce t he a pp eal o f t he se d e v ice s to y oun g p eo pl e as we ll a s en fo rce ment o f mea sure s t o pr ev en t i l le g al s al es an d m ar k et ing . All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. 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Smoking uptake in UK children: analysis of the UK Millennium Cohort Study. Thorax. 2019;74(6):607-10. 14. Tattan-Birch H, Jack son SE, Kock L, Dockrell M, Brown J. Rapid growth in disposable e- cigarette vaping among young adults in Great Britain from 2021 to 2022: a repeat cross-sectional survey. medRxiv. 2022. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprintthis version posted July 26, 2022. ; https://doi.org/10.1101/2022.07.25.22277745doi: medRxiv preprint Tabl e 1: sample, num ber s we ighted using sur v ey w eighting number % Age 11 to 13 years 997 38.2 14 to 15 years 625 23.9 16 to 17 years 649 24.8 18 years 341 13.1 Sex Male 1340 51.3 Female 1273 48.7 Social class ABC1 (higher) 1756 67.2 C2DE (lower) 755 28.9 Country England 2281 87.3 Scotland 206 7.9 Wales 126 4.8 Overall 2613 100 Tabl e 2: E-c igarette use (%) by toba c co s moki ng st a t u s Neve r smoked tobac co Non-r eg ula r Regula r sm o ke r Ev er sm o ke d t oba cc o Total Never used e-ci garett e * 91.0 8.5 0.5 9.0 80.9 Non regular e-c iga rette us e r 24.4 57.9 17.8 75.7 15.2 Regul ar e-ciga r ette user 10.6 41.2 48.2 89.4 4.0 Eve r e-ciga r ette user 35.4 52.6 12.0 64.6 19.2 Total 81.9 15.1 2.9 18.0 100 *Never = “ I have never used an e- ciga r ette”, N on regu lar = “I h av e only t rie d an e-c igarett e once or t wi ce ”; “I us ed e- cig a r ett es in the past b ut n o lo nger d o” ; “I use e- cigar ettes mor e All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprintthis version posted July 26, 2022. ; https://doi.org/10.1101/2022.07.25.22277745doi: medRxiv preprint th a n o nc e a mont h , but less t h an onc e a week ” ; “I us e e- cigaret tes som eti mes, b ut no mo re th a n o nc e a mon th ”, R egular = “ I use e-cigarett es m ore th an on c e a wee k b ut n ot every day” ; “I us e e-c igar e t tes every d ay”. Responden ts who r es po nded that t h ey ha d never heard o f e- cigarett es a lso c l ass if ied as never e-c igaret te users. Figure 1: E-cigarette use by age *Never = “ I have never used an e- ciga r ette”, N on regu lar = “I h av e only t rie d an e-c igarett e once or t wi ce ”; “I us ed e- cig a r ett es in the past b ut n o lo nger d o” ; “I use e- cigar ettes mor e th a n o nc e a mon th , but less t h an onc e a week ” ; “I us e e- cigaret tes som eti mes, b ut no mo re th a n o nc e a mon th ”, R egular = “ I use e-cigarett es m ore th an on c e a wee k b ut n ot every day” ; “I us e e-c igar e t tes every d ay”. Responden ts who r es po nded that t h ey ha d never heard o f e- cigarett es a lso c l ass if ied as never e-c igaret te users. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Age 11 Age 12 Age 13 Age 14 Age 15 Age 16 Age 17 Age 18 E-cigarette use by age group among 11-18 year olds Never Non regular Regular All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprintthis version posted July 26, 2022. ; https://doi.org/10.1101/2022.07.25.22277745doi: medRxiv preprint Tabl e 3: Ev er and regula r use of e-c igarettes by selected charac t eristics Ever use Re gular use Odds ratio p v alue O dds ratio p value Boys ref ref ref ref Girls 1.11 0.412 1.25 0.315 11 to 13 years ref ref ref ref 14 to 15 years 3.23 <0.001 2.80 0.049 16 to 17 years 7.93 <0.001 9.54 <0.001 18 years 13.79 <0.001 10.68 <0.001 England ref ref ref ref Scotland 1.23 0.279 1.02 0.949 wales 0.52 0.086 0.40 0.261 Higher social class (ABC1) ref ref ref ref Lower social cla ss (C2DE) 0.93 0.578 0.71 0.148 Has not seen e-cigarettes promoted ref ref ref ref Has seen e-cigarettes promoted* 1.61 <0.001 1.52 0.097 No e-cigarette use in home ref ref ref ref E-cigarette use in home 6.65 <0.001 20.75 <0.001 * In at least one of Billboards; shops; Online; On buses; On TV; In newspapers/ magazines; or “Somewhere else” All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprintthis version posted July 26, 2022. ; https://doi.org/10.1101/2022.07.25.22277745doi: medRxiv preprint Tabl e 4: Ev er and regula r tobac co smoking by selec t ed c ha r ac teris tics E v er s m o kin g R e g u la r s m o k i n g Odds r a t io p v alue O dds ratio p value Boys ref ref ref ref Girls 0.92 0.477 0.84 0.498 11 to 13 years ref ref ref ref 14 to 15 years 2.42 <0.001 1.28 0.625 16 to 17 years 6.50 <0.001 3.80 0.002 18 years 10.79 <0.001 5.81 <0.001 England ref ref ref ref Scotland 1.18 0.349 1.33 0.414 Wales 0.51 0.042 0.61 0.405 Higher social class (ABC1) ref ref ref ref Lower social class (C2DE) 1.01 0.966 1.11 0.677 No tobacco cigarette smoking in family ref ref ref ref Tobacco cigarette smoking in family 2.42 <0.001 3.87 <0.001 Tabl e 5: use of dispos a ble e-ci garett e s am ong eve r e - c igarette user s % Odds ratio p value Boys 50.9 ref ref Girls 59.3 1.69 0.010 11 to 13 years 41.1 ref ref 14 to 15 years 45.7 1.29 0.581 16 to 17 years 59.6 2.33 0.052 18 years 62.5 2.78 0.020 England 54.9 ref ref Scotland 56.7 0.80 0.433 All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprintthis version posted July 26, 2022. ; https://doi.org/10.1101/2022.07.25.22277745doi: medRxiv preprint Wales 60.3 1.79 0.457 Higher social class (ABC1) 53.3 ref ref Lower social cla ss (C2DE) 58.8 1.24 0.313 Has not seen e-cigarettes promoted 54.8 ref ref Has seen e-cigarettes promoted 56.6 1.22 0.400 No e-cigarette use in home 45.6 ref Ref E-cigarette use in home 66.3 2.60 <0.001 * In at least one of Billboards; shops; Online; On buses; On TV; In newspapers/ magazines; or “Somewhere else” All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprintthis version posted July 26, 2022. ; https://doi.org/10.1101/2022.07.25.22277745doi: medRxiv preprint