Study of British youth vaping causes outrage, but has flaws

Ammo - UK Ministry of DefenceA new British study on youth vaping has caused sensationalist headlines with its comparisons of the demographics, tobacco use and alcohol use of 14-to-17-year-olds who reported using or purchasing an e-cigarette.

The study, published in the journal BMC Public Health, comes from the Centre for Public Health at Liverpool John Moores University. It has been widely reported in UK media under headlines such as “Four in 10 teenage e-cigarette users would not have smoked, warn health experts” and “One in five teens owns an e-cigarette”.

But e-cigarette advocates such as Clive Bates, former director of the charity Action on Smoking and Health (ASH), point out that the study is not comparing like with like, by implicitly equating ever-use (or simply purchase) of an e-cigarette with a variety of tobacco and alcohol use levels.

As with many such studies, the data for the research was procured from a larger survey, in this case the fifth iteration of the Trading Standards North West Alcohol and Tobacco Survey – a voluntary questionnaire distributed to schools in the northwest of England.

That survey asked students whether they had ever tried or purchased e-cigarettes. The e-cig study then compared the answers of those who responded “yes” with their answers to a variety of other questions on tobacco use and alcohol. These included whether the students were former smokers, whether they only smoked when they drank, and – if they smoked daily – how many conventional cigarettes they consumed.

The researchers also compared answers on e-cigarette use with those to a similarly broad range of questions on alcohol consumption.

Measurement error

But asking whether young people had “ever used an e-cigarette” is a “poor measure of anything useful”, says Bates on his blog, The Counterfactual. “It captures large numbers of kids messing about, experimenting or trying it just once but not really doing anything that consolidates into ‘current use’ or a pattern of behaviour that may potentially cause harm. It’s a measure that generates the highest possible number and provides a basis for a moral panic, but gives no real insight into the scale of anything that might be harmful.”

The study did find some correlations among e-cigarette use, alcohol use, deprivation, and smoking by parents or guardians. The correlation with alcohol and deprivation suggested that e-cigarette use among youths is more likely for those children most vulnerable to risk-taking behaviours, the report said. And having a parent or guardian who smokes was one of the strongest predictors of e-cigarette use.

Taken together, these factors mean that legislation to prevent sales to under-18s could be ineffective, despite being expected to come into force in the UK before the end of 2015, the authors suggested. “Teenagers who access e-cigarettes are already familiar with strategies to bypass age legislation on restricted products,” they said.

However, they admit a number of shortcomings in their data which they say need further research – including the lack of questions on frequency of e-cigarette use, and whether it occurred before or after the students involved had tried conventional cigarettes.

What This Means: On its own this study does not add much to the already-developed store of knowledge on youth e-cigarette use; it’s already been established that general knowledge and ever-use of e-cigarettes is trending upwards as the products gain popularity, while young people’s tobacco use (even when including e-cigarettes) continues to trend downwards. And the association between e-cigs and youth risk-taking has also been established.

Moreover, the study is riddled with inconsistencies, for example concluding that an urgent need for controls on e-cigarette sales to children is required, yet also suggesting that such controls would largely be useless.

And it leaps into the territory of assumption, by claiming that “flavourings make e-cigarettes an attractive option to teenagers who would otherwise be put off conventional cigarettes by their taste”, despite also acknowledging that it could not be determined whether e-cigarette or conventional cigarette experimentation came first for most individuals, and without having any data at all on the influence of flavours.

As is sadly often the case with research into youth vaping, the response by pundits and policy-makers may provide more insight into how e-cigarettes are regarded than the answers given by its young subjects.

– Freddie Dawson ECigIntelligence staff

Photo: UK Ministry of Defence

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