Welsh primary schoolchildren’s perceptions of e-cigarettes: a mixed method study

Background: There are concerns that the growing popularity of e-cigarettes promotes experimentation among children. Current research has focused almost exclusively on children over 11 years. Given the possible lifelong health harms caused by behaviours established in early childhood, understanding younger children’s perceptions is essential; to inform tobacco control policies, prevention strategies and the wider debate on further regulation of vaping. In one of the first global studies to provide insights into younger children’s perceptions of e-cigarettes, we explored Welsh primary schoolchildren’s (aged 7-11) awareness of e-cigarettes relative to tobacco smoking, their understanding of the risks and benefits associated with e-cigarettes and their intentions and beliefs about vaping. Methods: Data was collected using a mix of methods in June and July 2017 from 8 purposively selected primary schools across Wales. Four hundred and ninety-five children (52% female), aged 7 years (n=165), 9 years (n=185) and 11 years (n=145) completed a class-administered booklet encompassing a draw and write exercise and questionnaire. Ninety-six children participated in 24 peer cohort-based discussion groups comprised of 2 boys and 2 girls. Data from the three tools were analysed independently and findings triangulated. Questionnaire analyses used frequencies, descriptive statistics and chi-squared tests. Content analysis was undertaken on the draw and write data and peer discussion groups were analysed thematically. Results: Primary schoolchildren have general awareness of e-cigarettes but understanding of any health harms or the role of nicotine in e-cigarettes is poor or misperceived, particularly in the youngest children. Vaping was viewed as healthier than smoking by most and there was some recognition that e-cigarettes were used for smoking cessation. Few children intended to smoke (1.8%) or vape (3.9%) in the future but almost half thought it was okay for grownups. Children’s perceptions were influenced by exposure through family and friends. Conclusions: There is a need for e-cigarette education in primary schools. Health promotion efforts should reinforce the message that vaping is ‘less harmful’ rather than ‘healthier’ and highlight associated risks of e-cigarette experimentation including the potential for tobacco initiation. Further research is needed to explore whether children’s perceptions influence their future use of tobacco or e-cigarettes.