Abstract
Background and Aims
E-cigarettes can aid smoking cessation and reduce carcinogen exposure. Understanding differences in characteristics between young adults who quit smoking, with or without e-cigarettes, or dual use can help tailor interventions. The aim of this study was to describe first transitions from smoking and explore substance use, sociodemographic, and health characteristic associations with the probability of each possible first transition from smoking.
Design and Setting
Longitudinal birth cohort data from the Avon Longitudinal Study of Parents and Children (ALSPAC), conducted in the United Kingdom.
Participants
A total of 858 participants were included who reported tobacco smoking in the past month at age 21 during a questionnaire collected in 2013.
Measurements
The first reported non-exclusive smoking event following smoking, observed approximately annually between ages 22 and 30, was categorized as either no nicotine use, exclusive e-cigarette use, or dual use. Discrete-time subdistribution hazard models were used to examine associations between different covariates, including substance use, sociodemographic, and health characteristics, with the probability of each first transition from smoking. Analyses were adjusted for early-life confounders and weighted to mitigate bias.
Findings
Among participants, 52% stopped nicotine use, 27% reported dual use, and 9% used e-cigarettes exclusively. Smoking weekly or more (Subdistribution Hazard Ratio [SHR] = 0.28, 95% Confidence Interval [CI] = 0.22–0.35), having many friends who smoke (SHR = 0.64, 95% CI = 0.50–0.81), and lower education (SHR = 0.68, 95% CI = 0.52–0.90) reduced the likelihood of no nicotine use and increased dual use (frequent smoking SHR = 3.00, 95% CI = 1.96–4.59; peer smoking SHR = 1.55, 95% CI = 1.07–2.24; education SHR = 1.72, 95% CI = 1.03–2.90). Cannabis use (SHR = 0.67, 95% CI = 0.49–0.92), drug use (SHR = 0.77, 95% CI = 0.59–0.99), less exercise (SHR = 0.71, 95% CI = 0.53–0.95), and early parenthood (SHR = 0.46, 95% CI = 0.27–0.79) reduced no nicotine use. Higher BMI (SHR = 1.58, 95% CI = 1.08–2.31) increased dual use.
Conclusions
In the United Kingdom, young adults who smoke frequently, have more smoking peers, have lower education, engage in drug use, exercise less, or become parents early appear to be less likely to stop nicotine use than other young adults who smoke. Frequent smoking, peer smoking, lower education, and higher body mass index also appear to be associated with increased dual use of cigarettes and e-cigarettes.
E-cigarettes can aid smoking cessation and reduce carcinogen exposure. Understanding differences in characteristics between young adults who quit smoking, with or without e-cigarettes, or dual use can help tailor interventions. The aim of this study was to describe first transitions from smoking and explore substance use, sociodemographic, and health characteristic associations with the probability of each possible first transition from smoking.
Design and Setting
Longitudinal birth cohort data from the Avon Longitudinal Study of Parents and Children (ALSPAC), conducted in the United Kingdom.
Participants
A total of 858 participants were included who reported tobacco smoking in the past month at age 21 during a questionnaire collected in 2013.
Measurements
The first reported non-exclusive smoking event following smoking, observed approximately annually between ages 22 and 30, was categorized as either no nicotine use, exclusive e-cigarette use, or dual use. Discrete-time subdistribution hazard models were used to examine associations between different covariates, including substance use, sociodemographic, and health characteristics, with the probability of each first transition from smoking. Analyses were adjusted for early-life confounders and weighted to mitigate bias.
Findings
Among participants, 52% stopped nicotine use, 27% reported dual use, and 9% used e-cigarettes exclusively. Smoking weekly or more (Subdistribution Hazard Ratio [SHR] = 0.28, 95% Confidence Interval [CI] = 0.22–0.35), having many friends who smoke (SHR = 0.64, 95% CI = 0.50–0.81), and lower education (SHR = 0.68, 95% CI = 0.52–0.90) reduced the likelihood of no nicotine use and increased dual use (frequent smoking SHR = 3.00, 95% CI = 1.96–4.59; peer smoking SHR = 1.55, 95% CI = 1.07–2.24; education SHR = 1.72, 95% CI = 1.03–2.90). Cannabis use (SHR = 0.67, 95% CI = 0.49–0.92), drug use (SHR = 0.77, 95% CI = 0.59–0.99), less exercise (SHR = 0.71, 95% CI = 0.53–0.95), and early parenthood (SHR = 0.46, 95% CI = 0.27–0.79) reduced no nicotine use. Higher BMI (SHR = 1.58, 95% CI = 1.08–2.31) increased dual use.
Conclusions
In the United Kingdom, young adults who smoke frequently, have more smoking peers, have lower education, engage in drug use, exercise less, or become parents early appear to be less likely to stop nicotine use than other young adults who smoke. Frequent smoking, peer smoking, lower education, and higher body mass index also appear to be associated with increased dual use of cigarettes and e-cigarettes.
| Original language | English |
|---|---|
| Journal | Addiction (Abingdon, England) |
| Early online date | 13 May 2025 |
| DOIs | |
| Publication status | E-pub ahead of print - 13 May 2025 |
Bibliographical note
Publisher Copyright:© 2025 The Author(s). Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.
Data Availability Statement
Data used in this project and any resulting data from the analyses are available on request to the ALSPAC Executive Committee ([email protected]) and subject to a data access fee. Study data were collected and managed using REDCap electronic data capture tools hosted at the University of Bristol [68]. The study website contains details of available data through a fully searchable data dictionary and variable search tool: http://www.bristol.ac.uk/alspac/researchers/our-data/.Ethical approval for the study was obtained from the ALSPAC Law and Ethics Committee and Local Research Ethics Committees (NHS Haydock REC: 10/H1010/70). Informed consent for the use of data collected via questionnaires and clinics was obtained from participants following the recommendations of the ALSPAC Ethics and Law Committee at the time. Consent for biological samples has been collected in accordance with the Human Tissue Act (2004). Data access for this project was granted (B3499/B4347) before this study. Datasets were created using syntax templates from the 25 January 2024.
The proposed analysis of data was pre-registered on the Open Science Framework (OSF) here: https://osf.io/nuz5b. Deviations from this pre-registration are described in Text S6. The code used for data analysis is available in a github repository here: https://github.com/alexandrayas/ALSPAC_CRUK_smkvap/tree/main/Transitions%20from%20smoking.
Funding
This work was supported by Cancer Research United Kingdom (UK) (PRCPJT-May21\100007); the Cancer Research UK Integrative Cancer Epidemiology Programme (C18281/A29019); and the Medical Research Council and University of Bristol Integrative Epidemiology Unit (MC_UU_00032/2 and MC_UU_00032/7). The UK Medical Research Council and Wellcome (217065/Z/19/Z) and the University of Bristol provide core support for ALSPAC. A comprehensive list of grants funding is available on the ALSPAC website (http://www.bristol.ac.uk/alspac/external/documents/grant-acknowledgements.pdf). This publication is the work of the authors and will serve as guarantors for the contents of this paper.
| Funders | Funder number |
|---|---|
| Medical Research Council | MC_UU_00032/2 , MC_UU_00032/7 |
Keywords
- ALSPAC
- e-cigarettes
- epidemiology
- participant characteristics
- risk factors
- smoking cessation
- young adults
ASJC Scopus subject areas
- Medicine (miscellaneous)
- Psychiatry and Mental health
