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Relationship between trying an electronic cigarette and subsequent cigarette experimentation in Scottish adolescents: a cohort study
  1. Catherine Best1,
  2. Farhana Haseen2,
  3. Dorothy Currie2,
  4. Gozde Ozakinci3,
  5. Anne Marie MacKintosh4,
  6. Martine Stead4,
  7. Douglas Eadie4,
  8. Andy MacGregor5,
  9. Jamie Pearce6,
  10. Amanda Amos7,
  11. John Frank7,
  12. Sally Haw1
  1. 1 Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
  2. 2 Child and Adolescent Health Research Unit, School of Medicine, University of St Andrews, St Andrews, UK
  3. 3 School of Medicine, University of St Andrews, St Andrews, UK
  4. 4 Institute for Social Marketing, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
  5. 5 ScotCen Social Research, Edinburgh, UK
  6. 6 Centre for Research on Environment Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK
  7. 7 The Usher Institute of Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Catherine Best, Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, UK; catherine.best2{at}


Background This study examines whether young never smokers in Scotland, UK, who have tried an e-cigarette are more likely than those who have not, to try a cigarette during the following year.

Methods Prospective cohort survey conducted in four high schools in Scotland, UK during February/March 2015 (n=3807) with follow-up 1 year later. All pupils (age 11–18) were surveyed. Response rates were high in both years (87% in 2015) and 2680/3807 (70.4%) of the original cohort completed the follow-up survey. Analysis was restricted to baseline ‘never smokers’ (n=3001/3807), 2125 of whom were available to follow-up (70.8%).

Results At baseline, 183 of 2125 (8.6%) never smokers had tried an e-cigarette and 1942 had not. Of the young people who had not tried an e-cigarette at baseline, 249 (12.8%) went on to try smoking a cigarette by follow-up. This compares with 74 (40.4%) of those who had tried an e-cigarette at baseline. This effect remained significant in a logistic regression model adjusted for smoking susceptibility, having friends who smoke, family members’ smoking status, age, sex, family affluence score, ethnic group and school (adjusted OR 2.42 (95% CI 1.63 to 3.60)). There was a significant interaction between e-cigarette use and smoking susceptibility and between e-cigarette use and smoking within the friendship group.

Conclusions Young never smokers are more likely to experiment with cigarettes if they have tried an e-cigarette. Causality cannot be inferred, but continued close monitoring of e-cigarette use in young people is warranted.

  • Electronic Nicotine Delivery Devices
  • Denormalization
  • Priority/special Populations

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • Contributors CB conducted the analysis and wrote the first draft of the paper, DC, GO and FH managed the administration of the school survey, data cleaning and analysis and commented on the development of the paper, DE, MS, AMMK, JP, AA, AM and JF were coinvestigators responsible for devising the overall study design and commented on the development of the paper, SH is principal investigator for the DISPLAY study and was involved in devising the overall study, drafting and revising this paper and is its guarantor.

  • Funding This project was funded by the UK National Institute for Health Research (NIHR) PHR project 10/3000/07. The study sponsor had no influence on study design and the collection, analysis, and interpretation of data and the writing of the article and the decision to submit it for publication.

  • Competing interests None declared.

  • Ethics approval University of St Andrews, School of Medicine Ethics Committee.

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

  • Data sharing statement Anonymised data from this study will be made publically available after the end of the study (December 2017). Stata syntax is available from the corresponding author on request.

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