Smoking and snus use among youth: A longitudinal analysis of risk factors and socioeconomic profile.

BACKGROUND: Norwegian youth smoking has, to a larger extent than snus use, been associated with lower socioeconomic strata, and research has pointed at ideas in the youth population about the popularity and normality of snus use that are not found for smoking. The objective of this study was to investigate the association between socioeconomic status and other risk factors with snus use and smoking among people in their late teens. METHODS: Based on data from the longitudinal MyLife school survey, collected in five yearly waves between 2017 and 2021 (N = 1830, age 16.8-20.6 years in 2021, 64% girls), logistic regressions were performed with monthly snus use and smoking as dependents, and parents' education, psychological characteristics and earlier smoking or snus use as independent variables. RESULTS: High socioeconomic status (parents' education) was associated with less smoking and snus use also after controlling for psychological characteristics and earlier smoking and snus use. Higher age increased the risk of snus use and reduced the risk of smoking. CONCLUSIONS: Youth snus use and smoking are associated with lower socioeconomic background. This supports the idea that snus use may have lost some of its position as a mainstream activity among youth.

Perceptions of plain packaging and health warnings among university students in Turkey: a survey-based experiment.

BACKGROUND: Cigarette pack design plays a crucial role in attracting customers, especially when other marketing methods are limited by policy. University students who engage in casual smoking take the risk of developing an addiction. The objective of this study was to assess the effects of plain packaging (PP) and graphic health warnings (GHWs) on cigarette packages on three outcome variables (negative affect, avoidant responses, and intentions to quit) among ever-smoker university students in Ankara, Turkey, where youth smoking prevalence is high. METHODS: An online survey-based experiment was used to collect data. The respondents were randomly assigned to one of the five conditions that contained images of cigarette packs with specific design elements. Regression analyses (n = 623) were used to compare across conditions and to estimate the effects of combined warnings (versus text-only warnings), stronger GHWs (versus old GHWs), and PP (versus branded packages) on the outcome variables, accounting for potential confounders. RESULTS: Stronger GHWs generated more negative affect (0.31 points out of 5, p = 0.010) and avoidant responses (0.42 points out of 5, p = 0.002) than old warnings (when brand logos were visible). Plain packages generated more negative affect (0.48 points out of 5, p < 0.001) and avoidant responses (0.46 points out of 5, p = 0.001) than branded packages (with old warnings). Disentangling the effects of PP and new GHWs revealed that neither had individual differential effect on intentions to quit within 6 months. CONCLUSIONS: Although no differential effect of PP or harsher GHWs was found on intentions to quit when respondents were exposed to images on screen, both design elements were found to be effective in generating negative affect and avoidant responses. More work is needed to design effective tobacco control measures among youth during critical years of tertiary education.

Clearing the air: underestimation of youth smoking prevalence associated with proxy-reporting compared to youth self-report.

BACKGROUND: Smoking remains a leading cause of disease burden globally. Declining youth smoking prevalence is an essential feature of effective tobacco control; however, accurate data are required to assess progress. This study investigates bias in youth smoking prevalence estimates by respondent type (proxy-reported, self-report with parent present, or self-report independently) for Aboriginal and Torres Strait Islander and total populations of Australia. METHODS: Repeated cross-sectional analysis of representative Aboriginal and Torres Strait Islander Health and National Health Surveys, 2007-2019. Data were restricted to participants aged 15-17 years. Prevalence ratios (PR) and 95% Confidence Intervals (CI) for ever-smoking by respondent type were calculated using Poisson regression with robust standard errors. National youth current-smoking prevalence was estimated if all data were collected by youth self-report; estimates and trends were compared to observed estimates. RESULTS: Over 75% of all smoking status data were reported by proxy or with parent present. Ever-smoking prevalence among youth self-reporting independently versus proxy-reported was 1.29 (95% CI:0.96-1.73) to 1.99 (95% CI:1.39-2.85) times as high for Aboriginal and Torres Strait Islander youth, and 1.83 (95% CI:0.92-3.63) to 2.72 (95% CI:1.68-4.41) times as high for total population youth. Across surveys, predicted national current-smoking prevalence if all youth self-reported independently was generally higher than observed estimate. CONCLUSIONS: Estimates of youth smoking prevalence are likely inaccurate and underestimated if data are collected by proxy or with parent present. Increased reliance on data reported by youth independently is crucial to improve data accuracy, including to enable accurate assessment of national prevalence.

