School-type differences in e-cigarette use and its correlates among Chinese adolescents

Studies examining e-cigarette use among adolescents in Shanghai, China, have focused largely on middle school students. Given the vast differences between vocational and traditional schools, we aimed to explore school-type differences in e-cigarette use and correlates among adolescents in Shanghai.

The study was conducted in September 2017 through multistage and stratified cluster random sampling, which consisted of 10699 adolescents aged 13-17 years attending traditional and vocational schools in Shanghai. Descriptive statistics and multivariate logistic regressions were conducted to assess the weighted prevalence and correlates of ever e-cigarette use stratified by school type.

The weighted prevalence of e-cigarette use was 5.21% among all respondents. Although e-cigarette use was more prevalent among students attending vocational schools (p<0.001), its correlates were similar across both school types. Among vocational school students, ever tobacco use (OR=3.10; 95% CI: 2.36-4.08) was the most significant correlate, followed by having most friends as smokers (OR=2.97; 95% CI: 1.84-4.81) and having morning cravings (OR=1.90; 95% CI: 1.64-2.20). Among traditional school students, having most friends as smokers (OR=4.87; 95% CI: 2.78-8.54) and ever tobacco use (OR=3.78; 95% CI: 2.68-5.34) were the most significant correlates, followed by knowledge of pro-tobacco advertisements (OR=2.12; 95% CI: 1.54-2.91).

Joint efforts from the national, school and family levels are needed to control e-cigarette use among adolescents in China, and such efforts should be tailored to address differences in school characteristics.