BACKGROUND: Flavoured cigarettes lure young and new smokers while tempering harm perceptions. We investigated the prevalence of flavoured cigarette use and its associations with current use, daily use, and susceptibility to cigarette use among adolescent ever smokers.
METHODS: This was a territory-wide cross-sectional school-based survey among secondary school students in Hong Kong, conducted from April to November 2023. We assessed whether the first cigarette used among ever smokers was flavoured (yes/no). Ever, current (past 30-day) and daily cigarette use, and the susceptibility to use cigarettes (yes/no) in the next 12 months were self-reported. We only included adolescent ever smokers in this study. Proportions of current use, daily use and susceptibility to cigarette use among ever smokers were weighted by sex, age and grade distribution of the underlying population. In association analysis, Poisson regression models with robust standard errors were fitted among adolescent ever smokers.
RESULTS: This study included 1665 adolescent ever smokers with a mean age of 15.4±1.8 years, and 58.1% were boys. Half (50.2%) of them used flavoured cigarettes when they first smoked, 19.4% were current users, 7.6% were daily users, and 28.4% were susceptible to cigarette use in the next 12 months. Compared with those who used ordinary cigarettes first, those who used flavoured cigarettes first were more likely to be current users (32.3% versus 10.4%, adjusted prevalence ratio APR 2.53, P<0.001), daily users (13.1% versus 3.6%, APR 2.81, P<0.001), and susceptible to cigarette use (41.7% versus 20.3%, APR 1.82, P<0.001).
CONCLUSIONS: Among Hong Kong adolescent ever smokers, around half of them used flavoured cigarettes at first smoking. Adolescents who first used flavoured cigarettes versus ordinary cigarettes were more likely to be current smokers, daily smokers and more susceptible to cigarette use in the next 12 months.