A descriptive study of a Smoke-free Teens Programme to promote smoke-free culture in schools and the community in Hong Kong.

BACKGROUND: Youth smoking continues to be a significant global public health concern. To ensure healthier lives for youths, healthcare professionals need to increase awareness among the youth of the health risks and addictive nature of smoking, strengthen their ability to resist negative peer influence and curiosity, and help those who smoked to quit. The Smoke-free Teens Programme was launched in 2012 to equip youngsters with up-to-date information about smoking and global trends in tobacco control and to encourage them to play a pioneering role in tobacco control. This paper describes the process and outcomes of this programme for youths in Hong Kong. METHODS: The Smoke-free Teens Programme contained three major components: (i) a 2-day-1-night training camp; (ii) creative activities to promote smoke-free messages in schools and the community; and (iii) an award presentation ceremony to recognize the efforts of outstanding Smoke-free Teens in establishing a smoke-free culture. All secondary school students or teenagers aged 14 to 18 years from secondary schools, youth centres and uniform groups were invited to join the programme. The outcome measures were changes in (1) knowledge about smoking hazards; (2) attitudes towards smoking, tobacco control, and smoking cessation; and (3) practices for promoting smoking cessation. RESULTS: A total of 856 teenagers were recruited during the study period (July 2014 to March 2017). The results showed statistically significant changes in participants' knowledge about smoking hazards, attitudes towards tobacco control, and practice for promoting smoking cessation. CONCLUSIONS: The Smoke-free Teens Programme demonstrated effectiveness in equipping youngsters with up-to-date information about smoking and global trends in tobacco control and in encouraging them to play a pioneering role in tobacco control. The trained Smoke-free Teens not only promoted the smoke-free messages among their schoolmates, friends, and families, but also gathered community support for a smoke-free Hong Kong. The programme has been instrumental in fostering a new batch of Smoke-free Teens to advocate smoke-free culture and protect public health. TRIAL REGISTRATION: Clinicaltrials.gov ID NCT03291132 (retrospectively registered on September 19, 2017).

The Association Between School Tobacco Control Policies and Youth Smoking Behavior.

BACKGROUND: While U.S. tobacco control policy has focused mainly on tobacco excise taxes, product advertising bans, and state tobacco control policies such as indoor/outdoor smoking bans, little attention has been paid to school tobacco control policies and their impact on youth smoking behavior. Thus, the objective of this study is to examine the impact of school tobacco control policies on smoking behavior among teenagers and young adults in the USA. METHODS: Using logistic regression approach, this study examines the effect of school tobacco control policies on individuals ever trying smoking and ever being a regular smoker using data from waves I, II, and III of the National Longitudinal Study of Adolescent Health. RESULTS: Findings indicate that school tobacco control policies targeting both students and employees of the school are associated with a reduced odds of smoking initiation among youth, but do not have much effect on youth becoming regular smokers. CONCLUSIONS: If implemented properly, school tobacco control policies could play a vital role in preventing youth smoking and help reduce youth smoking rates in the country, addressing a key public health issue.

Portrayal of waterpipe (shisha, hookah, nargile) smoking on Twitter: a qualitative exploration.

