determinants of e-cigarette use and intention to use in scottish adolescents dr catherine best...
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Determinants of e-cigarette use and intention to use in Scottish Adolescents
Dr Catherine BestProfessor Sally Haw
School of Health SciencesUniversity of Stirling
DISPLAY project
• Determining the Impact of Smoking Point of sale Legislation Among Youth (DISPLAY)
• Under Section 1 of the Tobacco and Primary Medical Services (Scotland) Act 2010, it is an offence: To display tobacco products or tobacco related products in places where tobacco
products are offered for sale Retailers will be required to conceal cigarettes from general view, either by covering up
cigarette gantries/dispensers or by storing cigarettes under the counter.
• Scotland POS ban April 2013 supermarketsPOS ban April 2015 small shops
Point of sale displays
Study Design Multi-modal before and after study using mixed methods in four purposively selected communities:
Data collection at baseline and longitudinal follow-up for 4 years
Communities defined as Secondary School Catchment and chosen to reflect 2 levels of rurality (urban vs small town) and 2 levels of deprivation (high vs medium to low) Selected from :
Has school roll of 1200+ Located in central belt of Scotland Non denominational Minority ethnic population of < 10%
Study Components
1. Annual mapping study of
tobacco retail outlets
2. Annual tobacco advertising and marketing audit
3. Annual cross-sectional school survey with embedded cohort
of school children
4. Annual focus group interviews with
purposive samples of school children
E-cig Point of Sale Displays
E cigarettes
• 2014 e-cigarettes added to survey (n=1404, S2 & S4) and retail audit (n=96)‘An e-cigarette is a tube that looks like or is similar
to a normal cigarette. An e-cigarette may have a glowing tip and puffs a vapour that looks like smoke but unlike normal cigarettes, they don’t burn tobacco’.
Heard of them Yes 74.7%, No 17.9% DK 7.3%Tried e-cigs -Yes 17.3%Will try next 6 months - Yes 6.8%
E-cig Point of Sale Displays
Does exposure to cigarette brands increase the likelihood of adolescent e-cigarette use?
Predictors• Current smoking• Never smoking• Frequency of visits to retail
outlets• Cig brand recognition• Tobacco retail outlet density• Frequency hanging round
street or park
Control for • Family Affluence Scale• Age• Gender• Ethnic group
Analysis
• Logistic regression Stata version 13• Purposeful selection• Nested likelihood ratio testing• Robust standard errors to account for
clustering by community• α =0.01
Logistic regression on tried e-cig Variable Model 1 Odds ratio
(99% CI)
Model 2 Odds ratio
(99 % CI)
Current smoker
Not current smoker
4.50 (1.27 to 15.96)
1
6.10 (1.19 to 31.22)
1
Never smoked
Ever smoked
Brand recognition
Gender male
female
Family Affluence Scale (1 low)
Family Affluence Scale (2 med)
Family Affluence Scale (3 high)
White ethnic group
Other ethnic group
Age in years
0.11 (0.05 to 0.24)
1
1.23 (1.11 to 1.37)
0.10 (0.05 to 0.20)
1
1.21 (1.06 to 1.39)
1
0.99 (0.42 to 2.31)
1
1.34 (0.74 to 2.45)
0.87 (0.21 to 3.63)
1
1.83 (0.63 to 7.93)
0.99 (0.42 to 2.31)
Logistic regression on intention to tryVariable Model 1Odds ratio
(99% CI)
Model 2 Odds ratio
(99% CI)
Current smoker
Not current smoker
3.22 (1.07 to 9.72)
1
4.69 (0.45 to 48.80)
1
Never smoked
Ever smoked
0.06 (0.02 to 0.14)
1
0.03 (0.08 to 0.13)
1
Brand recognition 1.34 (1.06 to 1.69) 1.41 (1.14 to 1.73)
Tobacco outlet density 1.13 (1.04 to1.23) 1.16 (1.06 to 1.27)
Hanging round in the street ≥1/wk
Hanging round in the street<1/wk
Gender male
female
Family Affluence Scale (low)
Family Affluence Scale (med)
Family Affluence Scale (high)
White
Other ethnic group
Age in years
3.13 (1.10 to 8.89)
1
2.89 (1.76 to 4.73)
1
1
0.46 (0.16 to 1.27)
1
1.92 (0.67 to 5.47)
1.72 (0.81 to 3.68)
1
0.60 (0.05 to 8.86)
0.50 (0.15 to 1.69)
Conclusions
In our Scottish sample:• Respondents who have never smoked less likely to use e-
cigs• More cigarette brands recognised more likely to use e-
cigarettes
• Respondents living in higher tobacco retail outlet density more likely to intend to try e-cig
• Respondents hanging round street or park more likely to intend to try e-cig
• Current smoking related to having tried e-cigarettes
Regulation
• Tobacco point of sale banned in UK• E-cigarette point of sale and advertising
unregulated until after EU directive comes into force in 2016.
• Current Bill includes restriction on advertising but no intention to ban at POS.
• Window of opportunity
E-cigs Debate
Positives• Harm reduction in
smokers• Cessation aid
Negatives• Long-term effects
unknown• Re-normalises smoking
• Growing use by never smokers
More evidence needed
Young people and e-cigs
Positives• Tends to be
experimentation not regular use
• Relatively harmless in comparison to other substances
• Potential health impact of occasional/one-off use minimal?
Negatives• Young people more easily
addicted nicotine• Gateway• Use by never smokers• Advertising spend is growing
and so is e-cig use- flavours appealing to young
• Re-normalising smoking
Project team
• Sally Haw (PI), Martine Stead, Douglas Eadie, Anne Marie MacKintosh, Catherine Best University of Stirling
• Andy MacGregor, Clare Sharp, ScotCen• Amanda Amos, Jamie Pearce, John Frank, Catherine
Tisch, Martine Miller University of Edinburgh• Winfried van der Sluijs, Farhana Haseen University of
St Andrews• Funded by NIHR PHR
