title: Use of electronic cigarettes among secondary and high school students from a socially disadvantaged rural area in Poland.
abstract: The use of e-cigarettes has been growing and has become a significant public health concern. Prevention of the youth access to, initiation and continuous use of e-cigarettes with special attention to vulnerable groups is a subject of a health debate. However, still little is known about characteristics of the underage e-cigarette users from different geographic and socio-economic backgrounds as well as other potential factors associated with the use of e-cigarettes, including simultaneous use with tobacco products or alcohol. The aim of the study was to investigate the prevalence and factors associated with ever and continued e-cigarette use among the secondary and high school students from a socially disadvantaged rural area in Poland.
  
  
  
  The study sample consisted of 3552 students aged 13-19 years from Piotrkowski district. The anonymous, self-administered questionnaire adapted from the Global Youth Tobacco Survey was implemented to collect relevant information. The uni- and multivariate logistic regression analyses were applied to identify factors associated with ever, current (in the previous 30 days) and continued e-cigarette use.
  
  
  
  Almost 22 % of the sample reported ever e-cigarettes use and 27 % of the respondents indicated e-cigarettes use in the past month. Boys, in comparison with girls, were more likely to report current e-cigarette use (OR = 1.7; p < 0.001). Current e-cigarette use was strongly associated with alcohol consumption (OR = 4.3; p < 0.001), current (OR = 32.5; p < 0.001) and ever tobacco smoking (OR = 7.5; p < 0.001) as well as smoking parents (OR = 1.4; p < 0.05) and friends (OR = 4.5; p < 0.05). The use of e-cigarettes was also significantly associated with harm perception (p < 0.001). A similar pattern was observed among ever e-cigarette users. Male gender (OR = 1.4; p < 0.05), current tobacco smoking (OR = 3.0; p < 0.01) and lack of knowledge about a ban on smoking in the school (OR = 1.4; p < 0.05) were predictors of the continued e-cigarette use. Higher paternal education (OR = 0.5; p < 0.001) and perception of e-cigarettes as more harmful comparing to tobacco (OR = 0.2; p < 0.001) protected from the continued e-cigarette use.
  
  
  
  E-cigarette use is widespread in the investigated population, especially among boys, those with other risky behaviors and with smoking parents or friends. There is a need for further research and preventive policies to protect the youth from that exposure.
authors.affiliation: Department of Tobacco Control, Preventive Medicine Department, Medical University of Lodz, Zeligowskiego 7/9 Str., 90-752, Lodz, Poland. dkaleta@op.pl.
authors.forename: Dorota
authors.initials: D
authors.lastname: Kaleta
authors.affiliation: Department of Tobacco Control, Preventive Medicine Department, Medical University of Lodz, Zeligowskiego 7/9 Str., 90-752, Lodz, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Wojtysiak
authors.affiliation: Department of Tobacco Control, Preventive Medicine Department, Medical University of Lodz, Zeligowskiego 7/9 Str., 90-752, Lodz, Poland.
authors.forename: Kinga
authors.initials: K
authors.lastname: Polańska
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000328:Adult; D000428:Alcohol Drinking; D066300:Electronic Nicotine Delivery Systems / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D011044:Poland / Q000453:epidemiology; D015995:Prevalence; D012309:Risk-Taking; D012424:Rural Population; D012574:Schools; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology*; D012931:Social Environment; D012959:Socioeconomic Factors; D013334:Students; D011795:Surveys and Questionnaires; D062789:Tobacco Products; D035862:Vulnerable Populations; D055815:Young Adult
keywords: E-cigarettes; Smoking; Socially disadvantaged rural areas; Tobacco; Youth