title: Reported electronic cigarette use among adolescents in the Niagara region of Ontario.
abstract: BACKGROUND
  Use of electronic cigarettes (e-cigarettes) among adolescents has not been fully described, in particular their motivations for using them and factors associated with use. We sought to evaluate the frequency, motivations and associated factors for e-cigarette use among adolescents in Ontario.
  
  
  METHODS
  We conducted a cross-sectional study in the Niagara region of Ontario, Canada, involving universal screening of students enrolled in grade 9 in co-operation with the Heart Niagara Inc. Healthy Heart Schools' Program (for the 2013-2014 school year). We used a questionnaire to assess cigarette, e-cigarette and other tobacco use, and self-rated health and stress. We assessed household income using 2011 Canadian census data by matching postal codes to census code.
  
  
  RESULTS
  Of 3312 respondents, 2367 answered at least 1 question in the smoking section of the questionnaire (1274 of the 2367 respondents [53.8%] were male, with a mean [SD] age of 14.6 [0.5] yr) and 2292 answered the question about use of e-cigarettes. Most respondents to the questions about use of e-cigarettes (n = 1599, 69.8%) had heard of e-cigarettes, and 380 (23.8%) of these respondents had learned about them from a store sign or display. Use of e-cigarettes was reported by 238 (10.4%) students. Most of the respondents who reported using e-cigarettes (171, 71.9%) tried them because it was "cool/fun/new," whereas 14 (5.8%) reported using them for smoking reduction or cessation. Male sex, recent cigarette or other tobacco use, family members who smoke and friends who smoke were strongly associated with reported e-cigarette use. Reported use of e-cigarettes was associated with self-identified fair/poor health rating (odds ratio [OR] 1.9 (95% confidence interval [CI] 1.2-3.0), p < 0.001), high stress level (OR 1.7 (95% CI 1.1-2.7), p < 0.001) and lower mean (33.4 [8.4] × $1000 v. 36.1 [10.7] × $1000, p = 0.001) and median [interquartile range] (26.2 [5.6] × $1000 v. 28.1 [5.7] × $1000) household incomes.
  
  
  CONCLUSIONS
  Use of e-cigarettes is common among adolescents in the Niagara region and is associated with sociodemographic features. Engaging in seemingly exciting new behaviours appears to be a key motivating factor rather than smoking cessation.
authors.affiliation: Department of Pediatrics (Khoury, Manlhiot, Fan, Chahal, McCrindle), Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ont.; Heart Niagara Inc. (Gibson, Stearne, Dobbin), Niagara Falls, Ont.
authors.forename: Michael
authors.initials: M
authors.lastname: Khoury
authors.affiliation: Department of Pediatrics (Khoury, Manlhiot, Fan, Chahal, McCrindle), Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ont.; Heart Niagara Inc. (Gibson, Stearne, Dobbin), Niagara Falls, Ont.
authors.forename: Cedric
authors.initials: C
authors.lastname: Manlhiot
authors.affiliation: Department of Pediatrics (Khoury, Manlhiot, Fan, Chahal, McCrindle), Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ont.; Heart Niagara Inc. (Gibson, Stearne, Dobbin), Niagara Falls, Ont.
authors.forename: Chun-Po Steve
authors.initials: CS
authors.lastname: Fan
authors.affiliation: Department of Pediatrics (Khoury, Manlhiot, Fan, Chahal, McCrindle), Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ont.; Heart Niagara Inc. (Gibson, Stearne, Dobbin), Niagara Falls, Ont.
authors.forename: Don
authors.initials: D
authors.lastname: Gibson
authors.affiliation: Department of Pediatrics (Khoury, Manlhiot, Fan, Chahal, McCrindle), Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ont.; Heart Niagara Inc. (Gibson, Stearne, Dobbin), Niagara Falls, Ont.
authors.forename: Karen
authors.initials: K
authors.lastname: Stearne
authors.affiliation: Department of Pediatrics (Khoury, Manlhiot, Fan, Chahal, McCrindle), Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ont.; Heart Niagara Inc. (Gibson, Stearne, Dobbin), Niagara Falls, Ont.
authors.forename: Nita
authors.initials: N
authors.lastname: Chahal
authors.affiliation: Department of Pediatrics (Khoury, Manlhiot, Fan, Chahal, McCrindle), Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ont.; Heart Niagara Inc. (Gibson, Stearne, Dobbin), Niagara Falls, Ont.
authors.forename: Stafford
authors.initials: S
authors.lastname: Dobbin
authors.affiliation: Department of Pediatrics (Khoury, Manlhiot, Fan, Chahal, McCrindle), Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ont.; Heart Niagara Inc. (Gibson, Stearne, Dobbin), Niagara Falls, Ont. brian.mccrindle@sickkids.ca.
authors.forename: Brian W
authors.initials: BW
authors.lastname: McCrindle
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D003430:Cross-Sectional Studies; D066300:Electronic Nicotine Delivery Systems / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D009042:Motivation; D016017:Odds Ratio; D009864:Ontario; D012574:Schools; D016540:Smoking Cessation / Q000379:methods*; D013334:Students / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires