2nd April 2019, issued by BMJ Journals

Rapid fall in favourable perceptions of regular smoking over same period as well

There is little evidence that the rapid growth of largely unregulated e-cigarettes between 2011 and 2015 was associated with the ‘renormalisation’ of smoking among teens, reveals research published in the journal Tobacco Control.

Favourable perceptions of regular smoking among this age group also fell at a faster rate after the proliferation of e-cigarettes, which wouldn’t be expected if smoking was in the process of being ‘renormalised,’ say the researchers.

E-cigarettes have polarised opinion among public health professionals, amid fears that vaping might act as a gateway to regular smoking, or prompt young to view smoking as socially acceptable once again–referred to as ‘renormalisation.’

National surveys in several countries indicate that smoking prevalence among the young has continued to fall in recent years, despite the rapid growth in e-cigarette use. 

But few attempts have been made to try and gauge the speed at which this decline has occurred. A faster fall would indicate that e-cigarettes might be displacing regular cigarettes, while a slower fall would indicate that renormalisation might be taking place, say the researchers.

They therefore set out to look at smoking trends among young people as well as their attitudes towards smoking since 1998. They focused particularly on any changes between 2011 and 2015–when e-cigarettes began to take off and before they were regulated.

The researchers also analysed trends in alcohol and cannabis use over the same timeframe to see if any changes identified were unique to tobacco use or reflected broader changes in substance use in this age group.

They drew on responses to nationally representative surveys of secondary school pupils aged approximately 13 and 15 years in England, Scotland, and Wales.

Pupils were asked if they had ever smoked, and if they were regular smokers (at least once a week). They were also asked if they thought it was OK to smoke/try smoking, and they were quizzed about their use of alcohol and cannabis.

Data on smoking were available for 248,324 respondents, while data on attitudes were available for 162,324 respondents.

Analysis of the responses showed that between 1998 and 2015 the percentage of 13 to 15- year olds who had ever smoked fell from 60 per cent to 19 per cent, while the proportion of regular smokers fell from 19 per cent to 5 per cent.

Perceptions of smoking also changed over time, with the percentage of teens who said that it was OK to try a cigarette falling from 70 per cent in 1999 to 27 per cent in 2015. The proportion of those in England saying that it was OK to smoke weekly fell from 36 per cent in 2003 to 14 per cent in 2014.

These patterns were reflected in alcohol and cannabis use. Between 1998 and 2015, the proportion of those who had ever tried cannabis fell from 29 per cent to 9 per cent, while those who had ever tried alcohol fell from 79 per cent to 48 per cent.

The change in the rate of decline in ever smoking after 2010 wasn’t significant, although the rate of decline in regular smoking did marginally slow between 2011 and 2015.

But further detailed analysis revealed that this was limited to groups among whom rates had fallen rapidly before 2010–girls and 13-year olds. Similar patterns were seen in relation to ever use of alcohol and cannabis, suggesting that any changes were not unique to tobacco use, but reflective of broader trends in substance use among young people.

Researchers of this study say: “Our results provide little evidence that renormalisation of smoking occurred during this period… What is more, positive perceptions of smoking attitudes declined at a faster rate following the proliferation of e-cigarettes, suggesting that attitudes towards smoking hardened while e-cigarettes were emerging rather than softening, as would be expected were smoking becoming renormalised.” 

The study, Have e-cigarettes renormalised or displaced youth smoking? Results of a segmented regression analysis of repeated cross sectional survey data in England, Scotland and Wales, is published in Tobacco Control.

First published: 2 April 2019

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