Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
Tobacco Control Unit, Division of Country Health Programmes, World Health Organization Regional Office for Europe, Copenhagen, Denmark.
Tob Control. 2024 Sep 25;33(5):622-627. doi: 10.1136/tc-2022-057749.
The Tobacco Products Directive (2014/40/EU) partially harmonised the regulation of electronic cigarettes (e-cigarettes) in Europe, but individual countries maintain jurisdiction over bans on use in public places, domestic advertising, taxation and flavour regulations. Their association with youth e-cigarette use has not been examined.
We used the cross-sectional 2019 European School Survey Project on Alcohol and Other Drugs data from 32 countries with 98 758 students aged 15-16 years and the 2020 WHO's assessment of the e-cigarette regulations. Multilevel logistic regression models on ever (vs never) and current (vs non-current) exclusive e-cigarette use, exclusive cigarette use and dual use by e-cigarette regulations' composite score were adjusted for age, gender, parental education, perceived family's financial well-being, perceived difficulty of obtaining cigarettes, country income level and general progress in tobacco control.
Of the respondents, 13.3% had ever used cigarettes, 10.6% e-cigarettes and 27.3% both; 13.0% currently used cigarettes, 6.0% e-cigarettes and 6.4% both. Higher composite country score in the e-cigarette regulations was associated with lower current exclusive e-cigarette use (OR=0.78; 95% CI 0.65 to 0.94) and current dual use (OR=0.80; 95% CI 0.67 to 0.95). Youth perceiving more difficulties in obtaining cigarettes were less likely to use cigarettes, e-cigarettes and both ever and currently (OR from 0.80 (95% CI 0.76 to 0.85) to 0.94 (95% CI 0.92 to 0.96)).
More comprehensive e-cigarette regulations and enforcement of age-of-sale laws may be protective of e-cigarette and dual use among adolescents.
《烟草制品指令（2014/40/EU）》在一定程度上协调了欧洲电子烟的监管，但个别国家仍对在公共场所使用、国内广告、税收和口味规定等方面拥有管辖权。目前还没有研究电子烟与青少年使用电子烟之间的关系。
我们使用了来自 32 个国家的 2019 年欧洲学校酒精和其他毒品调查项目的横断面数据，这些国家共有 98758 名 15-16 岁的学生，以及 2020 年世界卫生组织对电子烟法规的评估数据。使用多水平逻辑回归模型，根据电子烟法规综合评分，调整了年龄、性别、父母教育程度、感知家庭经济状况、获得香烟的难易程度、国家收入水平和烟草控制总体进展等因素，对电子烟的使用情况进行了分析，包括曾经（vs 从未）和当前（vs 非当前）使用电子烟的情况，以及单独使用香烟和同时使用香烟和电子烟的情况。
在被调查者中，13.3%的人曾经使用过香烟，10.6%的人曾经使用过电子烟，27.3%的人同时使用过香烟和电子烟；13.0%的人当前使用香烟，6.0%的人当前使用电子烟，6.4%的人同时使用香烟和电子烟。电子烟法规的国家综合评分越高，当前单独使用电子烟的比例越低（比值比=0.78；95%置信区间为 0.65 至 0.94），当前同时使用香烟和电子烟的比例也越低（比值比=0.80；95%置信区间为 0.67 至 0.95）。青少年认为获得香烟的难度越大，他们曾经和当前使用香烟、电子烟和同时使用香烟和电子烟的可能性就越低（比值比从 0.80（95%置信区间为 0.76 至 0.85）至 0.94（95%置信区间为 0.92 至 0.96））。
更全面的电子烟法规和销售年龄法的执行可能有助于保护青少年不使用电子烟和同时使用香烟和电子烟。
