E-cigarettes and Shisha – Gateways to regular smoking among British youth?

Martin Dockrell FRSPHDirector of Policy & ResearchAction on Smoking & Health

E-cigarette use among adults has increased rapidly

9%3% 7%

22%

34%

11%

0%

20%

40%

Currently use e-cigarettes Have ever tried e-cigarettes

2010 2012 2013

E-cigarette use among adult smokers in Great Britain

…but current use remains confined largely to current and ex-smokers

11%

24%

67%69%

57%

29%21%

7%3% 2% 2%

1% 5%0%

25%

50%

75%

100%

Never smoked(5972)

Ex-smoker (4303) Smoker (2009)

Don’t know

I have never heard ofe-cigarettes and havenever tried them

I have heard of e-cigarettes but havenever tried them

I have tried e-cigarettes but do notuse them (anymore)

I have tried e-cigarettes and still usethem

E-cigarette use in Britain, 2013(All adults)

Children who have never smoked rarely use e-cigarettes

E-cigarette use among children in Britain, 2013(All children, by smoking status N=12,171)

37%21%

14% 9% 12% 10%

62%

72%71%

68%53%

35%

6% 17%33%

44%

5%3%

7%4%5%4%6%

1%

0%

25%

50%

75%

100%

Neversmoked

Triedsmoking

once

Used tosmoke

Smoke <1 aweek

Smoke 1-6 a week

Smoke 6+ aweek

Don't want to say

I use them often(more than once aweek)

I use themsometimes (morethan once a month)

I have tried themonce or twice

I have never usedthem

Never heard of them

N=1680 N=235 N=74 N=79 N=26 N=60

43%

17%

54%

74%

2%

6%

1%

1%

1%

0%

0%

0%

0% 20% 40% 60% 80%

11 to

15

(N=

1328

)16

to 1

8 (N

=85

0) Wont say

I use them often (morethan once a week)

I use them sometimes(more than once amonth)

I have tried them onceor twice

I have never used them

Not heard of them

E-cigarette use in Britain, 2013(All children, by age)

Weekly use is rare and confined to older children

2 out of 3 children who had used e-cigarettes had not used them in the last month

64%

28%

0%

20%

40%

60%

80%

100%

Yes No

Have you used an e-cigarette in the last month? (Children who have ever used e-cigarettes N=97)

Children who have never used e-cigarettes don’t expect to try soon

93%

1% 6%0%

20%

40%

60%

80%

100%

All children who have never tried e-cigarettes

Yes Don’t know No

Do you expect you will try e-cigarettes soon? (Children who have never used e-cigarettes N=2075)

Shisha use is rare but more common among younger adults

6%2% 1% 1%

20% 18%

10%

57%61%

72%76% 76%

2% 3% 1% 1% 1%

12% 13% 15% 16%19%

5%3%

0%

20%

40%

60%

80%

18-24 25-34 35-44 45-54 55+

More than 3 to 4times a month

Once or twice amonth

Once or twiceevery 2 to 3monthsOnce every 6 to 12months

Less often

Never

Don’t know/ can’tremember

Not applicable – donot know what ashisha pipe is

Shisha use among adults in Britain, 2013 (N=12,171)

N=1324 N=1180 N=1758 N=2351 N=5558

58%

33%

33%

62%

7%

4%

1%

0%

0%

0%

0%

0%

0 0.25 0.5 0.75 1

Shi

sha

e-ci

gare

ttes

Wont say

I use them often(more than once aweek)I use them sometimes(more than once amonth)I have tried them onceor twice

I have never usedthem

Never heard of them

Shisha and e-cigarette use and awareness byChildren (N=2178)

Shisha use is more common than e-cigarette use among children

Awareness if shisha is lower among younger children

27%

67%

70%

30%

4%

3%

0% 25% 50% 75% 100%

11 to

15

(N=

1382

)16

to 1

8 (N

=85

0)

Don’t know

Not heard ofshisa

Heard ofshisha

Heard of shisha (All children by age)

Awareness of shisha is lower among never smokers

42%

67%

54%

30%

3%

3%

0% 25% 50% 75% 100%

All

(217

8)N

ever

sm

oked

(170

0) Don’t know

Not heard of shisah

Heard of shisha

All Children (N=2178)

1 in 5 older children have tried shisha

73%

33%

24%

48%

2%

15%

0%

3%

0%

0%

0% 25% 50% 75% 100%

11 to

15

(N=

379)

16 to

18

(N=

509)

Don't want to say

I use shisha often(more than once aweek)I use shishasometimes (morethan once a month)I have tried shishaonce or twice

I have never usedshisha

Never heard ofshisha

Shisha use and awareness(All children, by age)

Never smokers rarely try shisha

66%

32%36%

13%

23% 23%

31%

47%

37%

18%23%

32%

39%38%

21%

3%

14%9%

2%2%

9%

2%4%

0%

25%

50%

75%

never smokednot even a puff

or two

only ever triedsmoking once

used to smokesometimes

<1 a week 1-6 cigarettesa week

>6 cigarettes aweek

Never heard ofshisha

I have never usedshisha

I have tried shishaonce or twice

I use shishasometimes (morethan once a month)

I use shisha often(more than once aweek)

Don't want to say

Shisha use and awareness (All children, by smoking status)

N=573 N=159 N=47 N=69 N=20 N=46

Children who have never used shisha don’t expect to try soon

91%

2% 7%0%

20%

40%

60%

80%

100%

All children who have never tried shisha

Yes Don’t know No

Do you expect you will try shisha soon? (Children who have never used shisha N=1988)

7% of 18 year olds who have not yet tried shisha expect to try soon

Conclusions• e-cigarette use is a growing phenomenon

• but current use among children remains relatively rare and confined to older children and smokers

• Shisha use is almost twice as common but is also confined almost entirely to older children and smokers. However, more expect to start soon.

• We found negligible shisha smoking or e-cigarettes use among children who have never smoked so far

• When a young person smokes cigarettes every day and shisha once a month, tackle the cigarette smoking with the shisha use

• We need bigger, better, faster evidence to inform policy