Relationship between trying an electronic cigarette and subsequent cigarette experimentation in Scottish adolescents: a cohort study

This study examines the relationship between trying an electronic cigarette and subsequent cigarette experimentation in Scottish adolescents. It analyzes the cohort survey conducted in four high schools in Scotland and discusses the implications for smoking initiation and electronic cigarette use.

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Contents
STUDY 1: Relationship between trying an electronic cigarette and subsequent cigarette
experimentation in Scottish adolescents: a cohort study.................................................................3
STUDY 2: Fish sea food consumption, obesity and risk of type 2 diabetes: an ecological study. .5
REFERENCES................................................................................................................................9

STUDY 1: Relationship between trying an electronic cigarette and subsequent
cigarette experimentation in Scottish adolescents: a cohort study
This study is based on Scottish adolescents and examines that whether young never smokers who
have tried an electronic cigarette are more likely than those adolescents who have not. The
relationship between electronic cigarette use and smoking initiation in young never smokers. In
Scotland, United Kingdom, a cohort survey was conducted in four high schools during
February/March 2015 along with one year later follow-up. By reviewing the article, it has been
found that the response rates in both the years were high. The people who never tried tobacco
smoking are said to be never smokers who do not involve in regular electronic cigarette
utilisation which is sustained over time. In the article, the authors said about the concern
regarding electronic cigarette that it could is the path to experimentation which tobacco smoking
for adolescents who are never smokers (Best, and et. al., 2018).
By conducting the longitudinal study in area, that authors found that those young people who had
ever utilised an electronic cigarette at starting point were have high chances to have tried a
cigarette through follow up. According to the study, it has been evident that smoking initiation
and electronic cigarette use has come from United States of America. In the article, this evidence
had compared with different countries due to distinct national context like cultural and historical
factors around use of tobacco, varied tobacco control regulations, availability and supply of
goods, investment in product advertising and ethnic composition of population. This make it
complex to generalize findings all across the national boundaries. Over the last two decades, it
has been found that in young people of Scotland, prevalence of cigarette smoking has steadily
fallen. The study shows that only 7% of 15 years and 2% of 13-year-old youngsters were regular
smokers in year 2015. However, in Poland, around 27.4 percent of young people were found
using an electronic cigarette. The major European producer of electronic cigarette and tobacco is
Poland. It has also been found in this study that polish female adolescents make more use of
electronic cigarettes which increased the smoking rates of area although, that smoking rates are
stable in men (Newton, Dockrell and Marczylo, 2018).
The study shows that by late adolescence, most of the electronic cigarette uses of Poland
became dual uses. Around 21.8 percent of 16 to 18 years old students were dual uses as well as it
was not related with declined cigarette consumption in comparison to tobacco only users
(Relationship between trying an electronic cigarette and subsequent cigarette experimentation in

Scottish adolescents: a cohort study, 2020). The study on the young students of Poland depicts
that the national factors like industry involvement and tobacco production has potential role
in influencing levels of use of electronic cigarette and tobacco smoking in young people.
The cross-sectional research conducted in the study area depicts that in Wales, there is a
positive association between weekend intentions of not to smoke and use of an electronic
cigarette in young people aged 10 to 11 years. It was found that among young non-smokers the
use of electronic cigarette has maximized in Scotland with around 10% of non-smoking 15 year
adolescents having tried them in year 2013 and 24 percent in year 2015. There are various
variables on the basis of which respondents in the study were asked about the use of electronic
cigarettes and tobacco smoking. These variables include smoking status, susceptibility to
smoking, electronic cigarette use, family and number of friends who smoke and some
demographic variables in which respondents were asked about their ethnic group, date of birth
and gender. From this study, it has been found that among the adolescents who had tried
electronic cigarette at baseline, around 40.4% went on to start smoking cigarettes to follow up. It
compares with around 12.8% of those who never used electronic cigarette at baseline and
through follow up, went on to start smoking cigarettes. The study shows that never smokers were
more likely to try cigarettes (Gorini, and et. al., 2020).
According to researcher, it is possible that the relationship between tobacco
experimentation and electronic cigarettes may not be casual if never smoker adolescents who try
electronic cigarette will have gone to start smoking because of being favorably disposed to use of
tobacco. The study potentially contribute to public health practice and policy is this help in
controlling the factors related to transition to smoking like smoking among family and friends
and smoking susceptibility. The data in the study shows that the use of electronic cigarette had
greater impact on odds of cigarette experimentation among adolescents not traditionally thought
to be more risk, i.e., those with no smokers in their group of friends and those young people with
strong intention of not to smoke (Chien, and et. al., 2019). Three models were used in the
research which helps in determining the probability of obtaining results. The p-value in year
2015 was <0.001. The relative risks in the paper includes the data that indicates that the use of
electronic cigarette has greater impact on odds of cigarette experimentation. Another risk is that
the researcher doesn’t know about any young people will transition to smoking.

