Associations between parental smoking and teenage alcohol and drug use in the Growing Up in Ireland cohort study: a longitudinal observational study.

BACKGROUND: Children with a parent who smokes are more likely to become substance users than those who do not have a parent who smokes. In this study, we examined whether childhood or early adolescent exposure to primary parent smoking increased the risk of subsequent teenage alcohol and drug use at ages 17-18 years. METHODS: For this longitudinal observational study, we analysed data from 6039 teenagers and their parents from the waves 1-3 of the Growing up in Ireland Cohort 98' Study. Parental smoking was assessed at baseline (9 years) and wave 2 (13 years) with responses coded as yes or no. The primary parent was defined as the person who provided most care and who knew most about the Study Child, usually the mother or mother figure for 98% of study participants. Teenage alcohol and drug use assessed at ages 17-18 years (wave 3) was determined by responses to the question "Have you ever consumed alcohol?" (answers yes or no), drug use was assessed by questions on ever trying aerosols/gas, cannabis, and non-prescribed drugs, with those answering yes being classified as other-drug ever users. We did a logistic regression analysis to examine the associations between parents' smoking on teenage alcohol and drug use, controlling for covariates: gender, education, income, education, region, and household type. Ethics approval for the GUI project was obtained from the Health Research Board. FINDINGS: Of the 6039 teenagers included in our study, 2968 (49%) were female, 3070 (51%) were male, 5351 (89%) ever used alcohol, 5065 (85%) were current users, and 2098 (35%) used other drugs. Rates of primary parent smoking were 31% (n=1883) in wave 1 and 30% (n=1829) in wave 2. After adjusting for other exposures known to be associated with teenage substance use, primary parent smoking at waves 1 and 2 was associated with higher odds of teenage alcohol ever use (adjusted odds ratios [aORs] 1·89 [95% CI 1·44--2·46] at wave 1 and 1·53 [1·20-1·98] at wave 2), current alcohol use (1·88 [1·50-2·36] and 1·59 [1·28-1·97]) and other-drug ever use (1·699 [1·45-1·95] and 1·71 [1·47-1·98]). INTERPRETATION: Teenagers aged 17-18 years exposed at ages 9 and 13 years to parental smoking were more likely to report significantly higher odds of alcohol and drug use at age 17-18 years. The finding that exposure to parent smoking in childhood increases the risk of teenage alcohol and other drug use suggests a need for interventions aimed at parents who smoke Limitations include potential unmeasured or residual confounders and reliance on self-reported teenage substance use behaviours. FUNDING: Royal City of Dublin Hospital Trust, Irish Research Council Government of Ireland Postgraduate Scholarship Programme.

Odds of gambling among adolescents: a secondary analysis of the cross-sectional European School Survey Project on Alcohol and Other Drugs.

