Reducing e-cigarette use among youth and young adults: evidence of the truth campaign's impact

Changes in U.S. Adolescent Nicotine Vaping Prevalence From 2022 to 2023: The Role of Reduced Initiation Three Years Earlier During the Onset of the Pandemic

INTRODUCTION

The prevalence of adolescent nicotine vaping declined substantially after the COVID-19 pandemic onset in the United States during the Spring of 2020. This study examines whether the decline continued from 2022 to 2023, and the extent to which any decline reflects the lasting influence of lowered levels of initiation 3 years earlier, at the onset of the pandemic.

AIMS AND METHODS

Data for this study come from nationally representative, cross-sectional surveys of U.S. 12th-grade (n = 9854) and 10th-grade (n = 14 663) students administered in the Spring of 2022 and 2023. The main outcomes are past 12-month nicotine vaping and grade first ever vaped nicotine.

RESULTS

From 2022 to 2023 prevalence of past 12-month nicotine vaping declined a relative 20% for 12th-grade students, from 24.3% to 19.1%, and for 10th-grade students by a relative 16%, from 17.8% to 15.1%. Among 12th-grade students who vaped nicotine in the past 12 months, a significant decline in prevalence took place only among those who first ever vaped nicotine in ninth grade, and not among those who first ever vaped nicotine in any other grade. Among 10th grade students who vaped nicotine in the past 12 months, a significant decline in prevalence took place only among those who first ever vaped nicotine in seventh grade, and not among those who first ever vaped nicotine in any other grade.

CONCLUSIONS

These results contribute national-level evidence that forestalled initiation of nicotine use for 1 year may have a lasting effect that continues to lower adolescents' levels of use many years afterward.

IMPLICATIONS

These findings caution against looking to contemporaneous policy for explanations of the large, 1-year decline in nicotine vaping from 2022 to 2023. It can be tempting to interpret the decline as a victory for current efforts to restrict adolescent access to vaping products, or current education/media campaigns that warn adolescents of the dangers of vaping. The findings of this study suggest, instead, that the 1-year vaping declines primarily result from declines in initiation that were set into place 3 years ago during the pandemic onset, more so than the immediate result of contemporaneous policy.

Cross-sectional study of the associations between the implementation of the WHO FCTC tobacco advertising, promotion and sponsorship bans and current e-cigarette use among youth from countries with different income levels

BACKGROUND

The WHO Framework Convention on Tobacco Control (WHO FCTC) Article 13 requires countries to ban tobacco advertising, promotion and sponsorship (TAPS), and bans are recommended to cover electronic cigarettes (e-cigarettes). We examined youth e-cigarette prevalence by TAPS regulations in countries with different income levels.

METHODS

We analysed data on 165 299 respondents from 48 countries with 2016/2018 WHO FCTC implementation reports and 2016-2019 Global Youth Tobacco Survey. We used multilevel logistic regressions to examine associations between TAPS regulations and current e-cigarette use, stratified by country income.

RESULTS

About 1 in 10 respondents was currently using e-cigarettes. Respondents in countries with TAPS bans on the internet were less likely to use e-cigarettes (adjOR=0.58; 95% CI 0.39 to 0.86) than youth in countries without such bans. In lower middle-income and low-income countries, bans on displaying tobacco products at the point of sale (adjOR=0.55; 95% CI 0.34 to 0.90), bans on product placement (adjOR=0.44; 95% CI 0.28 to 0.69) and strength of additional TAPS measures were associated with lower prevalence of e-cigarette use among students. Being taught about the dangers of the use of tobacco in school was associated with lower odds of e-cigarette use. No differences in the use of e-cigarettes were observed by types of TAPS among respondents in high-income countries.

CONCLUSIONS

Strengthening implementation of TAPS policies and assuring they cover new and emerging products, online channels and points of sales are essential, especially in lower income countries. Maintaining tobacco health education is also important to protect youth from e-cigarette use.