The public health impacts of electronic cigarettes were outlined by levy and colleagues in
the study and estimate that under some conditions, electronic cigarettes might have positive
impact on the health of public at the level of population due to more benefits conferred on
smokers in comparison of their potential harm to adolescents. the significance of findings
regarding smoking initiation and electronic cigarette use has been debated based on the more use
of electronic cigarettes among adolescents is occasional. Thus, be enough to impact other
behaviours or unlikely to be harmful directly. The article also argued that the influence of
electronic cigarette experimentation might be psychosocial instead of chemical. It has been
identified from the study that the young people who are never smokers, but try electronic
cigarettes are at high risk of starting smoking in comparison to the people do not try electronic
cigarettes. Regular and careful monitoring of smoking rates and usage of electronic cigarette by
adolescents will enable public healthcare organisations to reduce it.
The rapidly changing tobacco landscape and availability of nicotine product, changes in
regulations related to advertising and strategies utilised by industry are some of the aspects that
needs to be considered while setting policies and practices related to healthcare. This study
enables healthcare professionals in analysing the relative risk associated with tobacco smoking
and electronic cigarette usage so that it can be addressed effectively. It also contributes in
improving health of young adolescents by developing effective practices and policies to limit
usage of electronic cigarettes and tobacco smoking. It helps health Care practitioner to support
smokers to stop smoking (Newton, Dockrell and Marczylo, 2018). It also supports in developing
regulations that helps in balancing the risk of electronic cigarette with their benefits. it also helps
in reducing smoking levels and encourage non-smokers to avoid uptake of electronic
cigarettes. The study conducted on relationship between electronic cigarette use and cigarette
experimentation supports and improving public health practices and policies. It enables
practitioners and health professionals to administer behavioural support to young smokers who
want to utilise electronic cigarette to assist in quitting smoking. It helps in minimising the ill
effects of smoking on health of young adolescents and help smokers in quitting smoking. As per
the above discussion, it has been concluded that there is a direct relationship between use of
electronic cigarette and smoking initiation among young adolescents as the people who were
never smokers but, the even tried electronic cigarettes are more likely to initiate smoking.

