E-cigarettes and Shisha –
Gateways to regular smoking
among British youth?
Martin Dockrell FRSPH
Director of Policy & Research
Action on Smoking & Health
E-cigarette use among adults has
increased rapidly
E-cigarette use among adult smokers in Great Britain
40%
2010
2012
2013
34%
20%
0%
22%
3%
7%
11%
Currently use e-cigarettes
9%
Have ever tried e-cigarettes
…but current use remains confined
largely to current and ex-smokers
E-cigarette use in Britain, 2013
(All adults)
100%
3%
29%
2%
2%
7%
21%
75%
57%
50%
69%
67%
25%
0%
Don’t know
24%
1%
5%
11%
Never smoked
(5972)
Ex-smoker (4303)
Smoker (2009)
I have never heard of
e-cigarettes and have
never tried them
I have heard of ecigarettes but have
never tried them
I have tried ecigarettes but do not
use them (anymore)
I have tried ecigarettes and still use
them
Children who have never smoked
rarely use e-cigarettes
E-cigarette use among children in Britain, 2013
(All children, by smoking status N=12,171)
100%
1%
6%
4%
4%
5%
6%
17%
3%
Don't want to say
5%
7%
33%
75%
62%
44%
72%
50%
71%
68%
I use them often
(more than once a
week)
I use them
sometimes (more
than once a month)
I have tried them
once or twice
53%
35%
25%
I have never used
them
37%
21%
14%
0%
Never
smoked
N=1680
Tried
smoking
once
N=235
Used to
smoke
N=74
9%
12%
Smoke <1 a Smoke 1-6
week
a week
N=79
N=26
10%
Smoke 6+ a
week
N=60
Never heard of them
Weekly use is rare and confined to
older children
11 to 15 (N=1328)
16 to 18 (N=850)
E-cigarette use in Britain, 2013
(All children, by age)
Wont say
1%
1%
1%
I use them often (more
than once a week)
6%
74%
17%
0%
I use them sometimes
(more than once a
month)
I have tried them once
or twice
0%
0%
I have never used them
2%
54%
Not heard of them
43%
0%
20%
40%
60%
80%
2 out of 3 children who had used ecigarettes had not used them in the
last month
Have you used an e-cigarette in the last month?
(Children who have ever used e-cigarettes N=97)
100%
80%
60%
64%
40%
20%
28%
0%
Yes
No
Children who have never used
e-cigarettes don’t expect to try soon
Do you expect you will try e-cigarettes soon?
(Children who have never used e-cigarettes N=2075)
93%
100%
80%
60%
40%
20%
6%
1%
0%
All children who have never tried e-cigarettes
Yes
Don’t know
No
Shisha use is rare but more
common among younger adults
Shisha use among adults in Britain, 2013 (N=12,171)
80%
76%
76%
72%
Once or twice a
month
61%
60%
More than 3 to 4
times a month
57%
Once or twice
every 2 to 3
months
Once every 6 to 12
months
40%
Less often
20%
20%
18%
13%
12%
6%
2%
2%
3%
19%
16%
15%
10%
1%
1%
5%
1% 1%
3% 1%
0%
18-24
25-34
35-44
45-54
55+
N=1324
N=1180
N=1758
N=2351
N=5558
Never
Don’t know/ can’t
remember
Not applicable – do
not know what a
shisha pipe is
Shisha use is more common than
e-cigarette use among children
e-cigarettes
Shisha and e-cigarette use and awareness by
Children (N=2178)
0%
0%
0%
4%
Wont say
I use them often
(more than once a
week)
I use them sometimes
(more than once a
month)
I have tried them once
or twice
62%
Shisha
33%
0%
0%
1%
I have never used
them
7%
Never heard of them
33%
58%
0
0.25
0.5
0.75
1
Awareness if shisha is lower
among younger children
16 to 18 (N=850)
Heard of shisha
(All children by age)
3%
Don’t know
30%
11 to 15 (N=1382)
67%
Not heard of
shisa
4%
Heard of
shisha
70%
27%
0%
25%
50%
75%
100%
Awareness of shisha is lower
among never smokers
Never smoked
(1700)
All Children (N=2178)
3%
Don’t know
30%
67%
Not heard of shisah
3%
All (2178)
Heard of shisha
54%
42%
0%
25%
50%
75%
100%
1 in 5 older children have tried shisha
Shisha use and awareness
(All children, by age)
11 to 15 (N=379)
16 to 18 (N=509)
Don't want to say
0%
3%
I use shisha often
(more than once a
week)
I use shisha
sometimes (more
than once a month)
I have tried shisha
once or twice
15%
48%
33%
0%
0%
2%
I have never used
shisha
24%
Never heard of
shisha
73%
0%
25%
50%
75%
100%
Never smokers rarely try shisha
Shisha use and awareness (All children, by smoking status)
Never heard of
shisha
75%
66%
I have never used
shisha
47%
50%
38%
36%
31%
39%
32%
37%
32%
25%
18%
14%
9%
2%
I use shisha
sometimes (more
than once a month)
23%23%
23%
21%
13%
3%
I have tried shisha
once or twice
2%
9%
4%
2%
Don't want to say
0%
never smoked only ever tried used to smoke
not even a puff smoking once
sometimes
or two
N=573
N=159
N=47
I use shisha often
(more than once a
week)
<1 a week
N=69
1-6 cigarettes >6 cigarettes a
a week
week
N=20
N=46
Children who have never used
shisha don’t expect to try soon
Do you expect you will try shisha soon?
(Children who have never used shisha N=1988)
100%
Yes
Don’t know
No
91%
80%
60%
40%
7% of 18 year olds who have not
yet tried shisha expect to try soon
20%
2%
7%
0%
All children who have never tried shisha
Conclusions
• e-cigarette use is a growing phenomenon
• but current use among children remains relatively rare and
confined to older children and smokers
• Shisha use is almost twice as common but is also confined
almost entirely to older children and smokers. However,
more expect to start soon.
• We found negligible shisha smoking or e-cigarettes use
among children who have never smoked so far
• When a young person smokes cigarettes every day and
shisha once a month, tackle the cigarette smoking with
the shisha use
• We need bigger, better, faster evidence to inform
policy