Open Journal of Respiratory Diseases, 2013, 3, 21-24 Published Online February 2013 (
E-Cigarette: A New Tobacco Product for
Schoolchildren in Paris
Bertrand Dautzenberg1,2,3,4, Pierre Birkui1, Maryvonne Noël5,
Johanna Dorsett2, Monique Osman1,2, Marie-Dominique Dautzenberg2,6,7
1Paris Sans Tabac (PST), Paris, France
2Office Français de Prévention du Tabagisme (OFT), Paris, France
3Groupe Hospitalier Pitié-Salpêtrière (APHP), Paris, France
4Université Pierre et Marie Curie, Paris, France
5Rectorat de l’Académie de Paris, Paris, France
6Hôpital Necker Enfants-Malades, Paris, France
7Université René Descartes, Paris, France
Received January 13, 2013; revised February 3, 2013; accepted February 10, 2013
Objectives: To explore if the dramatic decrease in price of e-cigarette has transformed this new product into a product
used for tobacco initiation among a teenage population. Methods: The authors added a question in 2012 on e-cigarette
in the yearly survey on tobacco consumption in Paris schoolchildren. The study is conducted on a randomly selected
sample from 2% of classes since 1991. Results: 277 (8.1%) of the 3409 schoolchildren studied (including 575 non re-
sponders to this question) reported having had an experience with e-cigarette. Experimentation rate is 6.4% among the
12 - 14-year-old, 11.8% among the 15 - 16-year-old and 9% among the 17-year-old schoolchildren. Among the 12 - 14-
year-old schoolchildren, 64.4% of e-cigarette experimentation was by non-smokers. Of the 17-year-old teenagers who
had used e-cigarettes, 12.4% were non-smokers. For the whole population, 33.2% of those having tried e-cigarette are
non-smoker, 22.7% occasional smoker, 3.6% ex-smoker and 40.4% daily smoker. Those who experiment cannabis, shi-
sha or binge-drinking are more frequently users of e-cigarette. In the smoker group, there is an inverse trend of rela-
tionship between the readiness to quit tobacco and the rate of use of e-cigarette. Conclusion: For teenager’s, e-cigare-
ttes have become not a product to aid quit tobacco but a product for experimentation and initiation of cigarette use.
Regulation is urgently needed to control the emergent use of this new tobacco product by children.
Keywords: E-Cigarettes; Teenagers; Tobacco Initiation; Epidemiologic Study
1. Introduction
The principle of the e-cigarette was born to an idea by
Herbert A. Gilbert, who on 1965 patented a device that
shares the main characteristics of e-cigarettes [1]. The
history of e-cigarette then restarted at the beginning of
XXI century. The invention of e-cigarettes is attributed to
Hon Lik, Chinese pharmacist [2]. The first prototype of
electronic cigarette uses a lithium battery to produce en-
ergy to vaporize glycerol and a nicotine solution through
a piezoelectric device. The beginning of each puff is con-
trolled by an on demand valve. The ultrasonic production
of aerosol has since been replaced by a heating element
in commercialised e-cigarettes. The device was first in-
troduced to the Chinese domestic market in May 2004 as
a support for smoking cessation. Then export began in
2005-2006, before an international patent in 2007 [1].
The efficacy of e-cigarettes for tobacco cessation has not
been shown [3]. Many health authorities refuse to say
that this product is beneficial for smoking cessation in
the absence of studies. More recently this product has
been sold for use where smoking is banned [4], but many
site managers of private or public places, such as airlines
companies [5], have taken the initiative to ban indoor e-
cigarette use. Now this product is most often sold as a
new, cool alternative to smoking. E-cigarette is cheap be-
cause they are not taxed as tobacco products and because
recently new disposable e-cigarettes has been marketed.
This cheap product potentially provides a gateway for to-
bacco use in teenagers due to a price decrease from 60 -
100 € to less than 6 - 10 €. This present study was con-
ducted to see whether the concern that e-cigarettes has
become a new product for tobacco initiation use in tee-
nagers is justified or not. We had introduced a question
about the e-cigarette in the yearly cross-sectional survey
conducted by Paris Sans Tabac [6].
opyright © 2013 SciRes. OJRD
2. Methods
A cross-sectional survey is conducted yearly with a one
page questionnaire by Paris Sans Tabac on 2% of stu-
dents randomly selected by class provided a representa-
tive sample of the 188,000 schoolchildren of Paris. Ano-
nymous questionnaires were distributed and collected
with the help of Paris School authorities. The study pro-
vides yearly data on smoking among Parisian schoolchil-
dren with the same methodology since 1991. A question
about e-cigarettes was added in 2012, like one we had
added a question about shisha ten years ago. This ques-
tion is “have you ever used an e-cigarette?”