OBJECTIVES: To describe and characterize social media content in relation to waterpipe smoking using qualitative methods. STUDY DESIGN: Exploratory qualitative design. METHODS: A representative sample of pre-existing social media content from Twitter relating to waterpipe smoking and written in the English language was collected during a 1 week period in July 2014. A total of 9671 tweets were collected; duplicates and retweets were removed leaving 4439 unique tweets. Data were analyzed semiotically (positive, negative, positive and negative, no sentiment, unclassifiable) and thematically. Photographs attached to tweets written by individual users indexed using #hookah (n = 299) were subjected to content analysis. RESULTS: Over half of all tweets were positive about waterpipe smoking (59%), with 3% negative, 21% lacking sentiment and 17% unclassifiable. However, there were variations by likely author of tweet, with 91% of tweets from individual users classified as positive. Twitter users focused on their emotional experience, location, other products they were consuming alongside waterpipe smoking, and who they were with. Analysis of photographs highlighted a high degree of synergy between text and visual representations of waterpipe smoking, and two thirds of photographs contained at least part of a waterpipe. CONCLUSIONS: Waterpipe smoking may be normalized as an enjoyable activity in this online environment, posing a challenge for public health.

Systematic review: internet-based program for youth smoking prevention and cessation.

PURPOSE: To review the characteristics and effects Internet-based youth smoking prevention and cessation programs. DESIGN: Systematic review of published articles in peer-reviewed journals in the past 10 years, focused on Internet-based youth smoking prevention and cessation programs. METHODS: Twelve articles were selected based on the following criteria: studies reporting the outcomes of Internet-based smoking cessation or prevention intervention programs for adolescents who are younger than 24 years. FINDINGS: The components of youth Internet-based smoking intervention programs are analyzed based on study features (i.e., sample, design, theoretical basis, analysis, outcome measures) and program characteristics (i.e., focus, setting, frequency, duration, intensity, and different components) that make the programs effective. The most common components of effective Internet-based programs are identified as the following: the use of multimedia, tailored approaches, personalized feedback, and interactive features. CONCLUSIONS: The characteristics and effects of the programs vary, but most programs show positive results in youth smoking prevention and cessation in spite of the studies' limitations. CLINICAL RELEVANCE: The evidence from this review provides useful information of recent efforts related to Internet-based youth smoking prevention and cessation programs, which can have significant clinical implications in developing future innovative youth smoking prevention and intervention programs.

Factors associated with intent to quit tobacco use in Cyprus adolescents.

OBJECTIVES: To identify factors associated with adolescent smokers' desire to quit based on the 2006 Cyprus Global Youth Tobacco Survey. METHODS: A cluster sample design was used to select a representative sample of students from all registered middle and high schools in Cyprus with >40 students in academic year 2005-2006. Multivariable logistic regression was used taking into account the weight associated with each of the respondents. RESULTS: Out of the total sample with available information (N=12,629), 1591 students were current smokers (weighted frequency=14%) and were included in the analysis, with 734 (46.1%) of them reporting that they want to quit smoking. In both males and females, strong predictors of intention to quit smoking include past quit attempts and physical activity. Intention to quit is also associated with the belief that smoking is harmful to them and inversely associated with having peers who smoke, in boys, and the belief that smoking is harmful to others and perceiving smokers as less attractive, and inversely associated with pocket money, in girls. CONCLUSIONS: The present study has identified factors that appear to influence youth's intention to quit tobacco, which is of major importance in developing successful tobacco cessation programs targeting adolescents.

Smoking initiation among Israeli adolescents: a 24-year time-to-event analysis.

INTRODUCTION: Preventing smoking initiation will protect future generations from smoking-attributable death and disease. This study examines the correlates and patterns of initiation among Israeli youth using time-to-event analysis and other methods. METHODS: Twenty-four consecutive representative samples (1986-2009) of new military recruits (N=50,254) were analyzed. Cox regression and Kaplan-Meier analysis were used to identify factors associated with smoking initiation, and logistic regression was used to identify factors associated with smoking status. RESULTS: The most hazardous age for smoking initiation was seventeen, subsequent to the mean age of smoking initiation (males: 15.7, females: 16.0). Age of initiation and age of greatest hazard for initiation declined among recruits between the years 1986 and 2009. Earlier smoking initiation among boys and girls was significantly associated with low education levels (<12years) (males: HR=2.98, CI: [2.79, 3.18]; females: HR=3.35, CI: [2.96, 3.80]), low paternal education levels, Russian birthplace, and religion. Earlier initiation in boys was associated with high fitness levels and low/medium socio-economic status. Earlier initiation in girls was associated with being Western-born and ever-use of contraception. CONCLUSIONS: Smoking initiation among Israeli youth recruited to the armed forces is associated with individual and family characteristics, particularly low education levels. Time-to-event analysis complements traditional means of understanding smoking initiation by identifying ages at which initiation hazard is high.

