Young people's use of e-cigarettes in Wales, England and Scotland before and after introduction of EU Tobacco Products Directive regulations: a mixed-method natural experimental evaluation

Graham Moore; Rachel Brown; Nicholas Page; Britt Hallingberg; Olivia Maynard; Jennifer McKell; Linsay Gray; Anna Blackwell; Emily Lowthian; Marcus Munafò; Anne Marie Mackintosh; Linda Bauld

doi:10.1016/j.drugpo.2020.102795

Young people's use of e-cigarettes in Wales, England and Scotland before and after introduction of EU Tobacco Products Directive regulations: a mixed-method natural experimental evaluation

Graham Moore, Rachel Brown, Nicholas Page, Britt Hallingberg, Olivia Maynard, Jennifer McKell, Linsay Gray, Anna Blackwell, Emily Lowthian, Marcus Munafò, Anne Marie Mackintosh, Linda Bauld

Research output: Contribution to journal › Article › peer-review

12 Citations (SciVal)

Abstract

Background: Young people's experimentation with e-cigarettes has increased in recent years, although regular use remains limited. EU Tobacco Products Directive (TPD) regulations introduced packet warnings, advertising restrictions, and regulated nicotine strength from 2016, in part due to concerns regarding use by young people. This paper examines e-cigarette use trajectories before and after TPD. Methods: E-cigarette use data were obtained from School Health Research Network/Health Behaviour in School-aged Children surveys in Wales and Smoking Drinking and Drug Use surveys in England. Data from Wales were analysed using segmented logistic regression, with before and after regression analyses of English data. Semi-structured group interviews included young people aged 14-16 years in Wales, England and Scotland in 2017 and 2018. Results: In Wales, ever use of e-cigarettes increased over time, but under a range of assumptions, growth did not appear to continue post-TPD. A small and non-significant change in trend was observed post-implementation (OR=0.96; 95%CI=0.91 to 1.01), which increased in size and significance after adjusting for ever smoking (OR=0.93; 95%CI=0.88 to 0.98). There was little increase in regular e-cigarette use from 2015 to 2017 in Wales. However, ever and regular use increased from 2014 to 2016 in England. Young people in all nations described limited interactions with components of TPD, while describing e-cigarette use as a ‘fad’, which had begun to run its course. Conclusions: This study provides preliminary evidence that young people's e-cigarette experimentation may be plateauing in UK nations. The extent to which this arises from regulatory changes, or due to a fad having begun to lose its appeal among young people in the UK countries, remains unclear. These trends contrast to those observed in North America, where newer products whose EU market entry and marketing have been impacted by TPD, have gained traction among young people. Long-term monitoring of e-cigarette use trends and perceptions among young people remain vital.

Original language	English
Article number	102795
Journal	International Journal of Drug Policy
Volume	85
DOIs	https://doi.org/10.1016/j.drugpo.2020.102795
Publication status	Published - 30 Nov 2020

Bibliographical note

Funding Information:
This research was funded by the National Institute for Health Research ( NIHR ) in England under its Public Health Research Board (grant number 16/57/01). The views expressed here are those of the authors and do not necessarily reflect those of the National Health Service (NHS), NIHR or the Department of Health for England. This work was also undertaken with the support of The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UK Clinical Research Collaboration (UKCRC) Public Health Research Centre of Excellence. Joint funding (MR/KO232331/1) from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the Welsh Government and the Wellcome Trust, under the auspices of the UKCRC, is gratefully acknowledged. The School Health Research Network is a partnership between DECIPHer at Cardiff University, Welsh Government, Public Health Wales and Cancer Research UK, funded by Health and Care Research Wales via the National Centre for Health and Wellbeing Research. LG acknowledges support from the Medical Research Council and the Chief Scientist Office (MC_ UU _12017/13) of the Scottish Government Health Care Directorates (SPHSU13). In addition, the authors would like to thank Laurence Moore, Douglas Eadie, and Jordan Van Godwin for their contributions to this study, and Chris Roberts for supplying the HBSC data for Wales.

