​Youth Smoking in Europe. Strategies for Prevention and Reduction

Youth Smoking in Europe. Strategies for Prevention and Reduction.Youth Smoking in Europe. Strategies for Prevention and Reduction. 2019. Dublin: TFRI. ISBN 978-0-9557528-3-4

A Qualitative Study of E-cigarette Use Among Young People in Ireland: Incentives, Disincentives and Putative Cessation.

Background Smoking prevalence in Ireland is falling in all age groups, but e-cigarette use is rising among young people. This qualitative study explores young people’s accounts of e-cigarette use in Ireland. Methods Semi-structured individual (22) and focus group (8) interviews were conducted with 62 young people aged 18–22 years, recruited from a higher-education institution and youth organisations working with early school-leavers across Dublin. All were smokers or exsmokers; 41 had tried e-cigarettes, 11 continued as dual users. We identified themes using thematic data analysis. Results Three broad themes were identified: incentivising features, disincentivising features, and ambivalent and unsuccessful cessation, named putative smoking cessation. Incentivising features included price, pleasing taste/ flavours, and the possibility of indoor use. Disincentivising features related to adverse health effects (pain, discomfort, sore throat, coughing, headache) and unpleasant physical effects (bad taste, problems resulting from device faults). Other disincentives were over-consumption arising from inability to control intake, greater addictiveness , product taste, and device faults. Putative cessation refers to the conflict between participants’ expected use of e-cigarettes as a smoking cessation/reduction aid and their observed reality of e-cigarettes’ failure in this regard, with reported outcomes including: failure to quit or reduce; continued or resumed cigarette and/or roll-your-own smoking; dual use of e-cigarettes and other tobacco products; and inability to quit ecigarettes. Conclusions Participants were sceptical about e-cigarettes’ purported relative healthihiness , concerned about addictiveness and potential long-term health consequences, and critically aware of advertising and industry strategies. E-cigarettes were viewed as being less denormalised, in part because they could be used in indoor spaces where smoking is banned in Ireland. Although price, taste, and perceived renormalisation were important motivators for young people’s use of e-cigarettes, they wanted to quit smoking. The regulation of e-cigarettes through age restriction of access, licensing of outlets, pricing, point of sale and advertising restrictions as well as through the banning of indoor use should be considered by legislators and tobacco control policymakers

Friends and family Matter Most: a trend analysis of increasing e-cigarette use among Irish teenagers and sociodemographic, personal, peer and familial associations

Background E-cigarette ever-use and current-use among teenagers has increased worldwide, including in Ireland. Methods We use data from two Irish waves (2015, 2019) of the European School Survey Project on Alcohol and other Drugs (ESPAD) to investigate gender and teenage e-cigarette use (n = 3421 16-year-olds). Using chi-square analyses, we report changes in e-cigarette ever-use, current-use, and associated variables. Using multivariable logistic regression, we analyse the increase in e-cigarette use and socio-demographic, personal, peer and familial associations, focusing on gender differences. Results E-cigarette ever-use increased from 23% in 2015 to 37% in 2019, and current-use from 10 to 18%. Compared with 2015, the odds in 2019, of becoming both an e-cigarette ever-user and current-user, were significantly higher for girls than boys (ever-use: AOR 2.67 vs 2.04; current-use: AOR 3.11 vs 1.96). Smoking and e-cigarette use are linked but never-smokers who try e-cigarettes rose significantly from 33 to 67% and those using e-cigarettes to quit smoking decreased significantly from 17 to 3%. Almost two-thirds of respondents (66%) in 2019 said that their reason for trying e-cigarettes was “out of curiosity”. Peer smoking is significantly associated with likelihood of e-cigarette ever-use (AOR 6.52) and current-use (AOR 5.45). If “Most/All friends smoke”, odds were significantly higher for boys than for girls (ever-use AOR 7.07 vs 6.23; current-use AOR 5.90 vs 5.31). Less parental monitoring is significantly associated with greater e-cigarette ever-use (AOR 3.96) and current-use (4.48), and having parents who usually don’t know where their child is on Saturday nights was also associated with significantly higher odds for boys than for girls (ever-use AOR 5.42 vs 3.33; current-use AOR 5.50 vs 3.50). Conclusion Respondents had significantly higher odds of being e-cigarette ever- and current-users in 2019 compared with 2015. Use is higher among boys but girls are increasingly at risk. Two-thirds had never smoked cigarettes at first e-cigarette use; two-thirds used out of curiosity but few (3%) for smoking cessation. The most prominent risk factors for e-cigarette use were peer- and parent-related, especially so for boys. Interventions that take account of friend and family influences may provide mechanisms for preventing an increasing risk of nicotine addiction

