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      Electronic Cigarette Use among Irish Youth: A Cross Sectional Study of Prevalence and Associated Factors

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          Abstract

          Purpose

          To examine prevalence of, and factors associated with, e-cigarette use among young people aged 16-17 in Ireland.

          Methods

          In 2014, a representative sample of 821 young people aged 16-17 recruited from secondary schools completed a pen and paper survey on e-cigarette use, tobacco use, and socio-demographic items.

          Findings

          A total of 23.8% of respondents had used e-cigarettes at least once. Dual trial of tobacco and e-cigarettes was common with 69.5% of regular smokers and 30.4% of ‘ever’ smokers having tried e-cigarettes and 10.6% of current smokers using e-cigarettes regularly. 4.2% of never smokers have tried e-cigarettes. Overall, current e-cigarette use (once a month or more) was low (3.2%). Binary logistic regression conducted through generalized estimating equations (GEE) determined that controlling for other variables, current tobacco use and ‘ever’ tobacco use predicted ever e-cigarette use. Gender and school-level socioeconomic status were also independent predictors of ever e-cigarette use. Gender stood as the only predictor of on-going e-cigarette use, with males being more likely to regularly use e-cigarettes at least once a month.

          Conclusions

          E-cigarette use among 16-17 year olds in Ireland is of note, with nearly a quarter of students having tried them. Concurrent or experimental use of e-cigarettes and tobacco is more common than sole use, while a small number have tried e-cigarettes without having tried tobacco.

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          Most cited references11

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          To GEE or not to GEE: comparing population average and mixed models for estimating the associations between neighborhood risk factors and health.

          Two modeling approaches are commonly used to estimate the associations between neighborhood characteristics and individual-level health outcomes in multilevel studies (subjects within neighborhoods). Random effects models (or mixed models) use maximum likelihood estimation. Population average models typically use a generalized estimating equation (GEE) approach. These methods are used in place of basic regression approaches because the health of residents in the same neighborhood may be correlated, thus violating independence assumptions made by traditional regression procedures. This violation is particularly relevant to estimates of the variability of estimates. Though the literature appears to favor the mixed-model approach, little theoretical guidance has been offered to justify this choice. In this paper, we review the assumptions behind the estimates and inference provided by these 2 approaches. We propose a perspective that treats regression models for what they are in most circumstances: reasonable approximations of some true underlying relationship. We argue in general that mixed models involve unverifiable assumptions on the data-generating distribution, which lead to potentially misleading estimates and biased inference. We conclude that the estimation-equation approach of population average models provides a more useful approximation of the truth.
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            Reducing obesity via a school-based interdisciplinary intervention among youth: Planet Health.

            To evaluate the impact of a school-based health behavior intervention known as Planet Health on obesity among boys and girls in grades 6 to 8. Randomized, controlled field trial with 5 intervention and 5 control schools. Outcomes were assessed using preintervention (fall 1995) and follow-up measures (spring 1997), including prevalence, incidence, and remission of obesity. A group of 1295 ethnically diverse grade 6 and 7 students from public schools in 4 Massachusetts communities. Students participated in a school-based interdisciplinary intervention over 2 school years. Planet Health sessions were included within existing curricula using classroom teachers in 4 major subjects and physical education. Sessions focused on decreasing television viewing, decreasing consumption of high-fat foods, increasing fruit and vegetable intake, and increasing moderate and vigorous physical activity. Obesity was defined as a composite indicator based on both a body mass index and a triceps skinfold value greater than or equal to age- and sex-specific 85th percentiles. Because schools were randomized, rather than students, the generalized estimating equation method was used to adjust for individual-level covariates under cluster randomization. The prevalence of obesity among girls in intervention schools was reduced compared with controls, controlling for baseline obesity (odds ratio, 0.47; 95% confidence interval, 0.24-0.93; P = .03), with no differences found among boys. There was greater remission of obesity among intervention girls vs. control girls (odds ratio, 2.16; 95% confidence interval, 1.07-4.35; P = .04). The intervention reduced television hours among both girls and boys, and increased fruit and vegetable consumption and resulted in a smaller increment in total energy intake among girls. Reductions in television viewing predicted obesity change and mediated the intervention effect. Among girls, each hour of reduction in television viewing predicted reduced obesity prevalence (odds ratio, 0.85; 95% confidence interval, 0.75-0.97; P = .02). Planet Health decreased obesity among female students, indicating a promising school-based approach to reducing obesity among youth.
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              E-cigarette prevalence and correlates of use among adolescents versus adults: a review and comparison.

              Perceived safer than tobacco cigarettes, prevalence of electronic cigarette (e-cigarette) use is increasing. Analyses of cartridges suggest that e-cigarettes may pose health risks. In light of increased use and the potential for consequences, we searched Google Scholar and Pubmed in July of 2013 using keywords, such as e-cigarette and vaping, to compare differences and similarities in prevalence and correlates of e-cigarette use among adolescents (grades 6-12) versus adults (aged ≥18 years). Twenty-one studies focused on e-cigarette use. Ever-use increased among various age groups. In 2011, ever-use was highest among young adults (college students and those aged 20-28; 4.9%-7.0%), followed by adults (aged ≥18; 0.6%-6.2%), and adolescents (grades 6-12 and aged 11-19; <1%-3.3%). However, in 2012 adolescent ever-use increased to 6.8% and, among high school students, went as high as 10.0%. While the identified common correlate of e-cigarette use was a history of cigarette smoking, a notable proportion of adolescents and young adults who never smoked cigarettes had ever-used e-cigarettes. E-cigarette use was not consistently associated with attempting to quit tobacco among young adults. Adults most often reported e-cigarettes as a substitute for tobacco, although not always to quit. Reviewed studies showed a somewhat different pattern of e-cigarette use among young people (new e-cigarette users who had never used tobacco) versus adults (former or current tobacco users). Research is needed to better characterize prevalences, use correlates, and motives of use in different population groups, including how adolescent and young adult experimentation with e-cigarettes relates to other types of substance use behaviors. Copyright © 2014 Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                Role: Academic Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                27 May 2015
                2015
                : 10
                : 5
                : e0126419
                Affiliations
                [001]TobaccoFree Research Institute Ireland, DIT Focas, Camden Row, Dublin, Ireland
                Legacy, Schroeder Institute for Tobacco Research and Policy Studies, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: LC KB. Performed the experiments: LC KB KT. Analyzed the data: KB LC KT. Contributed reagents/materials/analysis tools: LC KB. Wrote the paper: KB LC KT.

                Article
                PONE-D-15-00393
                10.1371/journal.pone.0126419
                4446031
                26018542
                05088411-d49a-4ce5-88ef-92cd9ccde570
                Copyright @ 2015

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

                History
                : 5 January 2015
                : 31 March 2015
                Page count
                Figures: 0, Tables: 4, Pages: 10
                Funding
                The TobaccoFree Research Institute received grant funding from the Irish Department of Health's National Lottery Grant Scheme which contributed to the salaries of the employees who worked on this research project. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Custom metadata
                This e-cigarette dataset is made available under Open Database License whose full text can be found at http://opendatacommons.org/licenses/odbl/. Any rights in individual contents of the database are licensed under the Database Contents License whose text can be found http://opendatacommons.org/licenses/dbcl/ - See more at: http://opendatacommons.org/guide/#sthash.0twhd8JV.dpuf. The public link to the dataset is: http://figshare.com/s/204f19b0dc4511e4bf1406ec4b8d1f61.

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