key: cord-0022548-o5mgz60k authors: Sunday, Salome; Hanafin, Joan; Clancy, Luke title: Increased smoking and e-cigarette use among Irish teenagers: a new threat to Tobacco Free Ireland 2025 date: 2021-10-25 journal: ERJ Open Res DOI: 10.1183/23120541.00438-2021 sha: 0aa2d2f705ccf5d3e93642d6b6902864a8d259a6 doc_id: 22548 cord_uid: o5mgz60k Smoking prevalence decreased in Irish teenagers in all ESPAD survey waves from 1995 until 2015. However, in ESPAD 2019, current teen smoking and e-cigarette use increased, threatening Ireland's 5% prevalence tobacco endgame strategy. https://bit.ly/3yXVAyN 2019, respondents perceived increased difficulty in accessing cigarettes and increased family wealth, and reported increased parental education. Sample characteristics that did not change significantly between 2015 and 2019 were perceived risk from occasional or regular smoking, peer smoking, truancy, household composition, familial regulation, and relationship with mother. Students who had ever-used e-cigarettes were significantly more likely to be current smokers and this risk was more pronounced for boys (IRR Truancy was significantly associated with current smoking, with students who reported that they skipped five or more days of school being more likely to be current smokers (IRR 1.53, 95% CI 1.32-1.78). Again, the risk was more pronounced for boys (IRR 1.61, 95% CI 1.33-1.96) than for girls (IRR 1.46, 95% CI 1.14-1.86). Students who reported that most/all of their friends smoked were more likely to be current smokers than were those who had no smoking friends (IRR 1.20, 95% CI 1.06-1.35) and this was more pronounced for girls (IRR 1.33, 95% CI 1.13-1.57) than for boys (IRR 1.08, 95% CI 0.92-1.28). We examined the increase in current smoking in 15-16-year-olds in Ireland between 2015 and 2019 and found that it was associated with e-cigarette use, truancy, household composition, familial regulation, and peer smoking. Consistent with PERELMAN et al. [3] and previous Irish ESPAD findings [2, 4] , the risks of current smoking were higher among those who reported truancy and were higher still among boys who reported skipping school more than five times. Household composition has previously been associated with current smoking [4, 5] , with students from two-parent families being less likely to smoke than those from single-parent families. We provide partial confirmation for these findings in relation to boys only, with boys from two-parent families, and also from blended families, being significantly less likely to report current smoking than boys from single-parent families. We confirm our previous findings showing an association between familial regulation and current smoking [4] . We recommend therefore that smoking intervention and prevention programmes be cognisant of family structure as well as gender [6]. Having peers who smoke is positively associated with teenage current cigarette smoking [7, 8] . The risks of smoking are higher for students who report that most or all their friends smoke than for those with no friends who smoke, and higher for girls than for boys. LIU et al. [9] , in a meta-analysis of 75 longitudinal teen smoking studies, found that having friends who smoke doubles the risk that youths aged 10 to 19 years will smoke. Our findings highlight the importance of making adolescents aware of, and attentive to, the role that friends play in their smoking initiation [10] . In Ireland, successive policy and legislative initiatives have led to teenagers' access to cigarettes decreasing [6]. Our previous studies showed the association between perceived access to cigarettes and current cigarette smoking among adolescents [1] , and our current study shows that teenagers perceive access to cigarettes to have become more difficult. The significant increase in cigarette smoking among teenagers in Ireland in 2019 suggests that further regulatory restrictions are needed to limit access by teenagers to tobacco products [10, 11] . This could be done by increasing the age for purchase of cigarettes to 21 years of age as has been done elsewhere [12] , and also by extending restrictions on where smoking is allowed [10, 13] . Our findings show a negative effect of e-cigarette ever-use on teenagers' likelihood of current smoking. When the model controlled for various factors associated with smoking, e-cigarette ever-use had an additional negative effect, increasing the risks of being a current smoker for both boys and girls. E-cigarette current-use also increased the risk for current smoking for both boys and girls. Our findings support the need for the extension of tobacco control legislation regarding minors to include e-cigarettes. This may be desirable to prevent exposure to second-hand aerosol [14] , but also because of the possible renormalisation of smoking [9] . We saw an increase in current cigarette smoking associated with an increasing use of e-cigarettes. Other associated factors did not deteriorate between 2015 and 2019, and access to cigarettes was perceived to have become more difficult during that period. We suggest that our findings highlight the negative impact that increased youth e-cigarette use had on current teenage cigarette smoking. We further suggest that this increase in e-cigarette use by teens poses a threat to the Tobacco Free Ireland policy goal of a smoking prevalence less than 5% by 2025 [1] . TobaccoFree Research Institute Ireland, TUDublin, Dublin, Ireland. Corresponding author: Luke Clancy (lclancy@tri.ie) Tobacco Free Ireland 2025: SimSmoke prediction for the end game Ireland: Results from the European Schools Project on Alcohol and Other Drugs in Ireland Smoking and school absenteeism among 15-to 16-year-old adolescents: a cross-section analysis on 36 European countries Family structure, family processes, and adolescent smoking and drinking Does smoke-free legislation work for teens too? 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Atlanta, USDHHS, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion An increase in the tobacco age-of-sale to 21: for debate in Europe 19-prompts-smoking-regulation-in-streets-and-terraces/ Date last updated Exposure to secondhand aerosol of electronic cigarettes in indoor settings in 12 European countries: data from the TackSHS Survey Acknowledgements: We wish to acknowledge the important part played by colleagues Sheila Keogan, who managed and supervised both Irish waves of ESPAD 2015 and 2019; and Keishia Taylor, Kate Babineau, Ellen Whelan and Ermelinda Furtado da Luz Brzychcyk, who were involved in the data collection and management of the two waves.Provenance: Submitted article, peer reviewed.Author contributions: S. Sunday performed the initial analysis and wrote the first version of the manuscript; J. Hanafin and L. Clancy conceptualised the structure, and agreed the methodology and the content of the study. All authors contributed to the development of the manuscript, and read and approved the final version. L. Clancy acquired the funding, and was responsible for resources and supervision. Support statement: We thank the RCDH Trust and the Dept of Health Ireland for their financial support. Funding information for this article has been deposited with the Crossref Funder Registry.Conflict of interest: None declared.