E-cigarettes: An emerging threat to the respiratory health of our next generation

Introduction: Given dramatic rises in electronic cigarette (e-cigarette) use among adolescents and ongoing dilemmas regarding their harms versus potential for harm reduction, this study examined the current pattern of e-cigarette use, the perceived health effects of e-cigarettes and the association of e-cigarette with the use of other tobacco products among Hong Kong secondary school students. Materials and Methods: 26,684 Hong Kong secondary school students participated in the territory-wide, school-based Hong Kong Secondary School Smoking and Health Survey 2016/17, conducted by the HKU School of Public Health. Data regarding demographics, self-reported harms of e-cigarette use, and its association with smoking intention, habits and quitting intention, was obtained and analysed. Results: Among Hong Kong secondary school students, 8.9% have ever-used e-cigarettes and the prevalence of past-30-day e-cigarette use was 3.0%. For those who had ever used e-cigarettes, 27.1% had their first puff before or at 11 years old. E-cigarette use among secondary school students was significantly associated with chronic respiratory symptoms (current users: AOR 1.59, 95% CI 1.13–2.23; ever users: AOR 1.36, 95% CI 1.22–1.53) and poorer perceived health status (current users: AOR 1.57, 95% CI 1.08–2.27; ever users: AOR 1.33, 95% CI 1.14–1.56), after adjusting for confounders. Current adolescent e-cigarette use was also significantly associated with increased intentions of tobacco smoking (AOR 1.17, 95% CI 1.12–2.46) and waterpipe use (AOR 2.63, 95% CI 1.77–3.91) in the next 12 months, cigarette smoking status (including those who ever-smoked, experimented, quit and currently smoke), and waterpipe and other tobacco product use in the past 30 days. Moreover, Hong Kong secondary school students who used e-cigarettes along with cigarettes did not show significant changes in quitting intention. Conclusions: E-cigarette use was associated with poorer perceived health status and respiratory symptoms, increased use and intention to use cigarettes and other tobacco products, and no significant changes in quitting intention. This study does not support e-cigarettes as a harm reduction tool and shows that e-cigarettes are not safe as general consumer products. Their function as a gateway to smoking and their failure to reduce quitting intention in adolescents may renormalize the tobacco industry and reverse all tobacco control efforts.