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Do electronic cigarettes increase cigarette smoking in UK adolescents? Evidence from a 12-month prospective study
  1. Mark Conner1,
  2. Sarah Grogan2,
  3. Ruth Simms-Ellis1,
  4. Keira Flett3,
  5. Bianca Sykes-Muskett1,
  6. Lisa Cowap3,
  7. Rebecca Lawton1,
  8. Christopher J Armitage4,
  9. David Meads5,
  10. Carole Torgerson6,
  11. Robert West5,
  12. Kamran Siddiqi7
  1. 1 School of Psychology, University of Leeds, Leeds, UK
  2. 2 Department of Psychology, Manchester Metropolitan University, Manchester, UK
  3. 3 Centre for Health Psychology, The Science Centre, Staffordshire University, Stoke-on-Trent, UK
  4. 4 Division of Psychology and Mental Health, Manchester Centre for Health Psychology, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
  5. 5 Institute of Health Sciences, University of Leeds, Leeds, UK
  6. 6 School of Education, Durham University, Durham, UK
  7. 7 Department of Health Sciences, University of York, York, UK
  1. Correspondence to Professor Mark Conner, School of Psychology, University of Leeds, Leeds LS2 9JT, UK,; m.t.conner{at}


Background In cross-sectional surveys, increasing numbers of adolescents report using both electronic cigarettes (e-cigarettes) and cigarettes. This study assessed whether adolescent e-cigarette use was associated prospectively with initiation or escalation of cigarette use.

Methods Data were from 2836 adolescents (aged 13–14 years at baseline) in 20 schools in England. At baseline, breath carbon monoxide levels, self-reported e-cigarette and cigarette use, sex, age, friends and family smoking, beliefs about cigarette use and percentage receiving free school meals (measure of socioeconomic status) were assessed. At 12-month follow-up, self-reported cigarette use was assessed and validated by breath carbon monoxide levels.

Results At baseline, 34.2% of adolescents reported ever using e-cigarettes (16.0% used only e-cigarettes). Baseline ever use of e-cigarettes was strongly associated with subsequent initiation (n=1726; OR 5.38, 95% CI 4.02 to 7.22; controlling for covariates, OR 4.06, 95% CI 2.94 to 5.60) and escalation (n=318; OR 1.91, 95% CI 1.14 to 3.21; controlling for covariates, this effect became non-significant, OR 1.39, 95% CI 0.97 to 1.82) of cigarette use.

Conclusions This is the first study to report prospective relationships between ever use of e-cigarettes and initiation and escalation of cigarette use among UK adolescents. Ever use of e-cigarettes was robustly associated with initiation but more modestly related to escalation of cigarette use. Further research with longer follow-up in a broader age range of adolescents is required.

  • electronic nicotine delivery systems
  • e-cigarettes
  • smoking
  • harm reduction
  • prevention

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  • Contributors MC had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: MC, SG, RL, CJA, CT, RW and KS . Acquisition, analysis or interpretation of data: MC, SG, RSE, KF, BSM, LC, RL, CJA, DM, CT, RW and KS . Drafting of the manuscript: MC and SG. Critical revision of the manuscript for important intellectual content: MC, SG, RL, CJA, DM, CT, RW and KS. Statistical analysis: RW and MC. Obtained funding: MC, SG, CJA, CT, RW and KS. Administrative, technical or material support: RS-E, KF, BSM and LC. Study supervision: MC, SG, RL and DM.

  • Competing interests All authors report receiving grants from the National Prevention Research Initiative during the study. The authors have no conflicts of interest.

  • Patient consent Guardian consent obtained.

  • Ethics approval Faculty of Medicine, University of Leeds, UK, ethical review committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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