Perceived friend and peer smoking and direct and indirect refusal skills as predictors of cigarette smoking in U.S. and Japanese middle school students.

Adolescents (aged 12-14 years) from the United States (n = 539) and Japan (n = 644) completed surveys regarding tobacco use, perceptions of friend and peer smoking, and their own likelihood of using smoking refusal skills. U.S. youth were more likely to report lifetime or monthly tobacco use, whereas Japanese youth were more likely to smoke ≥20 cigarettes per week. High perceived friend and peer smoking prevalence predicted lifetime smoking, whereas direct refusal skill use (e.g., "saying no") predicted less lifetime tobacco use. Results are discussed in terms of cultural influences that may mediate the effect of risk factors on U.S. and Japanese youth.

Dramatic Reductions in Cigarette Smoking Prevalence among High School Youth from 1991 to 2022 Unlikely to Have Been Undermined by E-Cigarettes.

There is concern that youth e-cigarette use could lead youth to initiate cigarette smoking. This study identifies epochs of cigarette smoking among U.S. high school students in three commonly utilized national school-based surveys over three decades without a priori assumptions. We examined trends in ever and current cigarette smoking among high school youth from 1991 to 2022 in three datasets: Monitoring the Future (MTF), the National Youth Risk Behavior Survey (NYRBS) and the National Youth Tobacco Survey (NYTS) via Joinpoint regression. High stable rates of ever smoking were noted from 1991 to 1999 (NYRBS and MTF) and then significantly declined from 1999 to 2013; declines accelerated through to 2022. In the NYTS, ever cigarette smoking significantly declined from 1999 to 2018 and then declines accelerated to 2022. Current cigarette smoking reached its peak in 1997, and then significantly declined from 1997 to 2013 in the NYRBS and MTF and similarly in the NYTS from 1999 to 2018. Declines in current smoking then accelerated in all surveys through to 2022. These findings suggest dramatic successes in reducing youth smoking since the late 1990s, with more rapid declines in prevalence in the past decade.

"The Menthol One Is More Friendly": Young Singaporeans' Perspectives on Flavored Cigarettes.

Over half of the cigarettes sold in Singapore contain added flavors such as menthol. We conducted nine focus group discussions (n = 46) with young (aged 20-25) current smokers in Singapore to understand the role of flavors in smoking initiation. We found that flavors triggered the curiosity to experiment with tobacco and e-cigarette products and played an important role in the formation of early cigarette preferences. Menthol-flavored cigarettes were the most appealing to participants due to their smoothness and cooling sensation, described as pleasant against Singapore's hot and humid climate. While some participants believed that flavored and nonflavored cigarettes were equally harmful, others believed that flavored variants had a lower nicotine content and were therefore less harmful, or that the added chemicals in flavored cigarettes could result in higher toxicant exposures. Thus, among young people in Singapore, flavors appear to play an important role in smoking initiation and there appear to be various misperceptions regarding their harmfulness.

Adolescent electronic cigarette use and tobacco smoking in the Millennium Cohort Study.

