Background Children in the United Kingdom (UK) today have grown up amidst strong smoking restrictions, decreasing tobacco use and increasing e-cigarette use. It is debated whether e-cigarettes interrupt downward trends in children’s smoking uptake or offer a means for adults to limit tobacco use in front of their children. This study examines change over time in experimentation with, and exposure to, smoking (2007–2019) and e-cigarettes (2014–2019).
Methods Mixed methods design combining data from four national surveys of Year 6 primary school pupils in Wales from 2007–2019 (n=6,741) and qualitative data from 22 focus groups within four primary schools.
Results Parental smoking (OR=0.85 95%CI=0.78–0.94), child tobacco experimentation (OR=0.50, 95%CI=0.40–0.63), and exposure to tobacco in all locations declined over time. Exposure to e-cigarettes increased in all locations from 2014–2019, as did pupil awareness (OR=2.56, 95%CI=2.13–3.09), and parental use (OR=1.26 95%CI=1.01–1.57]). Child ever e-cigarette use was unchanged (OR=0.80, 95%CI=0.58–1.12). Since 2014, pupils’ reports that parents used only e-cigarettes increased. Qualitative research identified strong disapproval for smoking and vaping indoors among children. Pupils from smoking families were more knowledgeable about e-cigarettes, with family smoking and e-cigarette use important in shaping children’s exposure to, and perceptions of, smoking and vaping.
Conclusion Children’s experimentation with, and exposure to, tobacco continues to decline. Further research is needed to understand whether use of e-cigarettes in cars and homes is displacing prior smoking in these locations or being introduced into environments where smoking had already been eliminated.
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