Prof Brown is Director of the UCL Tobacco and Alcohol Research Group and and co-leads a CRUK programme of research to i) provide insights into population-wide influences on smoking, smoking cessation and alcohol reduction principally by management and analysis of the major population surveys, the Smoking and Alcohol Toolkit Study, and ii) advance the scientific foundation, and further the development of, potentially wide-reach digital behaviour change technologies. In over 200 articles on a variety of topics, a particular focus has been on real-world monitoring and evaluation of national tobacco control and alcohol policies, events and smoking cessation treatments including e-cigarettes He has been invited to present his studies at international conferences, to the UK regulatory authorities for medicines and science and technology select committee, and has co-authored briefings to UK all-party parliamentary groups. He is a co-author of Theory of Addiction (second edition) and ABC of Behaviour Change Theories, a Senior Editor at the journal Addiction and an Editor of the Cochrane Tobacco Addiction Group.
Epidemic of youth nicotine addiction? What does the National Youth Tobacco Survey 2017-2019 reveal about high school e-cigarette use in the USA?
Aims: Between 2018 and 2020, the US Food and Drug Administration announced various restrictions on e-cigarette manufacturers in response to a perceived epidemic of e-cigarette use and nicotine dependence among high school students. The stimulus came from headline figures from the 2018 and 2019 National Youth Tobacco Survey (NYTS). We analysed e-cigarette use and dependence in the NYTS in relation to lifetime history of use of tobacco products.
Methods: Nationally representative annual survey of high school students 2017 to 2019. Participants: 10,186 students in 2017, 10,991 in 2018 and 10,097 in 2019.
Measurements: Any use of e-cigarettes in past 30 days, frequent e-cigarette use (>20 of past 30 days) and indicators of tobacco or nicotine dependence (strong craving in past 30 days; wanting to use within 30 minutes of waking) were analysed in relation to lifetime tobacco product use history, ranging from never use through to lifetime smoking of >100 cigarettes.
Results: Past-30-day e-cigarette use increased from 11.7% in 2017 to 20.8% in 2018, and 27.5% in 2019. In 2019 it was reported in 13.3% of those who had never tried any other tobacco product, 30.9% of those who had tried only a non-combustible product (OR 2.9, CI 1.9-4.5), and in 73.8 % of those who had smoked more than 100 cigarettes in their lifetime (OR 18.3, CI 8.4-40.1) Frequent use occurred in 1.0% of otherwise tobacco naive users in 2018 and 2.1% in 2019. Among otherwise tobacco naive past-30-day e-cigarette users in 2019, 8.7% reported craving and 2.9% reported wanting to use within 30 minutes of waking.
Conclusions: While use of e-cigarettes in US high-school students increased sharply between 2017 and 2019, frequent use and signs of e-cigarette dependence remained rare in students who had only ever used e-cigarettes and never any other tobacco product.