The non-independence between smoking status and ex-
perimentation of e-cigarette has been assessed by Chi-2
test. The relative risk (RR) with 95% confidence interval
was used to compare experimentation of e-cigarette ac-
cording to the other use of substances.
3. Results
A total of 3409 schoolchildren from 12 to 19 years old
were questioned during the first quarter of 2012. 49.5%
were girls. The mean age of this population is 15.3-years.
In this population the percentage of occasional tobacco
smoker’s increases from 6% to 12% between 12 and 14-
year-old, then remains close to 12%. The rate of daily ciga-
rette smoking increases from 5% for 13-year-old school-
children to 25% for 18-year-old schoolchildren.
A total of 277 teenagers from the study report to have
used e-cigarettes, 2557 never used and 575 provide no
answer to this question (83.2% answer rate). Among the
schoolchildren who have ever used e-cigarettes, 47 report
to have never used regular cigarettes (18.6% of ever
e-cigarette users).
The percentage of teenagers reporting experimentation
of e-cigarettes is 6.4% for 12 - 14-year-old schoolchil-
dren, 11.8% among 15 - 16-year-olds, 19% among 17-
year-old and drops down to 9.3% for the 18 - 19-year-
old schoolchildren. Until the age of 17 years, more girls
have experienced e-cigarettes than boys, with a maxi-
mum experimentation rate at age 17 for girls (23.2%)
(Figure 1).
The experimentation rate of e-cigarette changes accor-
ding to smoking status (Chi-2 test, P < 0.05): 4.4% of
non-smokers, 16.4% of occasional smokers, 19.6% of ex-
smokers and 33.4% of regular smokers have tried using
e-cigarettes. But as smoking regular cigarettes is low in
12 - 14 year old schoolchildren, 64.4% of those who tried
e-cigarette in these young teenagers are not regular ciga-
rette smokers.
Among the 421 daily smoking teenagers, 112 had tried
e-cigarettes (26.7%). The rate of e-cigarette users tend to
be lower for those who plan to quit now (26%), or in the
next 6-month period (25%), compare for those who plan
Figure 1. Percentage prevalence of the teenagers, separately
among girls and boys and age of those who had experiment-
ed on e-cigarettes assessed through the question: “have you
ever used an e-cigarette?” of the PST 2012 survey on 3409
Parisian schoolchildren.
to quit tobacco later (37%) or don’t plan to quit smoking
at all (33%) An inverse relationship trend exists between
ever use of e-cigarette and intent to quit regular smoking.
(RR 1.58; IC 95%: 0.89 - 2.80).
Experimentation of e-cigarette is more frequent among
a 12 - 15-year-old teenage population who have ever
used shisha (RR = 6.75; IC 95%: 4.84 - 9.41) and much
more frequent in the 16 - 19-year-old population who
have ever used shisha (RR = 14.81; IC 95%: 7.54 -
Experimentation of e-cigarettes is more frequent in the
12 - 15-year-old teenage population who had ever used
cannabis (RR = 5.52; IC 95%: 4.15 - 7.35) and as the 16
- 19 year old population (RR = 9.09; IC 95%: 6.12 -
Experimentation of e-cigarette is more frequent in 12 -
15-year-old teenagers who had experimented more than 4
times with more than 3 alcohol glasses the same day (RR
= 8.60; (IC 95%: 5.71 - 12.96) as in the 16 - 19 year old
population (RR = 3.44; IC 95%: 2.94 - 4.03).
4. Discussion
This is one of the first studies to our knowledge which
reports data on use of e-cigarettes in European teenagers.