Funding Information:
This research was funded by the National Institute for Health Research (NIHR) in England under its Public Health Research Board (grant number 16/57/01). The views expressed here are those of the authors and do not necessarily reflect those of the National Health Service (NHS), NIHR or the Department of Health for England. This work was also undertaken with the support of The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UK Clinical Research Collaboration (UKCRC) Public Health Research Centre of Excellence. Joint funding (MR/KO232331/1) from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the Welsh Government and the Wellcome Trust, under the auspices of the UKCRC, is gratefully acknowledged. The School Health Research Network is a partnership between DECIPHer at Cardiff University, Welsh Government, Public Health Wales and Cancer Research UK, funded by Health and Care Research Wales via the National Centre for Health and Wellbeing Research. LG acknowledges support from the Medical Research Council and the Chief Scientist Office (MC_UU_12017/13) of the Scottish Government Health Care Directorates (SPHSU13). In addition, the authors would like to thank Laurence Moore, Douglas Eadie, and Jordan Van Godwin for their contributions to this study, and Chris Roberts for supplying the HBSC data for Wales.

Publisher Copyright:
© 2020 The Authors

Funding

This research was funded by the National Institute for Health Research ( NIHR ) in England under its Public Health Research Board (grant number 16/57/01). The views expressed here are those of the authors and do not necessarily reflect those of the National Health Service (NHS), NIHR or the Department of Health for England. This work was also undertaken with the support of The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UK Clinical Research Collaboration (UKCRC) Public Health Research Centre of Excellence. Joint funding (MR/KO232331/1) from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the Welsh Government and the Wellcome Trust, under the auspices of the UKCRC, is gratefully acknowledged. The School Health Research Network is a partnership between DECIPHer at Cardiff University, Welsh Government, Public Health Wales and Cancer Research UK, funded by Health and Care Research Wales via the National Centre for Health and Wellbeing Research. LG acknowledges support from the Medical Research Council and the Chief Scientist Office (MC_ UU _12017/13) of the Scottish Government Health Care Directorates (SPHSU13). In addition, the authors would like to thank Laurence Moore, Douglas Eadie, and Jordan Van Godwin for their contributions to this study, and Chris Roberts for supplying the HBSC data for Wales. This research was funded by the National Institute for Health Research (NIHR) in England under its Public Health Research Board (grant number 16/57/01). The views expressed here are those of the authors and do not necessarily reflect those of the National Health Service (NHS), NIHR or the Department of Health for England. This work was also undertaken with the support of The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UK Clinical Research Collaboration (UKCRC) Public Health Research Centre of Excellence. Joint funding (MR/KO232331/1) from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the Welsh Government and the Wellcome Trust, under the auspices of the UKCRC, is gratefully acknowledged. The School Health Research Network is a partnership between DECIPHer at Cardiff University, Welsh Government, Public Health Wales and Cancer Research UK, funded by Health and Care Research Wales via the National Centre for Health and Wellbeing Research. LG acknowledges support from the Medical Research Council and the Chief Scientist Office (MC_UU_12017/13) of the Scottish Government Health Care Directorates (SPHSU13). In addition, the authors would like to thank Laurence Moore, Douglas Eadie, and Jordan Van Godwin for their contributions to this study, and Chris Roberts for supplying the HBSC data for Wales.