AIMS: To evaluate the catalyst, diversion and common liability hypotheses by examining associations between e-cigarette use and tobacco cigarette smoking at modal ages 14 and 17 years, controlling for adolescent and infancy risk factors. DESIGN: Intergenerational, prospective cohort data from the Millennium Cohort Study (MCS). Nationally representative sample of infants born September 2000 to January, 2002. SETTING: United Kingdom. PARTICIPANTS: Parent and child data from 10 625 youth assessed in infancy and modal ages 11, 14 and 17 years. MEASUREMENTS: Age 14 and 17 e-cigarette and combustible cigarette use (recency, frequency). Potential confounders were age 11 risk factors (e.g. alcohol use, externalizing behaviors, parental tobacco use, permissiveness), infancy risk factors (e.g. maternal smoking during pregnancy, smoke exposure in infancy) and demographic characteristics. FINDINGS: Among youth who had not smoked tobacco by age 14 (n = 9046), logistic regressions estimated that teenagers who used e-cigarettes by age 14 compared with non-e-cigarette users, had more than five times higher odds of initiating tobacco smoking by age 17 [odds ratio (OR) = 5.25, 95% confidence interval (CI) = 3.28-8.38] and nearly triple the odds of being a frequent tobacco smoker at age 17 (OR = 2.91, 95% CI = 1.56-5.41), net of risk factors and demographics. Among youth who had not used e-cigarettes by age 14 (n = 9078), teenagers who had smoked tobacco cigarettes by age 14 had three times higher odds of initiating e-cigarettes by age 17 (OR = 2.98, 95% CI = 1.74-5.09) compared with non-tobacco smokers and nearly three times higher odds of frequently using e-cigarettes at age 17 (OR = 2.90, 95% CI = 1.21-6.95), net of confounders. Similar links between e-cigarette and tobacco cigarette use were observed in regressions following coarsened exact matching. CONCLUSIONS: E-cigarette use by age 14 is associated with increased odds of tobacco cigarette initiation and frequent smoking at age 17 among British youth. Similarly, tobacco smoking at age 14 is associated with increased odds of both e-cigarette initiation and frequent use at age 17.

Evaluating the Effects of Denmark's New Tobacco Control Act on Young People's Use of Nicotine Products: A Study Protocol of the §SMOKE Study.

(1) Background: In December 2020, a broad majority of political parties in Denmark agreed on a new tobacco control act. In addition, price increases on tobacco in 2020 and 2022 became part of the Danish Finance Act. This study protocol describes the study "§SMOKE-A Study of Tobacco, Behavior, and Regulations" designed to monitor and evaluate the implementation and effect of the new strengthened tobacco control acts. The overall aim is to monitor tobacco use among young people before, during, and after implementation of the new tobacco control legislation, including an increased price on tobacco, a ban on point-of-sale tobacco displays, and plain packaging. Subgoals are to monitor overall use of nicotine products, attitudes, and norms. (2) Methods: This study is designed as a five-year impact evaluation with repeated cross-sectional survey data collections. The baseline survey was conducted before implementing an increased price on tobacco, the first step in the new legislation, initiated 1 April 2020. Study participants (n = 37,500) were a random sample of individuals living in Denmark aged 15 to 29 years. (3) Conclusions: This study examines the impact of the new strengthened tobacco control legislation in Denmark from 2020 to 2025. The findings of this study are relevant to other countries facing implementation of similar measures to explore intended and unintended consequences of the legislation and help to identify how the legislation could be further improved.

The effects of cigarette price and the amount of pocket money on youth smoking initiation and intensity in Canada.

OBJECTIVES: To investigate the price and income elasticities of adolescent smoking initiation and intensity to determine the extent to which increased pocket money leads to greater smoking among youth, and whether higher taxes can mitigate this effect. METHODS: We used the 2012/2013 Canadian Youth Smoking Survey including students in grades 7-12. The multivariable logistic regression was used to examine the probability of smoking initiation, and a linear regression to examine the smoking intensity determined by province-level prices of cigarettes, pocket money, and a vector of individual characteristics, including age, sex, race, and school-related and psychosocial factors. RESULTS: Of respondents, 28.8% have tried cigarette smoking. More than 90% of these initiated smoking between age 9 and 17. Male smokers consumed a higher average number of whole cigarettes daily than did females. The price elasticity of smoking initiation and intensity for youth in the full sample were - 1.13 and - 1.02, respectively, which means that a 10% increase in price leads to an 11.3% reduction in initiation and a 10.2% reduction in intensity. The income elasticity of smoking initiation and intensity for youth in the full sample were 0.07 and 0.06, respectively, which means that a 10% increase in income leads to a 0.7% increase in initiation and a 0.6% increase in intensity. CONCLUSION: Economic measures such as taxation that raise the price of cigarettes may be a useful policy tool to limit smoking initiation and intensity.