In our study, e-cigarettes appeared recently on the French
market and rapidly became a familiar product to young
Parisian schoolchildren. This 12 - 15-year-old teenager’s
school population produces a good picture of the general
population of Paris. For the 16 - 19-year-old teenagers,
the sample is representative of Paris school population,
but not of the general population because some teenagers
leave school then they are 16-year-old and many 16 -
19-year-old teenagers from suburbs of Paris come in Pa-
ris to follow the last years of school. The rate of cannabis
use or experimentation of binge-drinking among teena-
gers is quite different according to gender, but the expe-
rimentation of e-cigarette is quite equally distributed in
both genders. Users are mostly 14 - 17-year-old (10.6 %
in girls vs. 9.1% in boys (NS)). The older teenagers (18 -
19-year-old) had a lower rate of ever use of e-cigarette,
Copyright © 2013 SciRes. OJRD
probably because they were not exposed to e-cigarette
before initiation of regular-cigarette-smoking habit, at a
time where disposable e-cigarette were not available. The
experiment tobacco cigarette or shisha is mainly 14 - 17-
year-old teenagers in the PST studies. Our data are com-
patible with the same age of experimentation for e-ciga-
In our study there is a clear link between experimenta-
tion of cannabis, shisha or binge-drinking and the expe-
rimentation of e-cigarette among a population of teena-
gers. There is also a strong link with the tobacco smoking
status, but there is no positive link in our teenage smok-
ers between ever use of e-cigarette and the intent to quit
tobacco. In our study the trend was inversed. E-ciga-
rette is used by teenagers in Paris to experiment new sen-
sations, not to decrease tobacco use. E-cigarette is clearly
a product of initiation to cigarette, not a product for to-
bacco cessation in this teenager population.
Four studies are available on the use of e-cigarettes
from Medline research in November 2012.
A consumer-based mail-in survey [7] was completed
in the US by 10587 adults (18-year-old) in 2009 and
10,328 adults in 2010. Ever use more than quadrupled
from 2009 (0.6%) to 2010 (2.7%). Use of e-cigarette was
most common among women and those with lower edu-
cation. Current tobacco users, as in our study, were most
likely to try e-cigarettes. However, current smokers who
had tried e-cigarettes did not say they planned to quit
smoking more often than smokers who had never tried
them, as in our study in teenagers.
A study among US adults report data from 2 surveys
conducted in 2010 [8]: a national online study (n = 2
649) and the Legacy Longitudinal Smoker Cohort (n =
3658) who report another online survey. The use of e-ci-
garette was higher among current smokers (11.4%, 95%
CI:9.3 - 14.0) than in former smokers (2.0%, 95% CI:
1.0 - 3.8) or in never-smokers (0.8%, 95% CI: 0.35 -
A study conducted in Korea used the data from the
2008 Health Promotion Fund Project [9] those who had
tried e-cigarettes among adolescents in five schools in
Korea. Overall, 444 (10.2%) students responded as hav-
ing seen or heard of e-cigarettes. Only twenty-two stu-
dents who had seen this product reported as having used
an e-cigarette (0.5% of the student study population).
The contact routes of information on e-cigarettes were
the Internet (249, 46.4%), friends (150, 27.9%), televi-
sion (59, 11.0%), books (50, 9.3%), and others (29,
5.4%). This data had been conducted before the availa-
bility of disposable e-cigarettes.
More recently in Poland a large survey conducted in
high schools en 2011 [10] reported that 23.5% of stu-
dents aged 15 to 19 had ever use e-cigarettes and that
8.2% had done so within the previous 30 days. It is in the
same range but higher than reported among Parisian stu-
dents in our study. As in our study, in Poland a signifi-
cant number of never smoker’s students reported ever
used of e-cigarettes (3.2%).
Compared to publish studies, our 2012 study reports in
teenagers an experimentation ten times higher than the
experimentation rate of Korean students in 2008, two
times higher than in the US adult population in 2010, but
lower than the polish study. The use of e-cigarettes in
non-regular cigarette smokers and the general consump-
tion in our teenager study are high. In adults, a US study
shows no link with intent to stop tobacco. In our teenager
study there is an inverse correlation: daily smoking te-
enagers who plan to quit soon are less often ever users of
E-cigarette ever use is in high expansion in teenagers.
The majority of experimentation of e-cigarette in 12 - 14-
year-old occurs in non-smokers. E-cigarette ever use in
smokers who plan to quit soon was less than in those
who don’t plan to quit. E-cigarette is used as other new
tobacco products. To prevent this initiation and this use
as an initiation tobacco product, we recommend regulat-
ing e-cigarettes as it is done for other tobacco products
(or medicine), to prohibit any promotion and sale in
shops or on the Internet to teenagers under 18 years old.
The new project of EU directive on tobacco product [11]
opens a room with article 18 for regulation of product
other than tobacco who deliver nicotine. The prevention
of use of e-cigarette by teenagers is need in this new
5. Acknowledgements
This work was conducted with help of Paris school au-
thorities (Rectorat de l’Académie de Paris); PST is sup-
ported by the Paris section of National Insurance (CPAM)
and OFT receives a support of the French Ministry of
health (DGS) to assess e-cigarettes.
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