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Cross-sectional study examining the prevalence, correlates and sequencing of electronic cigarette and tobacco use among 11–16-year olds in schools in Wales
  1. Elen de Lacy1,
  2. Adam Fletcher2,
  3. Gillian Hewitt1,
  4. Simon Murphy1,
  5. Graham Moore1
  1. 1Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK
  2. 2Y Lab, School of Social Sciences, Cardiff University, Cardiff, UK
  1. Correspondence to Elen de Lacy; DelacyE{at}


Objectives To examine the prevalence and frequency of electronic (e)-cigarette use among young people in Wales, associations with socio-demographic characteristics, smoking and other substances and the sequencing of e-cigarette and tobacco use.

Design A cross-sectional survey of school students in Wales undertaken in 2015.

Setting 87 secondary schools in Wales.

Participants Students aged 11–16 (n=32 479).

Results Overall, students were nearly twice as likely to report ever using e-cigarettes (18.5%) as smoking tobacco (10.5%). Use of e-cigarettes at least weekly was 2.7% in the whole sample, rising to 5.7% among those aged 15–16. Almost half (41.8%) of daily smokers reported being regular e-cigarette users. Regular e-cigarette use was more prevalent among current cannabis users (relative risk ratio (RRR)=41.82; 95% CI 33.48 to 52.25)), binge drinkers (RRR=47.88; 95% CI 35.77 to 64.11), users of mephedrone (RRR=32.38; 95% CI 23.05 to 45.52) and laughing gas users (RRR=3.71; 95% CI 3.04 to 4.51). Multivariate analysis combining demographics and smoking status showed that only gender (being male) and tobacco use independently predicted regular use of e-cigarettes (p<0.001). Among weekly smokers who had tried tobacco and e-cigarettes (n=877), the vast majority reported that they tried tobacco before using an e-cigarette (n=727; 82.9%).

Conclusions Since 2013, youth experimentation with e-cigarettes has grown rapidly in Wales and is now almost twice as common as experimentation with tobacco. Regular use has almost doubled, and is increasing among never and non-smokers. These data suggest that e-cigarette use among youth is an emerging public health issue, even though there remains no evidence that it represents a new pathway into smoking. Mixed methods longitudinal research is needed to explore why young people use e-cigarettes, and to develop interventions to prevent further increases in use.

  • Electronic Cigarettes
  • E-cigarettes
  • Smoking
  • Children
  • Youth

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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  • Twitter Follow Elen de Lacy @ElendeLacy and Adam Fletcher @dradamfletcher

  • Contributors GM had the original idea for the paper, which was further developed in discussions with AF and EdL. GM led the statistical analysis. GM and GH led the development of e-cigarette questions within the School Health Research Network survey. SM, AF, GH and GM designed and manage the School Health Research Network in Wales, including the collection of the survey data reported in this study. EdL and GM wrote the first draft of the manuscript. All authors contributed to subsequent drafts and approved the final manuscript.

  • Funding The lead author is supported by an ESRC-funded PhD studentship (AE301OS151). The last author is supported by an MRC Population Health Scientist Fellowship (MR/KO21400/1). The School Health Research Network is a partnership between the Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer) at Cardiff University, Welsh Government, Public Health Wales and Cancer Research UK, funded by Health and Care Research Wales via the National Centre for Health and Well-being Research (505349). The work was undertaken with the support of DECIPHer, a UKCRC Public Health Research Centre of Excellence. Joint funding (MR/KO232331/1) from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the Welsh Government and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged.

  • Competing interests None declared.

  • Ethics approval The study was approved by the Cardiff University School of Social Sciences Research Ethics Committee.

  • Data sharing statement Details on data access to the School Health Research Network survey can be found by contacting Graham Moore: