New research by Public Health Institute on children’s perceptions of electronic cigarettes


The increasing popularity and rapid growth of electronic cigarettes has raised considerable concern about their impact on children and young people. Concerns relate to electronic cigarettes acting as a potential gateway to tobacco smoking for young never-smokers, increased experimentation leading to a renormalisation of smoking behaviour and potential health harms of vaping.

Current research is largely focused on adolescents and young adults. In view of the recognised influence of the early years on attitude and habit formation, better understanding of what young children think about electronic cigarettes is needed.

The Public Health Institute at Liverpool John Moores University was commissioned by Public Health Wales to undertake a study investigating primary school children’s perceptions of electronic cigarettes. The report describes the research that was conducted with children in Years 2, 4 and 6 (7-11 years of age) from 8 primary schools across Wales.

The research, ‘Is it all smoke without fire? Welsh primary school children’s perceptions of electronic cigarettes’, found that most children (95 percent) can distinguish between tobacco and electronic cigarettes, with many thinking that e-cigarettes are safer and better than tobacco cigarettes.

Almost 94% of the children acknowledged the harmful effects of smoking but children had little understanding of any health harms of electronic cigarettes. There was considerable uncertainty and many misperceptions. Some younger children for example, mistook the fruit flavours as being an indication that the e-liquids contained fruit and were therefore healthy.

Over a fifth of the children who completed the questionnaire had some exposure to electronic and tobacco cigarettes through family and friends at home. This was found to have influenced children’s perceptions of smoking and vaping with the findings suggesting that children exposed to electronic cigarettes at home are better informed than their peers.

Results highlight the need for comprehensive evidence based electronic cigarette education in Welsh primary schools and suggest that health messaging efforts should reinforce children’s views of electronic cigarettes as smoking cessation devices within a harm reduction narrative.

Suggested key areas to improve children’s understanding of the risks associated with electronic cigarettes were:

  • Including evidence based electronic cigarette education as part of the education curriculum of Welsh primary schools to address gaps in knowledge
  • Health messaging efforts should reinforce children’s views that electronic cigarettes are devices to help people quit tobacco cigarettes, but they are not without harm
  • More research is required to understand how primary school children’s perceptions can influence future vaping behaviour

Dr Lorna Porcellato, lead author of the study from the Public Health Institute, Liverpool John Moores University, said:

“As one of the first global studies to investigate electronic cigarettes in the context of childhood, this research contributes unique and important insights to an underdeveloped body of knowledge. Primary school children represent an important cohort. Understanding how they conceptualise electronic cigarettes prior to experimentation is imperative for the development of effective health promotion interventions that highlight potential risks and prevent uptake in young never smokers.”

The full report can be read here.


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