BACKGROUND: Gambling among adolescents is associated with gambling disorder in adulthood. This study investigated factors associated with gambling and excessive gambling in adolescents. METHODS: This secondary analysis of the cross-sectional European School Survey Project on Alcohol and Other Drugs (ESPAD) used nationally representative data from the Irish cohort of the 2019 ESPAD wave. Data were collected between March and May 2019. We included 1949 students aged 15-16 years (946 [48·5%] male, 1003 [51·5%] female), with a response rate of 85%. We calculated past year gambling prevalence as the rate of those who had gambled for money on at least one of four games of chance (slot machines, cards or dice, the lottery, betting on sports or animals) in the past 12 months. An adapted version of the three-item Consumption Screen for Problem Gambling was used to identify excessive gambling (score ≥4). We carried out descriptive and logistic regression analyses using binary covariates with Stata v16.1. We included 19 variables in the multivariable analysis. Ethics approval was granted by Dublin Institute of Technology's Ethics Committee. Non-consent forms were issued to all parents to opt out. FINDINGS: Overall, 447 (23%) of 1949 students gambled in the past year, of whom 45 (10%) engaged in excessive gambling. Using a mutually adjusted multivariable logistic regression analysis, past year gambling was associated with alcohol use (adjusted odds ratio [aOR] 1·6, 95% CI 1·1-2·2), experiencing serious arguments (aOR 1·4, 1·1-1·9), and trouble with the police (aOR 1·9, 1·2-2·8). Female gender was a protective factor (aOR 0·6, 0·4-0·9). In the univariable analysis, excessive gambling was associated with gaming (OR 2·3, 1·0-5·1), tobacco use (2·1, 1·1-4·2), e-cigarette use (2·1, 1·1-4·1), heavy episodic drinking (2·7, 1·4-5·1), trouble with the police (2·8, 1·5-5·4, p<0·01), and deliberately hurting themselves (2·8, 1·4-5·6). Female gender (OR 0·3, 0·1-0·6) and social media use (0·4, 0·2-0·8) were protective factors. Excessive gambling was also associated with betting on sports and animals (OR 3·6, 1·6-8·4), slot machines (2·9, 1·5-5·8), card or dice (2·4, 1·2-4·6), and online gambling (4·2, 2·0-8·0). INTERPRETATION: A large proportion of 15-16 year olds in Ireland have gambled for money in the past year, with one in ten of those having engaged in excessive gambling. This number is likely to be underestimated due to recall and social desirability bias. Reducing the availability, access, and appeal of gambling products in Ireland should be addressed through ongoing gambling reform. FUNDING: Institute of Public Health.

Friends and family matter Most: a trend analysis of increasing e-cigarette use among Irish teenagers and socio-demographic, personal, peer and familial associations.

BACKGROUND: E-cigarette ever-use and current-use among teenagers has increased worldwide, including in Ireland. METHODS: We use data from two Irish waves (2015, 2019) of the European School Survey Project on Alcohol and other Drugs (ESPAD) to investigate gender and teenage e-cigarette use (n = 3421 16-year-olds). Using chi-square analyses, we report changes in e-cigarette ever-use, current-use, and associated variables. Using multivariable logistic regression, we analyse the increase in e-cigarette use and socio-demographic, personal, peer and familial associations, focusing on gender differences. RESULTS: E-cigarette ever-use increased from 23% in 2015 to 37% in 2019, and current-use from 10 to 18%. Compared with 2015, the odds in 2019, of becoming both an e-cigarette ever-user and current-user, were significantly higher for girls than boys (ever-use: AOR 2.67 vs 2.04; current-use: AOR 3.11 vs 1.96). Smoking and e-cigarette use are linked but never-smokers who try e-cigarettes rose significantly from 33 to 67% and those using e-cigarettes to quit smoking decreased significantly from 17 to 3%. Almost two-thirds of respondents (66%) in 2019 said that their reason for trying e-cigarettes was "out of curiosity". Peer smoking is significantly associated with likelihood of e-cigarette ever-use (AOR 6.52) and current-use (AOR 5.45). If "Most/All friends smoke", odds were significantly higher for boys than for girls (ever-use AOR 7.07 vs 6.23; current-use AOR 5.90 vs 5.31). Less parental monitoring is significantly associated with greater e-cigarette ever-use (AOR 3.96) and current-use (4.48), and having parents who usually don't know where their child is on Saturday nights was also associated with significantly higher odds for boys than for girls (ever-use AOR 5.42 vs 3.33; current-use AOR 5.50 vs 3.50). CONCLUSION: Respondents had significantly higher odds of being e-cigarette ever- and current-users in 2019 compared with 2015. Use is higher among boys but girls are increasingly at risk. Two-thirds had never smoked cigarettes at first e-cigarette use; two-thirds used out of curiosity but few (3%) for smoking cessation. The most prominent risk factors for e-cigarette use were peer- and parent-related, especially so for boys. Interventions that take account of friend and family influences may provide mechanisms for preventing an increasing risk of nicotine addiction.

It's not all about price: factors associated with roll-your-own tobacco use among young people - a qualitative study.