E-cigarettes and smoking in Irish teens: a logistic regression analysis of current (past 30-day) use of e-cigarettes

Aim Electronic cigarette (e-cigarette) use among Irish teenagers has risen significantly. In 2019, prevalence of current use (last 30 days) among 15–17-year-olds was 17.3%. We examine social determinants of adolescent e-cigarette current use. Subject and methods A stratified random sample of 50 schools in Ireland was surveyed in 2019, part of the European School Survey Project on Alcohol and other Drugs (ESPAD), with 3495 students aged 15, 16, and 17. Bivariate and multivariable logistic regression [providing adjusted odds ratios (AORs)] analyses were performed using Stata version 16. Results Current e-cigarette users were more likely to be male (AOR = 0.55, 95% CI:0.32–0.96, p \u3c .01), younger (AOR = 0.34, 95% CI: 0.17–0.67, p = \u3c .05), to participate in sport (AOR = 2.21, 95% CI: 1.05–4.65, p \u3c .05), to have higher-educated parents (maternal higher education: AOR = 27.54, 95% CI: 1.50–505.77, p = \u3c .05, paternal higher education: AOR = 2.44, 95% CI: 1.00–5.91, p \u3c .05), and less likely to consider their families better off (AOR = 0.29, 95% CI: 0.13–0.65, p \u3c .01), or to report familial support (AOR = 0.78, 95% CI: 0.64–0.95, p \u3c .05). They were more likely to be cigarette smokers (AOR = 7.22, 95% CI: 3.97–13.12, p \u3c .001), to report problem cannabis use (AOR = 3.12, 95% CI: 1.40–6.93, p \u3c .01), to be ‘binge’ drinkers (AOR = 1.81, 95% CI : 1.00–3.32, p = .054), and to have friends who get drunk (AOR = 5.30, 95% CI: 1.34–20.86, p \u3c .05). Conclusion Boys, smokers, binge drinkers, problem cannabis users, and sport-playing teenagers from higher-educated families, are at particular risk. As the number of young people using e-cigarettes continues to rise, including teenagers who have never smoked, improved regulation of e-cigarettes, similar to other tobacco-related products, is needed urgently to prevent this worrying new trend of initiation into nicotine addiction

Does Smoke-free Legislation Work for Teens Too?: a Logistic Regression Analysis of Smoking Prevalence and Gender Among Sixteen Years Old in Ireland Using the 1995-2015 ESPAD School Surveys

Objectives: To assess the role of tobacco control legislation (TCL) in youth smoking in Ireland. To examine the effects of smoke-free legislation in youth. To consider whether TCL contributed to the gender equalisation in prevalence in 16 years old seen between 2003 and 2015. Setting Data are from the 4 yearly European School Survey Project on Alcohol and Other Drugs from 1995 to 2015. Total sample size was 12.394. A logistic regression model on grouped data was used. Dependent variable is whether a student was a smoker in last 30 days. Independent variables are time, gender and the policy indicators, workplace ban on smoking, point-of-sale (POS) display ban, the introduction of graphical images on packs and the average real price of cigarettes. Results Smoking prevalence dropped from 41% in 1995 to 13% in 2015. The effects of policies differed between boys and girls. For girls, estimates for workplace bans, graphical images on packs and a unit real (Consumer Price Index adjusted) price increase reduced prevalence by 7.31% (95%CI 2.94% to 11.68%), 8.80% (95% CI 2.60% to 15.01%) and 5.87 (95% CI 2.96 to 8.79), respectively. The POS ban did not have a significant effect in girls. For boys, estimates for workplace bans and a unit real price increase, reduced prevalence by 8.41% (95% CI 5.16% to 11.66%) and 4.93% (95% CI 0.77% to 9.08%), respectively, POS gave an increase of 7.02% (95% CI 1.96% to 12.40%). The introduction of graphical images had an insignificant effect. Conclusions TC legislation helps to explain the outof-trend reduction in youth smoking prevalence. The estimated differential effects of the workplace ban, POS displays, real price changes and graphical images on packs help to explain the sharper decline in girls than boys. These findings should remind policy-makers to give increased consideration to the possible effects on young people of any legislative changes aimed at adults in TCL