STUDY 2: Fish sea food consumption, obesity and risk of type 2 diabetes: an
ecological study
This article is based on ecological study based on fish seafood consumption, obesity and risk of
type 2 diabetes. As per the provided article, obesity is one of the major risk factor of type 2
diabetes as obesity increases the risk of diabetes exponentially (Nkondjock and Receveur, O.,
2003). The main reason behind this is intake of saturated fat and fat. High intake of Omega 3
fatty acids which is commonly found in seafood and fish is also the main cause of obesity among
people. In this article, a research was conducted on 41 nations in five continents with distant
sanitary conditions and socio demographic characteristics to obtain data on prevalence of obesity
and diabetes along with food balance sheets. By reviewing the article, it has been found that
there is an interaction effect between obesity, diabetes and total seafood and fish consumption.
The Nations where seafood and fish consumption is low, the people of those Nations has
increased risk of type 2 diabetes along with obesity. It has been found that the risk of type 2
diabetes is 5 fold higher in people of 45 to 64 years of age group in comparison to 20 to 44
years’ age group. There was a positive and strong relationship is found between type 2 diabetes
and obesity in this study, a relationship which grows stronger the age of an individual. In the
developed countries, the rates of obesity and type 2 diabetes are higher in comparison to
developing countries. In occurrence of these chronic diseases, industrialisation plays major role.
It has been found that around 12.2 kg, i.e., 235 gm per week annual average per capita intake of
seafood and fish. The information obtained from this study shows that high sea food and fish
intake may minimise the risk of prevalence of obesity and type 2 diabetes in the population
(Liaset, and et. al., 2019).
The geographic proximity of ecology of different countries and sea did not depict the overall
consumption of seafood and fish. It was found in the study that consumption of around 230
grams of seafood and fish proves to be beneficial for the health of heart. It has been noted that
the total consumption of seafood and fish modify the relationship among obesity and type 2
diabetes. In those countries where seafood and fish for human consumption are available with
low quantities, the occurrence of type 2 diabetes is significantly and positively related to obesity
whereas, in the countries where high consumption of fish and seafood, there is no evidence
found of this relation. The authors in the study reported that there is a protective effect of fish
consumption against glucose intolerance development and type 2 diabetes among people who are

in the age of 64 years and consuming 170 grams more fish per week. A significant reduction in
excretion of urinary glucose has been observed which is a predictor of type 2 diabetes in the
woman who are aged between 50 to 68 years old. In the epidemiological studies and animal
experiments, a beneficial effect has been found of Omega 3 fatty acids on people with type 2
diabetes (Oggioni, and et. al., 2014). A significant relationship was found between obesity and
type 2 diabetes and consumption of seafood and fish. It has been found in the study that the
people who intake high amount of sea food and fish has less risk of type 2 diabetes along with
high prevalence of obesity (Agrawal and et. al., 2014). As per the research paper, nations with
low consumption of sea food and fish, the prevalence of type 2 diabetes increasing significantly
with obesity (0.8 0.3% vs. 2.5 1.8%; P = 0.002 and 3.3 2.6% vs. 11.0 3.9%, P
0.0001 for the 20 to 44 and 45 to 64 year of age groups, respectively) which shows that there
was no significant difference in prevalence of type 2 diabetes among groups of nations with high
or low prevalence of obesity. The risk included in the paper is that the study may subject to
biases.
This study has potential contribution to the public health policies and practices. Through this
study, the relation between type 2 diabetes, obesity and consumption of seafood and fish
identified. It helps in gathering the data on different countries regarding the impact of intake of
fish and seafood on the people who are aged between 20 to 44 and 45 to 64 years. The study
shows that Finland and Spain were the Nations that consume high amount of fish and sea food
with 34.8 kg and 38.5 kg per capita respectively. This research provides authors with crucial
information about out trends and risk factors of disease and their outcomes (Hagen and et. al.,
2016). The study on consumption of sea food and fish on obesity and type 2 diabetes help in
providing the data different countries to the healthcare professionals which ultimately helps them
in improving the health of people who are aged between 20 to 44 years and 45 to 64 years. From
the study it has been examined that look prevalence of obesity has been exhibited in Nepal that is
0.1%. on the other hand, United States of America has the highest prevalence of obesity that is
22.5% as the people of the nation has consumed high amount of sea food and fish in comparison
to Nepal. The sub Saharan countries has low prevalence of obesity and type 2 diabetes along
with lowest dietary energy supply (Fish-seafood consumption, obesity, and risk of type 2
diabetes: an ecological study, 2013).

