E-cigarette use and conventional cigarette smoking among high school students in 35 European countries: findings from the 2019 ESPAD survey

Background: Few representative data on e-cigarette use among European adolescents are available. This study aimed to report current vaping and smoking individual and country-specific correlates among European students.

Methods: Data on 99,648 16-years-old students were gathered from the 2019 cross-sectional survey European School Survey Project on Alcohol and Other Drugs (ESPAD) collecting data on a representative sample of students in 35 European countries. Data were integrated with country-level data on Tobacco Control Scale (TCS) and TCS selected parameters to evaluate their correlation with prevalence of current uses.

Results: 12.4% of the students were current vapers, 19.3% current smokers. Vapers were more frequently lifetime smokers (OR=7.31, 95%CI:6.47-8.25), early smokers (OR=4.35, 95%CI:3.66-5.17), males (OR=1.61, 95%CI:1.55-1.67), pertaining to non-traditional families (OR=1.43, 95%CI:1.34-1.53), with low parents’ education (OR=1.15, 95%CI:1.10-1.20). Less frequently belong to average well-off family (OR=0.85, 95%CI:0.80-0.90) and live in countries with higher cigarette prices (OR=0.71, 95% CI:0.50-0.99), restrictive advisory measures (OR=0.79, 95%CI:0.63-0.99) and medium implementation of tobacco control measures (OR=0.57, 95%CI:0.38-0.85). Current smokers shared similar family characteristics with vapers, and less likely lived in countries with higher cigarette prices (OR=0.70, 95%CI:0.49-0.99) and higher spending on anti-tobacco media campaigns (OR=0.23, 95%CI:0.10-0.50).

Conclusion: Besides preventing tobacco smoking, the adoption of governmental tobacco control measures also contribute to prevent vaping among adolescents.