Youth E-cig use much lower in countries that prohibit e-cigs

A new paper, Electronic cigarettes use and ‘dual use’ among the youth in 75 countries: estimates from Global Youth Tobacco Surveys (2014–2019) shows that countries that prohibit the sale of e-cigarettes, like Thailand and Brazil, have much lower levels of youth cigarette use than countries that allow them and have laws to restrict sales to youth (5.6% youth prevalence vs 15.4%).

PolicyPrevalence95% CI
E-cig ban5.64.6-6.7
Regulations on nicotine and/or other contents 13.412.4-14.5
Allow selling e-cigs with sales restrictions/regulation15.413.4-17.5

The Global Youth Tobacco Survey is a collaboration between the US Centers for Disease Control and Prevention and the World Health Organization conducted in 75 countries around the world.

The authors, Chandrashekhar Sreeramareddy and colleagues, also found higher use in richer countries and among boys, among other findings.

There are several limitations of the study, including that data were collected over several years (not all the same for all countries) and there were some countries that either did not include the e-cigarette questions or for which the e-cigarette regulations — if they existed at all — were not available to the authors. (The table above does not include results for countries where regulations were not available.) Major e-cigarette countries, including the USA and England, do not participate in the GYTS.

Nevertheless, despite protestations by tobacco companies and e-cigarette advocates that they don’t want kids to use e-cigarettes, this paper shows that, there is no way to make e-cigarettes broadly available as consumer products without have widespread youth uptake.

Here is the abstract:

We report the country-level prevalence of awareness about electronic cigarette use, and ‘dual use’ and its association with age, sex, country income, and e-cigarette regulatory status. We analyzed the most recent Global Youth Tobacco Surveys done on nationally representative samples of school-going youth aged 13–15 years in 75 countries/territories. The weighted prevalence of ‘awareness’ (heard about e-cigarettes), ‘ever use’ (even tried a few puffs), ‘current use’ (during the last 30 days), and ‘dual use’ (e-cigarette use and cigarette smoking during the last 30 days) were estimated. Awareness was > 80% in 13 countries mostly from Europe Poland being the highest at 95.8% (95% CI 94.8- 96.6). In seven countries, 30–50% of the youth had ever used an e-cigarette, Italy was the highest at 55.1% (95%CI 51–3,58.9). In 30 countries, current e-cigarette use was > 10%, the highest of 35.1% (95%CI 32.4–38.0) in Guam. Awareness and use were highest in the European region (74.6% and 34.5%) and HIC (83.6% and 39.4%). Youth from HIC (compared to lMIC) and countries having restrictive e-cigarette regulations (compared to NRP) had 2.4 times (aOR 2.2.4, 95% CI 2.2, 2.7) and 1.8 times (aOR 1.8, 95% CI 1.6, 2.0) higher odds of being current e-cigarette users respectively. Youth in countries with the most restrictive e-cigarette regulations (compared to NRP) had 0.6 times lower odds of being current e-cigarette users (aOR 0.6, 95% CI 0.6, 0.7). Awareness and e-cigarette use varied by sex, country income level, and region. Continued global surveillance of youth e-cigarette use is needed for the formulation of e-cigarette regulatory policy. Awareness and use of e-cigarettes were higher among boys, in countries in Europe and America regions, and among those with higher income and restrictive policies, whereas it was lower in countries having the most restrictive policies. Higher awareness is strongly correlated with a trial and current use of e-cigarettes. E-cigarette marketing should be restricted, and continued surveillance of e-cigarette use is needed. Most restrictive policies such as the ban on e-cigarettes appear to reduce e-cigarette use among the youth.

The full citation is: Sreeramareddy, C.T., Acharya, K. & Manoharan, A. Electronic cigarettes use and ‘dual use’ among the youth in 75 countries: estimates from Global Youth Tobacco Surveys (2014–2019). Sci Rep 12, 20967 (2022). It is available here.

Published by Stanton Glantz

Stanton Glantz is a retired Professor of Medicine who served on the University of California San Francisco faculty for 45 years. He conducts research on tobacco and cannabis control and cardiovascular disease/

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