Changing awareness and sources of tobacco and e-cigarettes among children in Great Britain

Introduction It is illegal in the UK to sell tobacco or nicotine e-cigarettes to people under the age of 18 years, as is displaying tobacco cigarettes at the point of sale. This paper examined changes in exposure to display of these products in shops and sources of these products among adolescent users over time. Methods Data from representative repeated online cross-sectional surveys of youth in Great Britain (11-18 years) were used (2018-2022; n=12,445). Outcome measures included noticing product displays and sources of e-cigarettes and tobacco cigarettes. Logistic regressions examined the associations of these outcome variables over time and with sociodemographic variables. Results Of 12,040 participants with complete data, 10.1% used some form of nicotine product (4.2% cigarettes, 2.9% e-cigarettes, 3.0% both) at least occasionally. The likelihood of noticing tobacco cigarettes on display fell over time for both supermarkets (2018: 67.1% to 2022: 58.5%) and small shops (2018: 81.3% to 2022: 66.3%), but the likelihood of noticing e-cigarettes in supermarkets rose (2018: 57.4% to 2022: 66.5%). Sources of tobacco cigarettes did not differ over time, but e-cigarette users were more likely to get their e-cigarettes from small shops in 2022 (51.2%) vs. 2019 (34.2%) (Odds ratio 2.02; 95%CI 1.24, 3.29). Conclusion This study provides evidence that current policies to limit awareness of and access to both tobacco and e-cigarettes among adolescents in the UK may not be effective. UK policy on the advertising, promotion and sale of both tobacco and e-cigarettes need to be reinforced to deter use among children. ### Competing Interest Statement NSH is Chair of Action on Smoking and Health and Medical Director of Asthma and Lung UK. AAL is a Trustee of Action on Smoking and Health. HC, DA and LB are employees of Action on Smoking and Health. ### Funding Statement This work was supported by Cancer Research UK (CRUK PPRCTAGPJT\100005) ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics committee of Imperial College Research Governance and Integrity Team name gave ethical approval for this work (ICREC Ref: 20IC6625) I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data from this study was collected by YouGov and ASH