It’s Not All About Price: Factors associated with roll-your-own tobacco use among young people - a qualitative study

Background: Smoking prevalence in Ireland is falling in all age groups, but the prevalence of roll-your-own (RYO) tobacco use is rising among young people. This qualitative study aims to explore and understand the factors associated with young people\u27s use of RYO products. Methods: Semi-structured individual and focus group interviews were conducted with young people aged 16-22 years. Participants were recruited from a higher education institution and youth organisations working with early school leavers across Dublin. In total, there were 62 participants in the study, consisting of 22 individual interviews and eight focus group interviews with 40 participants. Categoric and thematic data analysis was used to generate the findings. Results: We identified two broad themes, incentivising and disincentivising factors. The lower cost of RYO products compared to pre-manufactured cigarettes was the most important incentive for users. However, other product characteristics, such as the artisanal factors associated with RYO products were also found. Social and environmental influences were apparent, in which certain groups and environments facilitated and normalised RYO practices. Amenities and facilities often provided smokers with normalised spaces which could be dedicated to the enactment of rolling practices and to the creation and maintenance of social bonds with other users. Disincentives included negative features related to the product itself, adverse health effects, and the effects of tobacco denormalisation. Conclusions: While the lower cost of RYO products is very important for young smokers, other product characteristics and influences also incentivise and disincentivise use. A more comprehensive understanding of the multi-dimensional appeal of these products will assist policymakers to target strategies to reduce the attractiveness to young smokers of these products

Sociodemographic, personal, peer, and familial predictors of e-cigarette ever use in ESPAD Ireland: A forward stepwise logistic regression model

Introduction:E-cigarette ever use has risen significantly in recent years in Ireland, similar to trends elsewhere in Europe, the United States, and Asia-Pacific region. Results from ESPAD Ireland (European School Survey Project on Alcohol and other Drugs) show teenage e-cigarette ever use increased from 18% (2015) to 37% (2019). Given this increase, our aim is to profile e-cigarette ever users and never users in this age group; to examine sociodemographic, personal, peer, and familial factors associated with e-cigarette ever use; and to suggest appropriate measures to reduce use.Methods:A nationally representative stratified random sample of 50 ESPAD schools was surveyed in 2019, with 3495 students aged 15–17 years. Bivariate and multivariable logistic regression analyses were performed using Stata version 16.Results:E-cigarette ever use was significantly associated with ever smoking (AOR=4.15; 95% CI: 1.29–13.41), ever cannabis use (AOR=2.21; 95% CI: 1.11–4.41) and ever inhalants use (AOR=2.51; 95% CI: 1.07–5.88). Children of university-educated mothers had significantly higher odds of e-cigarette ever use (AOR=3.46; 95% CI: 1.40–8.54). Associated with reduced AORs were reading books for enjoyment (AOR=0.32; 95% CI: 0.16–0.64), living in households where smoking was regulated (AOR=0.53; 95% CI: 0.30–0.94), and perceiving moderate risk in trying e-cigarettes once or twice (AOR=0.20; 95% CI: 0.07–0.67).Conclusions:E-cigarette ever use is part of a pattern of teenage polysubstance use including cigarette smoking, providing some support for the common liability theory. Regulation of smoking in the home, reading for enjoyment, and perceiving risk from e-cigarette use are associated with decreased likelihood of ever use, and higher parental education with increased likelihood. Thus, health education emphasizing the role of parents and risks of e-cigarette use is indicated to reduce the rise in e-cigarette ever use in teenagers

Increased smoking and e-cigarette use among Irish teenagers: A new threat to Tobacco Free Ireland 2025

