London School of Hygiene & Tropical Medicine

A new study in the journal BMC Public Health surveyed over 16,000 14-17 year-olds in North West England and asked participants about their alcohol and tobacco-related behaviours. The authors report that one in five had used e-cigarettes, and that they observed a link between alcohol consumption and the likelihood of e-cigarette access.

Commenting on this, Professor Martin McKee, Professor of European Public Health at the London School of Hygiene & Tropical Medicine, said:

"The rapid increase in sales of electronic cigarettes, driven by massive marketing campaigns, have left health policy makers struggling to know how best to respond. There are still very many unanswered questions about them, some of the most important relating to their adoption by adolescents.

"The authors have analysed data from over 16,000 young people attending schools in the North-West of England, gathering information about not only their use of electronic cigarettes but also smoking and hazardous drinking.  The study has many strengths, including its very large size, the ability to determine which young people were living in rich and poor areas, and the careful and detailed analysis undertaken. Its weakness, common to all studies undertaken on electronic cigarettes so far, is that it could not follow up individual children to determine what happens to young people who have not previously smoked but who are using electronic cigarettes. We also don't know if there are any young people who were regular users but have managed to wean themselves off them, an important piece of information given concerns about their long term use.

"Even so, the findings are very important. They show a very rapid increase in uptake of electronic cigarettes among young people, with one in five having used them. They also show that there are more young people who are using them but who have never previously smoked, who, it is feared, may subsequently graduate to smoking, than there are ex-smokers using them. Crucially, their use is most common among young people with other forms of hazardous behaviour, such as binge drinking, suggesting that they are simply being added to the portfolio of dangerous or addictive substances that these often vulnerable young people are using.

"This paper adds to the rapidly growing body of evidence raising concerns about the aggressive marketing of electronic cigarettes in those countries where it is still permitted. The paper's most important contribution is to show how, despite often being promoted as cessation aids, these products really are being used as just another recreational drug. That finding must inform debates on how they should be regulated."