BACKGROUND: Smoking prevalence in Ireland is falling in all age groups, but the prevalence of roll-your-own (RYO) tobacco use is rising among young people. This qualitative study aims to explore and understand the factors associated with young people's use of RYO products. METHODS: Semi-structured individual and focus group interviews were conducted with young people aged 16-22 years. Participants were recruited from a higher education institution and youth organisations working with early school leavers across Dublin. In total, there were 62 participants in the study, consisting of 22 individual interviews and eight focus group interviews with 40 participants. Categoric and thematic data analysis was used to generate the findings. RESULTS: We identified two broad themes, incentivising and disincentivising factors. The lower cost of RYO products compared to pre-manufactured cigarettes was the most important incentive for users. However, other product characteristics, such as the artisanal factors associated with RYO products were also found. Social and environmental influences were apparent, in which certain groups and environments facilitated and normalised RYO practices. Amenities and facilities often provided smokers with normalised spaces which could be dedicated to the enactment of rolling practices and to the creation and maintenance of social bonds with other users. Disincentives included negative features related to the product itself, adverse health effects, and the effects of tobacco denormalisation. CONCLUSIONS: While the lower cost of RYO products is very important for young smokers, other product characteristics and influences also incentivise and disincentivise use. A more comprehensive understanding of the multi-dimensional appeal of these products will assist policymakers to target strategies to reduce the attractiveness to young smokers of these products.

Inequalities in Smoking and E-Cigarette Use in Young Adults With Mental Ill-Health, 20 years After Ireland's Smoking Ban.

Background: Ireland's Smoking Ban reduced health inequalities known to be associated with smoking but some groups may not have benefitted. Mental ill-health and smoking are known to be associated with health inequalities. Whether similar patterns exist for e-cigarette use is less clear, as few data exist. Objectives: To examine: (1) self-reported doctor-diagnosed mental ill-health in Irish 20-year-olds; (2) smoking, e-cigarette, and dual use in those with and without mental ill-health; and (3) protective and risk factors for smoking and e-cigarette use in these groups. Methods: We use cross-sectional data from 20 year-olds in Wave 4 of Growing Up in Ireland Child Cohort. They were asked to self-report mental ill-health which had been diagnosed by a clinician, and their smoking and e-cigarette use. All analyses were performed using SPSS v27. Results: 19.4% (n = 1008) of the total sample (n = 4729) reported a mental ill-health diagnosis. Comparing those with and without, those with mental ill-health had significantly higher prevalence of current smoking (47%, n = 419 vs 36%, n = 1361; OR 1.57, CI: 1.36, 1.82), e-cigarette use (17%, n = 152 vs 13%, n = 485; OR 1.40, CI:1.15, 1.70), and dual use (12%, n = 109 vs 9%, n = 328; OR 1.46, CI:1.16, 1.84). Risk factors for smoking and e-cigarette use were, earlier smoking initiation, peers or primary caregivers who smoked, being in paid employment, one-parent family background, and social media use. Being female was protective. Most risk factors were significantly higher in young adults with mental ill-health but, after adjusting for these variables, respondents with mental ill-health still have significantly higher adjusted higher odds of smoking (aOR 1.28, CI:1.05, 1.56). Conclusions: Inequalities in smoking and e-cigarette use in young adults with mental ill-health are evident 20 years after Ireland's National Smoking Ban. Despite extensive Tobacco Control interventions in the past 20 years, there is still need in Ireland for new targeted interventions to reduce health inequalities for left-behind young smokers with mental ill-health.

The associations of parental smoking, quitting and habitus with teenager e-cigarette, smoking, alcohol and other drug use in GUI Cohort '98.

