Changes in E-cigarette Use, Cigarette Smoking, and Dual-Use among the Youth (13-15 Years) in 10 Countries (2013-2019)-analyses of Global Youth Tobacco Surveys

INTRODUCTION The increasing use of e-cigarettes among the youth is a public health problem that needs surveillance. We report changes in e-cigarette use, cigarette smoking, and 'dual use' among youth in 10 countries. METHODS Global Youth Tobacco Surveys from Georgia, Iraq, Italy, Latvia, Montenegro, Paraguay, Peru, Qatar, Romania, and San Marino were analyzed. Changes in prevalence of 'awareness of e-cigarettes', 'ever use' (even tried a few puffs) and 'current use' (during last 30 days) of e-cigarettes and cigarette smoking, and 'dual use' (both e-cigarette and cigarette smoking) between baseline (2013/2014) and most recent (2017-2019 ) surveys were estimated. RESULTS 'Awareness of e-cigarettes' and 'ever e-cigarette use' significantly increased (p<0.001). 'Ever e-cigarette use' was highest in Italy, 93% (95%CI 90.9, 94.4). 'Current e-cigarette use' significantly (p<0.05) increased by >50% in most countries. During the most recent surveys, 'current e-cigarette' use was >10% in five countries Italy (18.3%) and Latvia (18.5%) being the highest. Cigarette smoking significantly declined in Italy, Latvia, Peru, and San Marino (p<0.05) but remains unchanged in other countries. 'Dual use' (both electronic and conventional cigarettes) significantly increased in all countries (p<0.001). During the most recent surveys 'dual use' was highest in Italy (10%, 95%CI 8.1, 12.2) and Latvia (8.6%, 95%CI 7.2, 10.2). Youth aged 14 and ≥ 15 years the smokers, were more likely to be e-cigarette users. CONCLUSIONS Awareness and use of e-cigarettes and 'dual use' among youth have increased. Closer monitoring of tobacco use among youths and comprehensive tobacco control policies inclusive of e-cigarettes are needed. IMPLICATIONS Secondary data analyses of serial Global Youth Tobacco Surveys in 10 countries showed that both awareness of e-cigarette and e-cigarette use has increased among school-going youth aged 13-15 years. A concurrent increase in 'dual use' of e-cigarettes and cigarette smoking during the last 30 days in all 10 countries indicates continued cigarette smoking in the absence of e-cigarettes due to the common risk construct of tobacco product use. Results call for continued surveillance of both e-cigarettes and cigarette smoking among school-going youth. Comprehensive tobacco control measures inclusive of e-cigarettes should be implemented to reduce tobacco use among the youth.