Keywords

Adolescence
E-cigarette
Interrupted time series analysis
Mixed methods
Policy
Tobacco

ASJC Scopus subject areas

Medicine (miscellaneous)
Health Policy

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.drugpo.2020.102795Licence: CC BY

Cite this

Moore, G., Brown, R., Page, N., Hallingberg, B., Maynard, O., McKell, J., Gray, L., Blackwell, A., Lowthian, E., Munafò, M., Mackintosh, A. M., & Bauld, L. (2020). Young people's use of e-cigarettes in Wales, England and Scotland before and after introduction of EU Tobacco Products Directive regulations: a mixed-method natural experimental evaluation. International Journal of Drug Policy, 85, Article 102795. https://doi.org/10.1016/j.drugpo.2020.102795

Young people's use of e-cigarettes in Wales, England and Scotland before and after introduction of EU Tobacco Products Directive regulations: a mixed-method natural experimental evaluation. / Moore, Graham; Brown, Rachel; Page, Nicholas et al.
In: International Journal of Drug Policy, Vol. 85, 102795, 30.11.2020.

Research output: Contribution to journal › Article › peer-review

Moore, G, Brown, R, Page, N, Hallingberg, B, Maynard, O, McKell, J, Gray, L, Blackwell, A, Lowthian, E, Munafò, M, Mackintosh, AM & Bauld, L 2020, 'Young people's use of e-cigarettes in Wales, England and Scotland before and after introduction of EU Tobacco Products Directive regulations: a mixed-method natural experimental evaluation', International Journal of Drug Policy, vol. 85, 102795. https://doi.org/10.1016/j.drugpo.2020.102795

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abstract = "Background: Young people's experimentation with e-cigarettes has increased in recent years, although regular use remains limited. EU Tobacco Products Directive (TPD) regulations introduced packet warnings, advertising restrictions, and regulated nicotine strength from 2016, in part due to concerns regarding use by young people. This paper examines e-cigarette use trajectories before and after TPD. Methods: E-cigarette use data were obtained from School Health Research Network/Health Behaviour in School-aged Children surveys in Wales and Smoking Drinking and Drug Use surveys in England. Data from Wales were analysed using segmented logistic regression, with before and after regression analyses of English data. Semi-structured group interviews included young people aged 14-16 years in Wales, England and Scotland in 2017 and 2018. Results: In Wales, ever use of e-cigarettes increased over time, but under a range of assumptions, growth did not appear to continue post-TPD. A small and non-significant change in trend was observed post-implementation (OR=0.96; 95%CI=0.91 to 1.01), which increased in size and significance after adjusting for ever smoking (OR=0.93; 95%CI=0.88 to 0.98). There was little increase in regular e-cigarette use from 2015 to 2017 in Wales. However, ever and regular use increased from 2014 to 2016 in England. Young people in all nations described limited interactions with components of TPD, while describing e-cigarette use as a {\textquoteleft}fad{\textquoteright}, which had begun to run its course. Conclusions: This study provides preliminary evidence that young people's e-cigarette experimentation may be plateauing in UK nations. The extent to which this arises from regulatory changes, or due to a fad having begun to lose its appeal among young people in the UK countries, remains unclear. These trends contrast to those observed in North America, where newer products whose EU market entry and marketing have been impacted by TPD, have gained traction among young people. Long-term monitoring of e-cigarette use trends and perceptions among young people remain vital.",

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author = "Graham Moore and Rachel Brown and Nicholas Page and Britt Hallingberg and Olivia Maynard and Jennifer McKell and Linsay Gray and Anna Blackwell and Emily Lowthian and Marcus Munaf{\`o} and Mackintosh, {Anne Marie} and Linda Bauld",