We analyse parental smoking and cessation (quitting) associations with teenager e-cigarette, alcohol, tobacco smoking and other drug use, and explore parental smoking as a mechanism for social reproduction. We use data from Waves 1-3 of Growing Up in Ireland (Cohort '98). Our analytic sample consisted of n = 6,039 participants reporting in all 3 Waves. Data were collected in Waves 1 and 2 when the children were 9 and 13 years old and in Wave 3 at age 17/18 years. Generalized Estimating Equations (GEE) models were used to analyse teenage substance use at Wave 3. Parental smoking was associated with significantly increased risk of all teenage substance use, adjusted odds ratios were aOR2.13 (ever e-cigarette use); aOR1.92 (ever alcohol use); aOR1.88 (current alcohol use); aOR1.90 (ever use of other drugs); aOR2.10 (ever-smoking); and aOR1.91 (current smoking). Primary caregiver smoking cessation (quitting) was associated with a lower risk for teenager current smoking aOR0.62, ever e-cigarette use aOR 0.65 and other drug use aOR 0.57. Primary caregiver smoking behaviour had greater associations than secondary, and age13 exposure more than age 9. Habitus seems to play a role and wealth was protective for teenage smoking. The findings suggest that prevention interventions should target both caregivers and their children.

Particle Exposure Hazards of Visiting Outdoor Smoking Areas for Patients with Asthma or COPD Even in EU Countries with Comprehensive Smokefree Laws.

Smokefree laws are intended to protect against second-hand smoke (SHS) in outdoor areas. We examined if exposure to PM2.5 particles in outdoor smoking areas changed breathing rates in 60 patients with asthma (n = 30) or with COPD (n = 30), in an open, non-randomised, interventional study model in Czechia, Ireland and Spain. The patients wore a PM2.5 particle monitor (AirSpeck) and a breath monitor (RESpeck) for 24 h to determine changes in breathing rates (Br) at rest and during a visit to an outside smoking area. Spirometry and breath CO were measured before and the day after visiting an outdoor smoking area. The PM2.5 levels at the 60 venues were highly variable, ranging from ≥2000 µg/m3 (in 4 premises) to ≤10 µg/m3 (in 3 premises, which had only a single wall in the structure). At 39 venues, the mean PM 2.5 levels were ≥25 µg/m3. The breathing rate changed significantly in 57 of the 60 patients, resulting in an increase in some patients and a decrease in others. Comprehensive smokefree laws were ineffective in protecting asthma and COPD patients from exposure to high levels of SHS in outside areas of pubs and terraces, which should be avoided by these patients. These findings also support the extension of smokefree laws to outside areas.

Sociodemographic, personal, peer, and familial predictors of e-cigarette ever use in ESPAD Ireland: A forward stepwise logistic regression model.

INTRODUCTION: E-cigarette ever use has risen significantly in recent years in Ireland, similar to trends elsewhere in Europe, the United States, and Asia-Pacific region. Results from ESPAD Ireland (European School Survey Project on Alcohol and other Drugs) show teenage e-cigarette ever use increased from 18% (2015) to 37% (2019). Given this increase, our aim is to profile e-cigarette ever users and never users in this age group; to examine sociodemographic, personal, peer, and familial factors associated with e-cigarette ever use; and to suggest appropriate measures to reduce use. METHODS: A nationally representative stratified random sample of 50 ESPAD schools was surveyed in 2019, with 3495 students aged 15-17 years. Bivariate and multivariable logistic regression analyses were performed using Stata version 16. RESULTS: E-cigarette ever use was significantly associated with ever smoking (AOR=4.15; 95% CI: 1.29-13.41), ever cannabis use (AOR=2.21; 95% CI: 1.11-4.41) and ever inhalants use (AOR=2.51; 95% CI: 1.07-5.88). Children of university-educated mothers had significantly higher odds of e-cigarette ever use (AOR=3.46; 95% CI: 1.40-8.54). Associated with reduced AORs were reading books for enjoyment (AOR=0.32; 95% CI: 0.16-0.64), living in households where smoking was regulated (AOR=0.53; 95% CI: 0.30-0.94), and perceiving moderate risk in trying e-cigarettes once or twice (AOR=0.20; 95% CI: 0.07-0.67). CONCLUSIONS: E-cigarette ever use is part of a pattern of teenage polysubstance use including cigarette smoking, providing some support for the common liability theory. Regulation of smoking in the home, reading for enjoyment, and perceiving risk from e-cigarette use are associated with decreased likelihood of ever use, and higher parental education with increased likelihood. Thus, health education emphasizing the role of parents and risks of e-cigarette use is indicated to reduce the rise in e-cigarette ever use in teenagers.

