title: Associations between e-cigarette access and smoking and drinking behaviours in teenagers.
abstract: BACKGROUND
  Public health concerns regarding e-cigarettes and debate on appropriate regulatory responses are focusing on the need to prevent child access to these devices. However, little is currently known about the characteristics of those young people that are accessing e-cigarettes.
  
  
  METHODS
  Using a cross-sectional survey of 14-17 year old school students in North West England (n = 16,193) we examined associations between e-cigarette access and demographics, conventional smoking behaviours, alcohol consumption, and methods of accessing cigarettes and alcohol. Access to e-cigarettes was identified through a question asking students if they had ever tried or purchased e-cigarettes.
  
  
  RESULTS
  One in five participants reported having accessed e-cigarettes (19.2%). Prevalence was highest among smokers (rising to 75.8% in those smoking >5 per day), although 15.8% of teenagers that had accessed e-cigarettes had never smoked conventional cigarettes (v.13.6% being ex-smokers). E-cigarette access was independently associated with male gender, having parents/guardians that smoke and students' alcohol use. Compared with non-drinkers, teenagers that drank alcohol at least weekly and binge drank were more likely to have accessed e-cigarettes (adjusted odds ratio [AOR] 1.89, P < 0.001), with this association particularly strong among never-smokers (AOR 4.59, P < 0.001). Among drinkers, e-cigarette access was related to: drinking to get drunk, alcohol-related violence, consumption of spirits; self-purchase of alcohol from shops or supermarkets; and accessing alcohol by recruiting adult proxy purchasers outside shops.
  
  
  CONCLUSIONS
  There is an urgent need for controls on the promotion and sale of e-cigarettes to children. Findings suggest that e-cigarettes are being accessed by teenagers more for experimentation than smoking cessation. Those most likely to access e-cigarettes may already be familiar with illicit methods of accessing age-restricted substances.
authors.affiliation: Centre for Public Health, Liverpool John Moores University, 15-21 Webster Street, L3 2ET, Liverpool, UK. k.e.hughes@ljmu.ac.uk.
authors.forename: Karen
authors.initials: K
authors.lastname: Hughes
authors.affiliation: Centre for Public Health, Liverpool John Moores University, 15-21 Webster Street, L3 2ET, Liverpool, UK. m.a.bellis@ljmu.ac.uk.|Public Health Wales, Hadyn Ellis Building, Maindy Road, CF24 4HQ, Cardiff, UK. m.a.bellis@ljmu.ac.uk.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Bellis
authors.affiliation: Centre for Public Health, Liverpool John Moores University, 15-21 Webster Street, L3 2ET, Liverpool, UK. k.a.hardcastle@ljmu.ac.uk.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Hardcastle
authors.affiliation: Centre for Public Health, Liverpool John Moores University, 15-21 Webster Street, L3 2ET, Liverpool, UK. pmchale99@gmail.com.
authors.forename: Philip
authors.initials: P
authors.lastname: McHale
authors.affiliation: Centre for Public Health, Liverpool John Moores University, 15-21 Webster Street, L3 2ET, Liverpool, UK. andrew.bennett@hegroup.org.uk.
authors.forename: Andrew
authors.initials: A
authors.lastname: Bennett
authors.affiliation: Health Equalities Group, 2nd floor, 151 Dale Street, L2 2JH, Liverpool, UK. robin.ireland@hegroup.org.uk.
authors.forename: Robin
authors.initials: R
authors.lastname: Ireland
authors.affiliation: Trading Standards North West, New Town House, Buttermarket Street, WA1 2NH, Warrington, UK. kpike@warrington.gov.uk.
authors.forename: Kate
authors.initials: K
authors.lastname: Pike
mesh_terms: D000293:Adolescent; D000428:Alcohol Drinking / Q000453:epidemiology*; D019973:Alcohol-Related Disorders / Q000453:epidemiology; D000434:Alcoholic Beverages; D003430:Cross-Sectional Studies; D066300:Electronic Nicotine Delivery Systems / Q000706:statistics & numerical data*; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D016017:Odds Ratio; D015995:Prevalence; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology*; D014754:Violence / Q000706:statistics & numerical data