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Seeing e-cigarettes in shops may influence their use by teenagers

Adolescents who recall seeing e-cigarettes in shops are more likely to have tried them in the past and are more likely to intend to try them in the future, according to a study published in the open access journal BMC Public Health.
The cross-sectional collaborative study led by researchers from the University of Stirling, UK, which involved 3,808 Scottish adolescents, is the first to examine the relationship between adolescents’ recollection of e-cigarette displays at point of sale (POS) and their self-reported past use and future intention to use e-cigarettes.

Young people who had tried e-cigarettes in the past were found to be more likely to intend to use them again. The researchers also found that young people were more likely to try e-cigarettes if they had previously smoked tobacco. Young people who had never smoked tobacco were much less likely to have tried e-cigarettes or intend to do so in the future. Most adolescents in the study who reported using e-cigarettes had only tried them once or twice and were not regular users.

It was previously known that exposure to cigarette POS displays influences smoking behavior and intentions in young people and that increased availability of cigarettes – for example through a high number of shops selling tobacco near a person’s home – is associated with higher consumption and uptake. However, to date there has been no evidence regarding the relationship between e-cigarette POS display exposure and e-cigarette use in young people. As cigarette brands are far more established and more instantly recognizable than e-cigarettes, the association between tobacco POS exposure and smoking behavior in young people could not necessarily be assumed to be the same for e-cigarettes, according to the researchers.

To examine a potential relationship between exposure to POS displays and e-cigarette use in adolescents, the researchers conducted a survey in four high schools in Scotland which involved 3,808 students between 11 and 18 years of age. The data collected was part of an ongoing 6-year study designed to assess the impact of Scottish legislation banning tobacco POS displays on young people’s smoking behavior and their attitudes towards smoking. Additional information on e-cigarette advertising exposure, e-cigarette use and smoking status was gathered through a school-based survey conducted in early 2015.

Respondents were asked whether they had heard of e-cigarettes, whether they had ever used them, and whether they intended to try them in the next 6 months. They were also asked if they had ever smoked cigarettes and if they intended to do so in the next year.

A strong association between recall of e-cigarette displays at point of sale and use of e-cigarettes and intention to use in the future was found in this study. However, it used a cross-sectional design and so no causal relationship between POS recall and e-cigarette use or intention to use could be established. Therefore, it is unclear whether young people who plan to try e-cigarettes do so because they notice e-cigarettes at POS or whether they notice e-cigarettes because they intend to try them in the future.

The sample used in this study was not randomly selected and is not necessarily representative of the Scottish population, and there was a 13% non-response rate to the survey which relied on recall and self-reporting. The researchers note that collection of additional longitudinal data is needed to establish causality.

Catherine Best, the corresponding author, said: “Given that our study found an association between POS exposure to e-cigarettes and both their use and intention to use in young people, policy makers in the EU and elsewhere need to consider very carefully how to balance the promotion of e-cigarettes to adult smokers as an aid to help them quit, while at the same time minimizing their uptake by young people.”

As of May 20th 2016 EU member states will be required to have legislation that restricts the advertising of e- cigarettes.

Sally Haw, lead author of the study, said: “We have seen considerable investment in e-cigarette advertising by the tobacco industry. While these new restrictions on e-cigarette advertising through broadcast and print media, sponsorship and product placement are very much welcomed, they are more limited than those that apply to tobacco advertising. However, individual jurisdictions will be able to extend their restrictions to include e-cigarette advertising on bill boards and at point of sale. This requires careful consideration. ”

-ENDS-

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Notes to editor:
1. Relationship between e-cigarette point of sale recall and e-cigarette use in secondary school children: a cross-sectional study
Catherine Susan Best, Farhana Haseen, Winfried van der Sluijs, Gozde Ozakinci, Dorothy Currie, Martine Stead, Anne Marie MacKintosh, Jamie R Pearce, Catherine Tisch, Andy MacGregor, Amanda Amos, John Frank, Sally J Haw
BMC Public Health 2016
DOI: 10.1186/s12889-016-2968-2

The article is available at the journal website.

Please name the journal in any story you write. If you are writing for the web, please link to the article. All articles are available free of charge, according to BioMed Central's open access policy.

2. BMC Public Health is an open access, peer-reviewed journal that considers articles on the epidemiology of disease and the understanding of all aspects of public health. The journal has a special focus on the social determinants of health, the environmental, behavioral, and occupational correlates of health and disease, and the impact of health policies, practices and interventions on the community.

3. BioMed Central is an STM (Science, Technology and Medicine) publisher which has pioneered the open access publishing model. All peer-reviewed research articles published by BioMed Central are made immediately and freely accessible online, and are licensed to allow redistribution and reuse. BioMed Central is part of Springer Nature, a major new force in scientific, scholarly, professional and educational publishing, created in May 2015 through the combination of Nature Publishing Group, Palgrave Macmillan, Macmillan Education and Springer Science+Business Media.

4. The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government’s strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website (www.nihr.ac.uk).

This article presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. 

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