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Evidence that an intervention weakens the relationship between adolescent electronic cigarette use and tobacco smoking: a 24-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 Armitage4,
  9. David Meads5,
  10. Laetitia Schmitt6,
  11. Carole Torgerson7,
  12. Robert West5,
  13. Kamran Siddiqi8
  1. 1 School of Psychology, University of Leeds, Leeds, UK
  2. 2 Department of Psychology, Manchester Metropolitan University, Manchester, UK
  3. 3 Faculty of Health Sciences, Staffordshire University, Staffordshire, UK
  4. 4 Psychology, University of Manchester, Manchester, Greater Manchester, UK
  5. 5 Institute of Health Sciences, University of Leeds, Leeds, UK
  6. 6 Academic Centre for Health Economics, University of York, York, UK
  7. 7 Education, Durham University, Durham, Durham, UK
  8. 8 Institute of Health Sciences, University of York, York, North Yorkshire, UK
  1. Correspondence to Professor Mark Conner, School of Psychology, University of Leeds, Leeds LS2 9JT, UK; m.t.conner{at}


Background The electronic cigarette (e-cigarette) use to subsequent smoking relationship in adolescents has received much attention. Whether an intervention to reduce smoking initiation attenuated this relationship was assessed.

Method Data were from 3994 adolescent never smokers (aged 13–14 years at baseline) as part of a cluster randomised controlled trial. Self-report measures of smoking, e-cigarette use and covariates were assessed and used to predict ever smoked cigarettes, any recent tobacco smoking and regularly smoked cigarettes at 24-month follow-up.

Results Baseline ever use of e-cigarettes was associated with ever smoked cigarettes (OR=4.03, 95% CI 3.33 to 4.88; controlling for covariates, OR=2.78, 95% CI 2.20 to 3.51), any recent tobacco smoking (OR=3.38, 95% CI 2.72 to 4.21; controlling for covariates, OR=2.17, 95% CI 1.76 to 2.69) and regularly smoked cigarettes (OR=3.60, 95% CI 2.35 to 5.51; controlling for covariates, OR=1.27, 95% CI 1.17 to 1.39) at follow-up. For ever smoked cigarettes only, the impact of e-cigarette use was attenuated in the intervention (OR=1.83) compared with control (OR=4.53) condition. For ever smoked cigarettes and any recent tobacco smoking, the impact of e-cigarette use was attenuated among those with friends who smoked (OR=2.05 (ever smoked); 1·53 (any tobacco use)) compared with those without friends who smoked (OR=3.32 (ever smoked); 2·17 (any tobacco use)).

Conclusions This is one of the first studies to show that e-cigarette use was robustly associated with measures of smoking over 24 months and the first to show an intervention to attenuate the relationship. Further research with a broader age range of adolescents is required.

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

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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, CA, CT, RW and KS. Acquisition, analysis or interpretation of data: MC, SG, RS-E, KF, BS-M, LC, RL, CA, DM, CT, RW and KS. Drafting of the manuscript: MC and SG. Critical revision of the manuscript for important intellectual content: MC, SG, RL, CA, DM, CT, RW and KS. Statistical analysis: MC and RW. Obtained funding: MC, SG, CA, CT, RW and KS. Administrative, technical or material support: RS-E, KF, BS-M and LC. Study supervision: MC, SG, RL and DM.

  • Funding The research was supported by a grant from the UK Medical Research Council/National Preventive Research Initiative. CA is additionally supported by the National Institue for Health Research Manchester Biomedical Research Centre and the National Insitute of Health Research Greater Manchester Patient Safety Translational Research Centre. All authors report receiving grants from the National Prevention Research Initiative during the study.

  • Disclaimer The UK Medical Research Council had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and the decision to submit the manuscript for publication.The authors of this article affirm that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data availability statement All available data can be obtained by contacting the corresponding author; the study team will retain exclusive use until the publication of major outputs. Data are available upon reasonable request.

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