Smoking Trends among Thailand's Youths from 1996-2015: An Age-Period-Cohort Analysis of National Health Surveys.

BACKGROUND: This study aimed to investigate secular trends of smoking among Thailand's youths. METHODS: We combined 8 datasets from national representative surveys between 1996 and 2015. Multi-stage cluster sampling was applied in all studies. Overall, 231459 participants aged 11-26 yr were included and analyzed. Participants were classified as current smokers if they responded "yes" to the question "Do you currently smoke?", and former smoker if they reported no current smoking but had smoked previously. Age-period-cohort (APC) models were used to estimate age, period, and cohort effects on smoking for investigating secular trend of smoking. RESULTS: The prevalence of smoking tended to decrease over time. Among those aged 11-14, the prevalence of current and former smoking was low but not negligible. Rates of underage smoking remained quite steady, around 3.8% in 1996 and 3.6% in 2015. The results of the APC model show that the prevalence of smoking among young male cohorts was lower than in older cohorts. CONCLUSION: Thailand's tobacco control program has been effective in deterring youths from smoking. The prevalence of smoking in this population needs to be reduced further though, something achieved by reorienting tobacco consumption prevention campaigns towards this age group.

Retailer Compliance as a Predictor of Youth Smoking Participant and Consumption.

BACKGROUND: Ninety percent of smokers report having their first whole cigarette before the age of 19. Policies, such as youth access laws, are essential to prevent youth from becoming future smokers. In Canada, the Tobacco Act prohibits retailers from furnishing tobacco products to individuals under the age of 18. These laws can only be effective when retailers comply with them. This paper investigates the effect of retailer compliance on youth smoking behavior. METHODS: Data on individual smoking behavior in conjunction with provincial retailer compliance rates and cigarette prices for the years 1999-2005 were employed to examine the effects of retailer compliance on youth smoking participation and consumption. RESULTS: Both price and retailer compliance were significant predictors of smoking participation. A large portion of participants endorsed obtaining their cigarettes through social means. Price elasticity of demand for the overall sample was estimated to be -0.54. CONCLUSIONS: Consistent with previous literature, our results found that retailer compliance is an essential component to the successful implementation of youth access laws. Given that youth access laws and retailer compliance did not quell social access to cigarettes, there is an apparent need within schools and communities to reduce the social sale of tobacco products.

Adolescent media use and its association to wellbeing in a Canadian national sample.

Our objective is to describe associations between media usage and multiple wellbeing indicators in a nationally representative sample of Canadian youth (CSTADS 2012-13) enrolled in grades 7 to 12 (N = 41,057). Youth reported media usage (television/movie viewing, videogame playing, and surfing the internet), wellbeing (academic achievement, school connectedness, self-esteem, physical activity, intake of fruits and vegetables, and bullying), and psychological (drug use, drinking, and smoking) and sociodemographic confounds (ethnicity, grade, province, gender). Videogame playing was negatively associated with academic achievement, b = -0.07 (99% CI, -0.08-05), physical activity, b = -3.09, (99% CI, -3.63-2.56), school connectedness, b = -0.03 (99% CI, -0.04-0.02), self-esteem, b = -0.13 (99% CI, -0.16-0.09), and the consumption of fruits and vegetables b = -0.07 (99% CI, -0.11-0.03). Internet usage was negatively related to self-esteem, b = -0.25 (99% CI, -0.28-0.21), school connectedness, b = -0.03 (99% CI, -0.03-0.02), academic achievement, b = -0.02 (99% CI, -0.03-0.002) and physical activity b = -1.42 (99% CI, -1.92-0.91). Finally, television exposure was linked with less fruits and vegetable consumption, b = -0.09 (99% CI, -0.12-0.06), academic achievement b = -0.05 (99% CI, -0.07-0.04), school connectedness b = -0.02 (99% CI, -0.03-0.01), self-esteem b = -0.06 (99% CI, -0.11-0.003), and physical activity b = -1.09 (99% CI, -1.64-0.54). Internet, television/movies, and videogame time also increased the odds of bullying others by 9%, OR = 1.09 (99% CI, 1.04-1.14) 8%, OR = 1.08 (99% CI, 1.01-1.16) and 7%, OR = 1.07 (99% CI, 1.01-1.14) respectively. Overall effect sizes were small yet may represent significant impairment for heavy media users.

