Teen smokers most likely to combine conventional tobacco and e-cigarettes 

Adolescents don't see e-cigarettes as an adjunct to quitting a sustained smoking habit, new study finds

Teenagers who smoke are more likely to use both conventional tobacco products and e-cigarettes, while the prevalence of e-cigarette use among 15–16 year-olds has increased more than four fold since 2014.

The research indicates that adolescents don't see e-cigarettes as an adjunct to quitting a sustained smoking habit, its authors found.

The study, which involved input from almost 4,500 teenagers in the west of Ireland, did however, find young people engaged in sport may see e-cigarettes as a "healthier alternative" and that "that e-cigarettes are targeting a lower risk group who would not otherwise engage in smoking".

The study, called E-cigarette-only and dual use among adolescents in Ireland: Emerging behaviours with different risk profiles, is based on a cross-sectional analysis of data collected in October 2018 as part of the Planet Youth Pilot Programme undertaken in Galway, Mayo, and Roscommon.

Written by researchers at the Royal College of Surgeons in Ireland (RCSI), it found that among 4,422 adolescents, 22.1% were current nicotine product users (comprising more males than females). This group comprised 5.1% e-cigarette only users, 7.7% conventional cigarette only users, and 9.3% dual-users.

Among all participants, 26.7% reported they had a parent who smoked and 70.8% reported they had at least a few friends who smoked.

As for peer-related factors, 13.8% said they "smoked to fit in", with the percentage highest among dual users.

Parental supervision

"A factor with a potentially protective association with nicotine product use was parental supervision, which had a significant inverse association with all behaviours.

Almost all participants (94%) perceived their parents to be strongly against conventional cigarettes. Adolescents who believed their parents were strongly against conventional cigarettes had reduced odds of conventional cigarette use but not e-cigarette use."

The authors said the study was the first to show that dual-use is the most prevalent behaviour among adolescent nicotine product users in Ireland and that the prevalence of e-cigarette use among 15–16 year olds has increased 4.5 fold since 2014.

It also said the public health message around e-cigarettes has been "mixed". 

"For most adolescents, e-cigarettes are not being used as an adjunct to quit a sustained smoking habit. Therefore, adolescents are being exposed to the harmful effects of e-cigarettes without the potential benefits of harm reduction. The public health message must be tailored accordingly."

Healthy activities

The authors said this was also a factor when it comes to young people engaged in healthy activities. Participation in team sport at least four times a week were reported by 26.9% of e-cigarette only users, 24.8% of non-users, 9.4% of conventional cigarette users, and 17% of dual-users.

"Participating in team sport four times/week or more significantly reduced the odds of conventional cigarette and dual-use but had no association with e-cigarette only use," the report said.

"E-cigarettes, marketed as a healthier alternative, may appeal to those engaged in healthy behaviours such as sport. These findings again support the hypothesis that e-cigarettes are targeting a lower-risk group who would not otherwise engage in smoking."