Implementation of the Article 13 of the WHO FCTC and prevention of youth e-cigarette use

Introduction The tobacco industry and related entities use multiple strategies and channels to attract youth into tobacco and nicotine use. Exposure to tobacco advertising, promotion, and sponsorship (TAPS) has been linked to increased use of electronic cigarettes (e-cigarettes) among adolescents. There is limited evidence related to the impact of the TAPS measures introduced by the World Health Organization’s Framework Convention on Tobacco Control (WHO FCTC). This study examined the association between the implementation of the WHO FCTC Article 13 and youth e-cigarette use. Material and Methods Data from the 2016 or 2018 WHO FCTC implementation reports and the 2016 or 2019 Global Youth Tobacco Survey on students aged 11-17 years from 48 countries were analyzed (n = 165,299). Multi-level logistic regression models were used to assess the associations between the implementation of TAPS measures, individual- and country-level factors, and youth current e-cigarette use. Results All individual-level characteristics were associated with e-cigarette use. Higher age, male gender, and higher perceived amount of pocket money were risk factors for e-cigarette use. Adolescents who saw people using tobacco in the media were more likely to use e-cigarettes (ORadj=1.29; 95% CI: 1.23–1.34). Adolescents who were taught about the dangers of tobacco use in school were less likely to use e-cigarettes (ORadj=0.82; 95% CI: 0.79–0.85). In lower-middle and low-income countries, bans on TAPS covering Internet, points of sale, product placement, and the strength of additional TAPS measures were all associated with lower odds of youth e-cigarette use. Conclusions Our study provides new evidence on the importance of the implementation of the WHO FCTC for prevention of e-cigarette use among youth. Further research on tobacco control interventions tailored for younger populations is warranted to ensure these interventions target new and emerging products, especially in lower-income countries.