Reported electronic cigarette use among adolescents in the Niagara region of Ontario

Background:Use of electronic cigarettes (e-cigarettes) among adolescents has not been fully described, in particular their motivations for using them and factors associated with use. We sought to evaluate the frequency, motivations and associated factors for e-cigarette use among adolescents in Ontario.Methods:We conducted a cross-sectional study in the Niagara region of Ontario, Canada, involving universal screening of students enrolled in grade 9 in co-operation with the Heart Niagara Inc. Healthy Heart Schools’ Program (for the 2013–2014 school year). We used a questionnaire to assess cigarette, e-cigarette and other tobacco use, and self-rated health and stress. We assessed household income using 2011 Canadian census data by matching postal codes to census code.Results:Of 3312 respondents, 2367 answered at least 1 question in the smoking section of the questionnaire (1274 of the 2367 respondents 53.8%] were male, with a mean SD] age of 14.6 0.5] yr) and 2292 answered the question about use of e-cigarettes. Most respondents to the questions about use of e-cigarettes (n = 1599, 69.8%) had heard of e-cigarettes, and 380 (23.8%) of these respondents had learned about them from a store sign or display. Use of e-cigarettes was reported by 238 (10.4%) students. Most of the respondents who reported using e-cigarettes (171, 71.9%) tried them because it was “cool/fun/new,” whereas 14 (5.8%) reported using them for smoking reduction or cessation. Male sex, recent cigarette or other tobacco use, family members who smoke and friends who smoke were strongly associated with reported e-cigarette use. Reported use of e-cigarettes was associated with self-identified fair/poor health rating (odds ratio OR] 1.9 (95% confidence interval CI] 1.2–3.0), p < 0.001), high stress level (OR 1.7 (95% CI 1.1–2.7), p < 0.001) and lower mean (33.4 8.4] × $1000 v. 36.1 10.7] × $1000, p = 0.001) and median interquartile range] (26.2 5.6] × $1000 v. 28.1 5.7] × $1000) household incomes.Interpretation:Use of e-cigarettes is common among adolescents in the Niagara region and is associated with sociodemographic features. Engaging in seemingly exciting new behaviours appears to be a key motivating factor rather than smoking cessation.Electronic cigarettes (e-cigarettes) are novel devices that are designed to mimic the physical and tactile experience of conventional cigarettes while producing a smoke-free vapour. They have quickly gained popularity despite limited evidence regarding the health risks associated with their use and a lack of regulation.¹ In addition, existing literature about e-cigarettes suggests that they may not be effective for achieving smoking reduction or cessation, a use for which they are often marketed.^1–3 Given their physical similarities to conventional cigarettes, there are concerns that the increasing use of e-cigarettes may result in the “renormalization” of cigarette smoking.^4,5 Previous studies have suggested that use of e-cigarettes among adolescents and young adults may be associated with use of and exposure to tobacco.^1,6,7Rates of the use of e-cigarettes at least once among high school students in the United States have increased annually.^6,8 Among adolescents in Canada, use of e-cigarettes is now more common than cigarette use.⁹ However, questions still remain regarding the motivations and factors associated with e-cigarette use among adolescents. Therefore, we sought to evaluate the frequency, motivations and associated factors for use of e-cigarettes by students in grade 9 who were undergoing universal school-based screening for cardiovascular risk factors in the Niagara region in Ontario.