Young People and E-Cigarettes in Scotland: A Survey of Secondary School Pupils

Conclusion

The majority of secondary pupils in Scotland are aware of e-cigarettes and know family members and friends who use them. They see e-cigarettes being used and marketed in a wide range of public and private spaces.

Surveys on e-cigarette usage have shown a steady increase in the number of people trying e-cigarettes and using them on a more sustained basis in recent years. Evidence from others countries and other parts of the UK suggests that rates of children and adolescents trying and using e-cigarettes have increased over the past few years, but more research is needed to understand which young people are most likely to use or experiment with e-cigarettes, reasons for use, and the implications of use for health and social behaviours.

In Scotland, SALSUS and the YPIS provide us with robust baselines for adolescent experience of e-cigarettes. Consistent with other parts of the UK, a proportion of secondary pupils have experimented with e-cigarettes but use is largely confined to those who already smoke tobacco, although it is not known whether this will inevitably continue to be the case over the longer term. Current data show that experimentation for the vast majority is not leading to habitual use and the small proportion who are using e-cigarettes regularly (at least once a month) are already smoking tobacco.

Overall, 16% of respondents reported having ever used e-cigarettes and this was highest amongst the small number who smoked more than 6 cigarettes a week and lowest amongst those who have never smoked cigarettes, the vast majority of the sample. Three per cent of respondents reported currently using e-cigarettes. This was highest amongst those who reported smoking between 1 and 6 cigarettes a week (52%) and lowest amongst those who have never smoked cigarettes (under 1%). Of the small group who had tried both smoking normal cigarettes and using e-cigarettes, 8% reported having tried an e-cigarette first. No respondent who reported currently smoking more than 6 cigarettes a week (the heaviest smokers) reported having used an e-cigarette before trying tobacco.

When asked their reasons for initially trying an e-cigarette, 42% of respondents stated, "I just wanted to try them to see what they were like", with a further 46% stating that they saw a friend or family member use them and wanted to try them as a result. The responses on motivation for first use suggest that curiosity about a relatively new phenomenon is a main driver, contrasting with the main reasons why adults start to use e-cigarettes as part of a smoking quit attempt or to reduce their tobacco consumption.

While a majority of the small number (N=32) of pupils who use e-cigarettes at least once a week state their reason for doing so is to reduce the number of cigarettes they smoke or to stop smoking entirely, about a third of this group reported that they use e-cigarettes simply because they enjoy doing so.

The majority (83%) had tried their first e-cigarette after being given it by either a friend or family member, or trying someone else's e-cigarette without permission, while just a tenth reported purchasing it. There are possibly a number of reasons for these responses, including the likely opportunistic or impulsive nature of initial experimentation; a social context for experimentation which may involve sharing; and the initial cost of buying some e-cigarettes which may deter purchase, as well as the fact that within the e-cigarette industry there is a voluntary standard for not selling to under-18s.

The YPIS clearly shows that a majority of Scottish secondary pupils had recently been exposed to e-cigarette marketing and promotion, particularly in places where the products are sold, and they were conscious of adverts across a wide range of channels.

Responses to questions on knowledge, understanding and attitudes reflect high levels of uncertainty about e-cigarettes, as is the case with adults, due in part to a lack of reliable publicly available information.

It is probably too early for a measurable shift in attitudes to have taken place which might indicate any increased social acceptability of smoking amongst young people which could herald renormalisation. The negative attitudes towards smoking and the low smoking rates of respondents to the YPIS and SALSUS do not hint at incipient renormalisation or a gateway effect. However, the markets for e-cigarettes and other novel nicotine and tobacco products have shown rapid developments in the past few years so care is needed not to be too complacent that this could not change and good survey data will be essential for monitoring.

The YPIS survey provides useful baseline Scottish data on secondary pupils' experiences and perceptions of e-cigarettes, based on a set of questions which could be repeated in the future to monitor trends. This will help the Scottish Government and public health partners to understand and respond to the evolving behavioural landscape.