Increased smoking and e-cigarette use among Irish teenagers: a new threat to Tobacco Free Ireland 2025.

Smoking prevalence decreased in Irish teenagers in all ESPAD survey waves from 1995 until 2015. However, in ESPAD 2019, current teen smoking and e-cigarette use increased, threatening Ireland's 5% prevalence tobacco endgame strategy. https://bit.ly/3yXVAyN.

A qualitative study of e-cigarette use among young people in Ireland: Incentives, disincentives, and putative cessation.

BACKGROUND: Smoking prevalence in Ireland is falling in all age groups, but e-cigarette use is rising among young people. This qualitative study explores young people's accounts of e-cigarette use in Ireland. METHODS: Semi-structured individual (22) and focus group (8) interviews were conducted with 62 young people aged 18-22 years, recruited from a higher-education institution and youth organisations working with early school-leavers across Dublin. All were smokers or ex-smokers; 41 had tried e-cigarettes, 11 continued as dual users. We identified themes using thematic data analysis. RESULTS: Three broad themes were identified: incentivising features, disincentivising features, and ambivalent and unsuccessful cessation, named putative smoking cessation. Incentivising features included price, pleasing taste/ flavours, and the possibility of indoor use. Disincentivising features related to adverse health effects (pain, discomfort, sore throat, coughing, headache) and unpleasant physical effects (bad taste, problems resulting from device faults). Other disincentives were over-consumption arising from inability to control intake, "greater addictiveness", product taste, and device faults. Putative cessation refers to the conflict between participants' expected use of e-cigarettes as a smoking cessation/reduction aid and their observed reality of e-cigarettes' failure in this regard, with reported outcomes including: failure to quit or reduce; continued or resumed cigarette and/or roll-your-own smoking; dual use of e-cigarettes and other tobacco products; and inability to quit e-cigarettes. CONCLUSIONS: Participants were sceptical about e-cigarettes' "purported relative healthiness", concerned about addictiveness and potential long-term health consequences, and critically aware of advertising and industry strategies. E-cigarettes were viewed as being less denormalised, in part because they could be used in indoor spaces where smoking is banned in Ireland. Although price, taste, and perceived renormalisation were important motivators for young people's use of e-cigarettes, they wanted to quit smoking. The regulation of e-cigarettes through age restriction of access, licensing of outlets, pricing, point of sale and advertising restrictions as well as through the banning of indoor use should be considered by legislators and tobacco control policymakers.

Adolescent Suicide Ideation, Depression and Self-Esteem: Relationships to a New Measure of Gender Role Conflict.

Among 15-24 year olds in Ireland, completed suicide was responsible for 4.1 times more male deaths than female deaths in 2014 (World Health Organization [WHO], 2017). Few international research studies have investigated the relationship between masculinity [as assessed by a measure of gender role conflict (GRC)] and suicide ideation, and none have done so with Irish adolescents. Therefore, the purpose of the current study was to investigate the relationships between a new measure of GRC developed specifically for use with Irish adolescents (I-GRCS-A; O'Beaglaoich et al., 2016), and depression, self-esteem, and negative/protective suicide ideation. A sample of 176 adolescent boys (M = 16.9, SD = 0.94) from a non-clinical population participated in the study. Regression analyses and tests of mediation revealed that depression significantly mediated the relationship between GRC and negative suicide ideation, whilst self-esteem and depression significantly mediated the relationship between GRC and positive suicide ideation. Implications and limitations of the current study are outlined and directions for future research are discussed.