Cardiff University | Prifysgol Caerdydd ORCA
Online Research @ Cardiff 
WelshClear Cookie - decide language by browser settings

Cross-sectional study examining the prevalence, correlates and sequencing of electronic cigarette and tobacco use among 11–16-year olds in schools in Wales

De Lacy, Elen, Fletcher, Adam ORCID:, Hewitt, Gillian ORCID:, Murphy, Simon ORCID: and Moore, Graham ORCID: 2017. Cross-sectional study examining the prevalence, correlates and sequencing of electronic cigarette and tobacco use among 11–16-year olds in schools in Wales. BMJ Open 6 , e012784. 10.1136/bmjopen-2016-012784

[thumbnail of de Lacy et al 2017 Prevalence, correlates and sequencing of e-cigarette and tobacco use BMJ Open.pdf]
PDF - Published Version
Available under License Creative Commons Attribution.

Download (1MB) | Preview
License URL:
License Start date: 1 January 2017


Objectives To examine the prevalence and frequency of electronic (e)-cigarette use among young people in Wales, associations with socio-demographic characteristics, smoking and other substances and the sequencing of e-cigarette and tobacco use. Design A cross-sectional survey of school students in Wales undertaken in 2015. Setting 87 secondary schools in Wales. Participants Students aged 11–16 (n=32 479). Results Overall, students were nearly twice as likely to report ever using e-cigarettes (18.5%) as smoking tobacco (10.5%). Use of e-cigarettes at least weekly was 2.7% in the whole sample, rising to 5.7% among those aged 15–16. Almost half (41.8%) of daily smokers reported being regular e-cigarette users. Regular e-cigarette use was more prevalent among current cannabis users (relative risk ratio (RRR)=41.82; 95% CI 33.48 to 52.25)), binge drinkers (RRR=47.88; 95% CI 35.77 to 64.11), users of mephedrone (RRR=32.38; 95% CI 23.05 to 45.52) and laughing gas users (RRR=3.71; 95% CI 3.04 to 4.51). Multivariate analysis combining demographics and smoking status showed that only gender (being male) and tobacco use independently predicted regular use of e-cigarettes (p<0.001). Among weekly smokers who had tried tobacco and e-cigarettes (n=877), the vast majority reported that they tried tobacco before using an e-cigarette (n=727; 82.9%). Conclusions Since 2013, youth experimentation with e-cigarettes has grown rapidly in Wales and is now almost twice as common as experimentation with tobacco. Regular use has almost doubled, and is increasing among never and non-smokers. These data suggest that e-cigarette use among youth is an emerging public health issue, even though there remains no evidence that it represents a new pathway into smoking. Mixed methods longitudinal research is needed to explore why young people use e-cigarettes, and to develop interventions to prevent further increases in use.

Item Type: Article
Status: Published
Schools: Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer)
Social Sciences (Includes Criminology and Education)
Subjects: H Social Sciences > H Social Sciences (General)
R Medicine > RA Public aspects of medicine
Publisher: BMJ Publishing Group
ISSN: 2044-6055
Funders: Medical Research Council
Date of First Compliant Deposit: 6 February 2017
Date of Acceptance: 19 December 2016
Last Modified: 08 Jul 2023 18:06

Citation Data

Cited 40 times in Scopus. View in Scopus. Powered By Scopus® Data

Actions (repository staff only)

Edit Item Edit Item


Downloads per month over past year

View more statistics