note = "Funding Information: This research was funded by the National Institute for Health Research ( NIHR ) in England under its Public Health Research Board (grant number 16/57/01). The views expressed here are those of the authors and do not necessarily reflect those of the National Health Service (NHS), NIHR or the Department of Health for England. This work was also undertaken with the support of The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UK Clinical Research Collaboration (UKCRC) Public Health Research Centre of Excellence. Joint funding (MR/KO232331/1) from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the Welsh Government and the Wellcome Trust, under the auspices of the UKCRC, is gratefully acknowledged. The School Health Research Network is a partnership between DECIPHer at Cardiff University, Welsh Government, Public Health Wales and Cancer Research UK, funded by Health and Care Research Wales via the National Centre for Health and Wellbeing Research. LG acknowledges support from the Medical Research Council and the Chief Scientist Office (MC_ UU _12017/13) of the Scottish Government Health Care Directorates (SPHSU13). In addition, the authors would like to thank Laurence Moore, Douglas Eadie, and Jordan Van Godwin for their contributions to this study, and Chris Roberts for supplying the HBSC data for Wales. Funding Information: This research was funded by the National Institute for Health Research (NIHR) in England under its Public Health Research Board (grant number 16/57/01). The views expressed here are those of the authors and do not necessarily reflect those of the National Health Service (NHS), NIHR or the Department of Health for England. This work was also undertaken with the support of The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UK Clinical Research Collaboration (UKCRC) Public Health Research Centre of Excellence. Joint funding (MR/KO232331/1) from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the Welsh Government and the Wellcome Trust, under the auspices of the UKCRC, is gratefully acknowledged. The School Health Research Network is a partnership between DECIPHer at Cardiff University, Welsh Government, Public Health Wales and Cancer Research UK, funded by Health and Care Research Wales via the National Centre for Health and Wellbeing Research. LG acknowledges support from the Medical Research Council and the Chief Scientist Office (MC_UU_12017/13) of the Scottish Government Health Care Directorates (SPHSU13). In addition, the authors would like to thank Laurence Moore, Douglas Eadie, and Jordan Van Godwin for their contributions to this study, and Chris Roberts for supplying the HBSC data for Wales. Publisher Copyright: {\textcopyright} 2020 The Authors",

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AU - Page, Nicholas

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AU - Maynard, Olivia

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AU - Blackwell, Anna

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AU - Munafò, Marcus

AU - Mackintosh, Anne Marie

AU - Bauld, Linda

N1 - Funding Information: This research was funded by the National Institute for Health Research ( NIHR ) in England under its Public Health Research Board (grant number 16/57/01). The views expressed here are those of the authors and do not necessarily reflect those of the National Health Service (NHS), NIHR or the Department of Health for England. This work was also undertaken with the support of The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UK Clinical Research Collaboration (UKCRC) Public Health Research Centre of Excellence. Joint funding (MR/KO232331/1) from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the Welsh Government and the Wellcome Trust, under the auspices of the UKCRC, is gratefully acknowledged. The School Health Research Network is a partnership between DECIPHer at Cardiff University, Welsh Government, Public Health Wales and Cancer Research UK, funded by Health and Care Research Wales via the National Centre for Health and Wellbeing Research. LG acknowledges support from the Medical Research Council and the Chief Scientist Office (MC_ UU _12017/13) of the Scottish Government Health Care Directorates (SPHSU13). In addition, the authors would like to thank Laurence Moore, Douglas Eadie, and Jordan Van Godwin for their contributions to this study, and Chris Roberts for supplying the HBSC data for Wales. Funding Information: This research was funded by the National Institute for Health Research (NIHR) in England under its Public Health Research Board (grant number 16/57/01). The views expressed here are those of the authors and do not necessarily reflect those of the National Health Service (NHS), NIHR or the Department of Health for England. This work was also undertaken with the support of The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UK Clinical Research Collaboration (UKCRC) Public Health Research Centre of Excellence. Joint funding (MR/KO232331/1) from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the Welsh Government and the Wellcome Trust, under the auspices of the UKCRC, is gratefully acknowledged. The School Health Research Network is a partnership between DECIPHer at Cardiff University, Welsh Government, Public Health Wales and Cancer Research UK, funded by Health and Care Research Wales via the National Centre for Health and Wellbeing Research. LG acknowledges support from the Medical Research Council and the Chief Scientist Office (MC_UU_12017/13) of the Scottish Government Health Care Directorates (SPHSU13). In addition, the authors would like to thank Laurence Moore, Douglas Eadie, and Jordan Van Godwin for their contributions to this study, and Chris Roberts for supplying the HBSC data for Wales. Publisher Copyright: © 2020 The Authors

