Adolescents' Perceptions of Harmfulness of Tobacco and Tobacco-like Products in Finland

A systematic review on risk factors and reasons for e-cigarette use in adolescents

INTRODUCTION

The aim was to establish EC use risk and protective factors, the reasons for use, associations with tobacco and other substance use, and use for smoking cessation.

METHODS

A systematic review following PRISMA guidelines was registered in PROSPERO (CRD42024532771). Searches in Web of Science and PubMed/MEDLINE (March-April 2024) used terms like 'electronic cigarette' and 'adolescents' with a PICO framework. Inclusion criteria covered studies on adolescents aged 10-19 years, published in English or Spanish (2018-2024). Three reviewers independently screened studies, achieving 96% inter-rater reliability. Data extraction followed standardized tables, and methodological quality was assessed using MMAT and GRADE tools, ensuring a robust evaluation of evidence on adolescent electronic cigarette use.

RESULTS

From 895 studies, 50 met the inclusion criteria. The strongest risk factors for adolescent EC use include social acceptance and use within peer or family circles (13 studies), male gender (10 studies), low risk perception (6 studies), younger age (3 studies), and greater financial resources (3 studies). Motives for use include low perceived risk and appealing flavors, supported by both longitudinal and cross-sectional studies. EC use is significantly associated with smoking initiation (7 studies), cannabis consumption (8 studies), and alcohol use (4 studies). Evidence on the effectiveness of ECs as harm reduction or smoking cessation tools in adolescents remains inconclusive, with some cross-sectional studies supporting their utility and others finding contrary evidence. High-quality research indicates ECs are predominantly used alongside traditional cigarettes, with dual nicotine consumption patterns commonly observed.

CONCLUSIONS

Evidence on adolescent EC use identifies risk factors, motives, and links to substance use. However, its role in harm reduction and smoking cessation remains insufficient and controversial. High-quality research is needed, as most studies are low quality. Targeted prevention strategies addressing social influences, perceptions, and accessibility are crucial to reduce adolescent EC use.

Effectiveness of a Digital Health Game Intervention on Early Adolescent Smoking Refusal Self-Efficacy

Smoking poses a significant threat to adolescent health because of its immediate and long-term detrimental health effects. Smoking refusal self-efficacy predicts smoking behavior in adolescence. In adolescents' health education, digital interventions are potential tools to support smoking refusal self-efficacy. The aim of this two-arm cluster randomized controlled trial was to evaluate the effectiveness of a digital health game intervention compared with a no-intervention control group on smoking refusal self-efficacy in 10- to 13-year-old Finnish early adolescents. The early adolescents (n = 781) were randomized to the control group (n = 394) and the health game intervention group (n = 387). Smoking refusal self-efficacy, sources of smoking and snus refusal self-efficacy, and motivation to decline smoking and snus use in the future were measured at baseline, 2-week postintervention, and 3-month follow-up. Data were analyzed using linear mixed model and Wilcoxon rank-based test for clustered data. According to the results, the intervention group made improvements in sources of smoking and snus refusal self-efficacy between baseline and postintervention, and in sources of snus refusal self-efficacy between baseline and follow-up, compared with the control group. The intervention group showed improvements in smoking refusal self-efficacy among 12-year-olds between baseline and follow-up, and postintervention and follow-up compared with the control group. Similar improvements were also found among those with a smoking friend or a smoking parent between postintervention and follow-up. The results were promising for the use of digital health game interventions to promote early adolescent smoking refusal self-efficacy and preventing smoking experimentation. Further research can evaluate the long-term effects for adolescents.

Perceptions and usage of traditional cigarettes, electronic cigarettes, and waterpipes among young and middle-aged adults in Iraq: A descriptive study

Tobacco use poses significant public health concerns, linked to various mental and physical health outcomes. Iraq has a high prevalence of smoking, predominantly with traditional cigarettes, but there is also growing popularity of electronic cigarettes and waterpipes among younger and middle-aged adults. This study aims to explore the perceptions and usage of traditional cigarettes, electronic cigarettes, and waterpipes among this population in Iraq. A descriptive study was conducted among 402 young and middle-aged adults (50.25% females), aged between 18 and 45 years, with a mean age of 25.88 (SD = 7.27). For the data collection, an online questionnaire was developed utilizing distribution channels on common social networking platforms. The results showed that 41.79% of respondents have used traditional cigarettes, while 31.1% of participants reported that they use electronic cigarettes. Ninety-four per cent of respondents acknowledged that they use waterpipes. The results also indicated that a significant proportion believe that using electronic cigarettes is either much more harmful or more harmful than traditional cigarettes. Participants commonly perceived all three types of tobacco products as highly harmful, including secondhand smoke, addictive qualities, and popularity among peers. Additionally, significant differences in perceptions emerged between smokers and nonsmokers regarding electronic cigarettes and traditional cigarettes, although no such differences were observed for waterpipes. These findings contribute to understanding the attitudes toward different forms of tobacco use among respondents, highlighting the need for targeted interventions to address the perceived harm associated with tobacco products.

Use of and Beliefs toward Novel Tobacco and Nicotine Products among Portuguese University Students: A Pandemic Survey

Over the last decade, novel tobacco and nicotine product experimentation and use have dramatically increased among the youth, even in countries with strong tobacco control and anti-smoking social norms. We performed an online questionnaire-based cross-sectional study in March-June 2021, targeting students from the University of Beira Interior, Portugal. The aim was to assess the experimentation and use of tobacco and nicotine products and students' beliefs towards these products. Of the 452 participants, 67.0% were female; the mean age was 21.9 ± 3 years. Most students (60.4%) reported experimenting with tobacco/nicotine products; 31.2% were current users; polyconsumption was common. Of the current users, all used cigarettes, 41.1% used heated tobacco, 20.6% e-cigarettes, and 14.9% used water pipes. Our multivariate analysis showed that being male, being in the third year of study, and cohabiting or socializing with smokers were strongly associated with tobacco/nicotine use. While most students agree that heated tobacco and e-cigarettes are addictive, that they are not less harmful than cigarettes, and that second-hand exposure may cause health problems, few tobacco/nicotine users are ready to quit, and few students support a smoke-free university campus. These findings indicate high experimentation and the regular dual use of novel tobacco and nicotine products and suggest a pro-smoking social norm among university students.