Trends in smoking and smokeless tobacco use among Danish Adolescents, 1997-2014.

INTRODUCTION: High rates of smoking among adolescents remain a public health concern. This study investigates smoking behavior and use of smokeless tobacco among Danish high-school students and assesses how smoking and use of smokeless tobacco cluster in schools and school classes. We estimate the trend in cigarette smoking from 1997 to 2014. METHODS: We used data on 70 243 students, from 3 214 school classes in 119 high schools, who participated in the Danish National Youth Study from 2014. We had information on 87% of all Danish high schools and 85% of eligible students. We also used data from 1997 on 26 644 high-school students from a similar data set to assess the chronological trend in smoking. We calculated prevalences and intraclass correlation coefficients (ICCs) to estimate between-school and between-school class clustering in smoking and use of smokeless tobacco. RESULTS: In all, 14% of boys and 11% of girls were daily smokers. A large fraction of the variation in smoking and the use of smokeless tobacco was attributable to the school and school-class level (ICC of 0.19, 0.12, 0.16 and 0.27, for daily smoking, waterpipe smoking, use of electronic cigarettes and snuff/chewing tobacco, respectively). Daily smoking decreased from 15% in 1997 to 12% in 2014, while more students were occasional smokers in 2014 than in 1997 (30% vs 18%). CONCLUSIONS: The prevalence of smoking was high among Danish high-school students and had changed little since 1997. The school and class environment accounted for a large part of the variation in smoking behavior.

Uptake of e-cigarettes among a nationally representative cohort of UK children.

INTRODUCTION: Using nationally representative data this study examined experimentation with and regular use of e-cigarettes among children not using tobacco at age 11 years, followed up to age 14 years. METHODS: Data come from 10 982 children in the UK Millennium Cohort Study. Logistic regression assessed experimentation with and current use of e-cigarettes by age 14 years. We considered associations of sociodemographics at age 11 years with subsequent e-cigarette use, including data on family income, peer and caregiver smoking. Subsequent models were adjusted for current tobacco use to assess both the strength of the assocations between e-cigarette use and tobacco, and whether sociodemographics were associated with e-cigarettes independently of tobacco. RESULTS: Among 10 982 children who reported never smoking at age 11 years, 13.9% (1525) had ever tried an e-cigarette by age 14 years, and of these 18.2% (278) reported being current users. Children in lower income households were more likely to have tried an e-cigarette than those in higher income households (Adjusted Odds Ratio, AOR 1.89, p=0.002). Children who reported friend (AOR 2.28, p<0.001) or caregiver smoking (AOR 1.77, p<0.001) at age 11 years were more likely to have tried an e-cigarette by age 14 years. After adjusting for current tobacco use, there was some attenuation of these associations, although associations of friend and caregiver smoking with e-cigarette use remained statistically significant. CONCLUSIONS: Children from lower income families were more likely to experiment with e-cigarettes by age 14 years, although this was heavily mediated by concurrent tobacco use. Caregiver and friend smoking are linked to trying e-cigarettes, although these relationships are less clear for regular e-cigarette use.