PY - 2020/11/30

Y1 - 2020/11/30

N2 - Background: Young people's experimentation with e-cigarettes has increased in recent years, although regular use remains limited. EU Tobacco Products Directive (TPD) regulations introduced packet warnings, advertising restrictions, and regulated nicotine strength from 2016, in part due to concerns regarding use by young people. This paper examines e-cigarette use trajectories before and after TPD. Methods: E-cigarette use data were obtained from School Health Research Network/Health Behaviour in School-aged Children surveys in Wales and Smoking Drinking and Drug Use surveys in England. Data from Wales were analysed using segmented logistic regression, with before and after regression analyses of English data. Semi-structured group interviews included young people aged 14-16 years in Wales, England and Scotland in 2017 and 2018. Results: In Wales, ever use of e-cigarettes increased over time, but under a range of assumptions, growth did not appear to continue post-TPD. A small and non-significant change in trend was observed post-implementation (OR=0.96; 95%CI=0.91 to 1.01), which increased in size and significance after adjusting for ever smoking (OR=0.93; 95%CI=0.88 to 0.98). There was little increase in regular e-cigarette use from 2015 to 2017 in Wales. However, ever and regular use increased from 2014 to 2016 in England. Young people in all nations described limited interactions with components of TPD, while describing e-cigarette use as a ‘fad’, which had begun to run its course. Conclusions: This study provides preliminary evidence that young people's e-cigarette experimentation may be plateauing in UK nations. The extent to which this arises from regulatory changes, or due to a fad having begun to lose its appeal among young people in the UK countries, remains unclear. These trends contrast to those observed in North America, where newer products whose EU market entry and marketing have been impacted by TPD, have gained traction among young people. Long-term monitoring of e-cigarette use trends and perceptions among young people remain vital.

AB - Background: Young people's experimentation with e-cigarettes has increased in recent years, although regular use remains limited. EU Tobacco Products Directive (TPD) regulations introduced packet warnings, advertising restrictions, and regulated nicotine strength from 2016, in part due to concerns regarding use by young people. This paper examines e-cigarette use trajectories before and after TPD. Methods: E-cigarette use data were obtained from School Health Research Network/Health Behaviour in School-aged Children surveys in Wales and Smoking Drinking and Drug Use surveys in England. Data from Wales were analysed using segmented logistic regression, with before and after regression analyses of English data. Semi-structured group interviews included young people aged 14-16 years in Wales, England and Scotland in 2017 and 2018. Results: In Wales, ever use of e-cigarettes increased over time, but under a range of assumptions, growth did not appear to continue post-TPD. A small and non-significant change in trend was observed post-implementation (OR=0.96; 95%CI=0.91 to 1.01), which increased in size and significance after adjusting for ever smoking (OR=0.93; 95%CI=0.88 to 0.98). There was little increase in regular e-cigarette use from 2015 to 2017 in Wales. However, ever and regular use increased from 2014 to 2016 in England. Young people in all nations described limited interactions with components of TPD, while describing e-cigarette use as a ‘fad’, which had begun to run its course. Conclusions: This study provides preliminary evidence that young people's e-cigarette experimentation may be plateauing in UK nations. The extent to which this arises from regulatory changes, or due to a fad having begun to lose its appeal among young people in the UK countries, remains unclear. These trends contrast to those observed in North America, where newer products whose EU market entry and marketing have been impacted by TPD, have gained traction among young people. Long-term monitoring of e-cigarette use trends and perceptions among young people remain vital.

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KW - E-cigarette

KW - Interrupted time series analysis

KW - Mixed methods

KW - Policy

KW - Tobacco

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M1 - 102795

ER -

Young people's use of e-cigarettes in Wales, England and Scotland before and after introduction of EU Tobacco Products Directive regulations: a mixed-method natural experimental evaluation

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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