Exclusive and Dual Use of Electronic Cigarettes Among European Youth in 32 Countries with Different Regulatory Landscapes
Overview
Affiliations
Background: The Tobacco Products Directive (2014/40/EU) partially harmonised the regulation of electronic cigarettes (e-cigarettes) in Europe, but individual countries maintain jurisdiction over bans on use in public places, domestic advertising, taxation and flavour regulations. Their association with youth e-cigarette use has not been examined.
Methods: We used the cross-sectional 2019 European School Survey Project on Alcohol and Other Drugs data from 32 countries with 98 758 students aged 15-16 years and the 2020 WHO's assessment of the e-cigarette regulations. Multilevel logistic regression models on ever (vs never) and current (vs non-current) exclusive e-cigarette use, exclusive cigarette use and dual use by e-cigarette regulations' composite score were adjusted for age, gender, parental education, perceived family's financial well-being, perceived difficulty of obtaining cigarettes, country income level and general progress in tobacco control.
Results: Of the respondents, 13.3% had ever used cigarettes, 10.6% e-cigarettes and 27.3% both; 13.0% currently used cigarettes, 6.0% e-cigarettes and 6.4% both. Higher composite country score in the e-cigarette regulations was associated with lower current exclusive e-cigarette use (OR=0.78; 95% CI 0.65 to 0.94) and current dual use (OR=0.80; 95% CI 0.67 to 0.95). Youth perceiving more difficulties in obtaining cigarettes were less likely to use cigarettes, e-cigarettes and both ever and currently (OR from 0.80 (95% CI 0.76 to 0.85) to 0.94 (95% CI 0.92 to 0.96)).
Conclusions: More comprehensive e-cigarette regulations and enforcement of age-of-sale laws may be protective of e-cigarette and dual use among adolescents.
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Villanueva-Blasco V, Belda-Ferri L, Vazquez-Martinez A Tob Induc Dis. 2025; 23.
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The Vaper's Perspective: A Qualitative Study of E-Cigarette Users and Smokers in Slovenia.
Pavlic D, Maksuti A, Kopcavar Gucek N, Albaradi I, Stepanovic A Zdr Varst. 2024; 63(4):198-204.
PMID: 39319022 PMC: 11417507. DOI: 10.2478/sjph-2024-0026.
Electronic cigarettes: "wolves in sheep's clothing".
Chong-Silva D, SantAnna M, Riedi C, SantAnna C, Ribeiro J, Vieira L J Pediatr (Rio J). 2024; 101(2):122-132.
PMID: 39245237 PMC: 11889694. DOI: 10.1016/j.jped.2024.06.015.
Sanchez-Romero L, Li Y, Zavala-Arciniega L, Gallegos-Carrillo K, Thrasher J, Meza R medRxiv. 2024; .
PMID: 38746147 PMC: 11092684. DOI: 10.1101/2024.04.28.24306511.
Doumi R, Khaytan S, Alobaidan A, Alqahtany B, Aldosari N, Almutairi A Healthcare (Basel). 2023; 11(22).
PMID: 37998490 PMC: 10671544. DOI: 10.3390/healthcare11222998.