Introduction Tobacco Free Ireland is an Irish Government policy which demands that the prevalence of tobacco smoking in Ireland be less than 5% by 2025. From 1995 to 2015, teen smoking decreased from 41% in 1995 to 13.1 % in 2015, and SimSmoke modelling suggested that the 5% 2025 target was achievable in that group (1). But, in 2019, current smoking (smoked in the past 30 days) increased overall from 13.1% in 2015 to 14.4% in 2019, with the increase being greater in boys than girls (16.2%) vs (12.8% ) (2). This threatens the Tobacco Free Ireland endgame and we drew on data from two waves (2015 and 2019) of the Irish ESPAD (European School Survey Project on Alcohol and other Drugs) to analyse the use of tobacco products by teenagers and offer an explanation for the change. Statistical analysis Descriptive statistics were used to show differences in sample characteristics from the two waves of the survey (2015 and 2019). Adjusted incidence risk ratios (IRR, 95% confidence intervals (CI)) for current smoking were estimated using a Poisson regression analysis and are shown for all respondents and, separately, by gender, with p-value of less than 0.05 considered statistically significant. All statistical analysis was conducted using STATA version 16, presented in Table 1. Conclusion We saw an increase in current cigarette smoking associated with an increasing use of e-cigarettes. Other associated factors did not deteriorate between 2015 and 2019, and access to cigarettes was perceived to have become more difficult during that period. We suggest that our findings highlight the negative impact that increased youth e-cigarette use had on current teenage cigarette smoking. We further suggest that this increase in e-cigarette use by teens poses a threat to the Tobacco Free Ireland policy goal of a smoking prevalence less than 5% by 2025 (1)

Recent Lung Cancer Patterns in Younger Age-Cohorts in Ireland

Background: Smoking causes 85% of all lung cancers in males and 70% in females. Therefore, birth cohort analysis and annual-percent-changes (APC) in age-specific lung cancer mortality rates, particularly in the youngest age cohorts, can explain the beneficial impacts of both past and recent anti-smoking interventions. Methods: A long-term time-trend analysis (1958-2002) in lung cancer mortality rates focusing on the youngest age-cohorts (30-49 years of age) in particular was investigated in Ireland. The rates were standardised to the World Standard Population. Lung cancer mortality data were downloaded from the WHO Cancer Mortality Database to estimate APCs in death rates, using the Joinpoint regression (version 3.0) program. A simple age-cohort modelling (log-linear Poisson model) was also done, using SAS software. Results: The youngest birth cohorts (born after 1965) have almost one-fourth lower lung cancer risk relative to those born around the First World War. A more than 50% relative decline in death rates among those between 35 and 39 years of age was observed in both sexes in recent years. The youngest age-cohorts (30-39 years of age) in males also showed a significant decrease in death rates in 1998-2002 by more than 3% every five years from 1958-1962 onwards. However, death rate declines in females are slower. Conclusions: The youngest birth cohorts had the lowest lung cancer risk and also showed a significant decreasing lung cancer death rate in the most recent years. Such temporal patterns indicate the beneficial impacts of both recent and past tobacco control efforts in Ireland. However, the decline in younger female cohorts is slower. A comprehensive national tobacco control program enforced on evidence-based policies elsewhere can further accelerate a decline in death rates, especially among the younger generations

Sex-Differences in Lung Cancer Cell-Types? An Epidemiologic Study in Ireland

Objective: This study assesses the epidemiological pattern of lung cancer cell-types in Ireland, with identification of any underlying gender variations. Methods: Lung cancer incidence data, including the major cell-types: squamous-cell-carcinoma (SCC), adenocarcinoma (AC), small-cell-lung-carcinoma (SCLC) and large-cell-carcinoma (LCC) were obtained from the national cancer registry (1994–2000), together with individual characteristics, such as age, gender, smoking status, and the year of diagnosis. Age-standardised incidence rates (ASIR), male-to-female (M: F) rate ratios (RR) of ASIR for SCC and AC, as well as RR of AC: SCC according to smoking status for both sexes, were estimated. Estimated-annual-percent-changes for each of the cell-types were calculated. Results: AC incidence in females is rising annually (8.5%, p=0.008) from 1994 to 2000, while SCC is declining (−5.4%, p=0.01) in males. M: F ratios of ASIR are consistently greater than ‘one’, but converging recently. RR of AC: SCC is also approaching ‘unity’ across both sexes, irrespective of the smoking status. Conclusions: An apparent increase in lung AC incidence in females was observed in Ireland that might indicate some local environmental risk factors, in addition to changing smoking habits. The study findings do not support the hypothesis that females in general are at higher risk for lung cancer development, but tobacco and histologic-specific susceptibility cannot be ruled out