It provides opportunities to healthcare professional to improve health of individual who suffer
from obesity and type 2 diabetes. The research on this topic has led to significant discoveries,
formulation of new therapies and improvement it in public health. The comparison of energy
supply of different countries shows that the group with high type 2 diabetes rate, high obesity
and low consumption of fish and seafood are different. It was found that those nations where
availability of sea food and fish are high and people consume these more, the risk of type 2
diabetes is less in those countries, but high in obesity. As large number of studies have
emphasized on females, the obesity problems among adult women is considered as the indicator
of it in population. This research helps healthcare professionals in determining the seafood and
fish consumption ratio in different countries (Ward and Hintze, 2016). This assist in determining
the Nations in which people suffer more with high obesity and type 2 diabetes. This will help in
formulating appropriate practices and policies which helps people in reducing level of diabetes
and obesity. This research also helps in providing people with right direction so that they may
not suffer with obesity and can enable to reduce the rate of type 2 diabetes. Obesity and type 2
diabetes is highly interrelated with consumption of sea food and fish. The people who consume
more sea food and fish, they were less suffer with diabetes but on the other hand, they were high
in obesity. So, this paper will help health care professionals to execute appropriate practices and
develop effective policies to measure and control the rate of type 2 diabetes and obesity. This
will help people in living healthy and disease free life as obesity is one of the main cause of
major chronic diseases (Marushka and et. al., 2018). So, from the above discussion, it has been
concluded that the risk of occurrence of type 2 diabetes is less among the people who consume
more sea food and fish, but the risk of obesity is high among them.

REFERENCES
Books and Journals
Agrawal, S. and et. al., 2014. Frequency of fish intake and diabetes among adult Indians. Journal
of the American College of Nutrition, 33(3), pp.215-230.
Best, C., and et. al., 2018. Relationship between trying an electronic cigarette and subsequent
cigarette experimentation in Scottish adolescents: a cohort study. Tobacco control, 27(4),
pp.373-378.
Chien, Y. N., and et. al., 2019. Electronic cigarette use and smoking initiation in Taiwan:
evidence from the first prospective study in Asia. International journal of environmental
research and public health, 16(7), p.1145.
Gorini, G., and et. al., 2020. Prevalence of tobacco smoking and electronic cigarette use among
adolescents in Italy: Global Youth Tobacco Surveys (GYTS), 2010, 2014,
2018. Preventive Medicine, 131, p.105903.
Hagen, I.V and et. al., 2016. High intake of fatty fish, but not of lean fish, affects serum
concentrations of TAG and HDL-cholesterol in healthy, normal-weight adults: a
randomised trial. British Journal of Nutrition, 116(4), pp.648-657.
Liaset, B., and et. al., 2019. Seafood intake and the development of obesity, insulin resistance
and type 2 diabetes. Nutrition research reviews, 32(1), pp.146-167.
Marushka, L., and et. al., 2018. The relationship between persistent organic pollutants exposure
and type 2 diabetes among First Nations in Ontario and Manitoba, Canada: A difference
in difference analysis. International journal of environmental research and public
health, 15(3), p.539.
Newton, J. N., Dockrell, M. and Marczylo, T., 2018. Making sense of the latest evidence on
electronic cigarettes. The lancet, 391(10121), pp.639-642.
Newton, J.N., Dockrell, M. and Marczylo, T., 2018. Making sense of the latest evidence on
electronic cigarettes. The lancet, 391(10121), pp.639-642.
Nkondjock, A. and Receveur, O., 2003. Fish-seafood consumption, obesity, and risk of type 2
diabetes: an ecological study. Diabetes & metabolism, 29(6), pp.635-642.
Oggioni, C., and et. al., 2014. Shifts in population dietary patterns and physical inactivity as
determinants of global trends in the prevalence of diabetes: An ecological
analysis. Nutrition, Metabolism and Cardiovascular Diseases, 24(10), pp.1105-1111.
Ward, R. and Hintze, K., 2016. Fish and Fish Oil for Cardiovascular Disease in Diabetes. In Fish
and Fish Oil in Health and Disease Prevention (pp. 217-229). Academic Press.
Online
Relationship between trying an electronic cigarette and subsequent cigarette experimentation in
Scottish adolescents: a cohort study, 2020. [Online]. Available through:
https://tobaccocontrol.bmj.com/content/27/4/373
Fish-seafood consumption, obesity, and risk of type 2 diabetes: an ecological study, 2003.
[Online]. Available through: <https://www.ncbi.nlm.nih.gov/pubmed/14707894>