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Investigating the added value of biomarkers compared with self-reported smoking in predicting future e-cigarette use: Evidence from a longitudinal UK cohort study
Amy E Taylor
Suzanne H Gage
Marcus R Munafò
Jasmine N Khouja
Rebecca C Richmond
Caroline L Relton
Novel Coronavirus
Acceso Abierto
Introduction Biomarkers can be used to assess smoking behaviour more accurately and objectively than self-report. This study assessed the association between cotinine (a biomarker of smoke exposure) and later e-cigarette use among a population who were unexposed to e-cigarettes in youth. Methods Young people in the Avon Longitudinal Study of Parents and Children took part in the study. We observed associations between cotinine at 15 years (measured between 2006 and 2008 before the wide availability of e-cigarettes) and self-reported ever use of e-cigarettes at 22 (measured between 2014 and 2015 when e-cigarettes were widely available) using logistic regression. A range of potential confounders were adjusted for (age, sex, body mass index, alcohol use and passive smoke exposure). Additionally, we adjusted for the young people's self-reported smoking status/history to explore potential misreporting and measurement error. Results In a sample of N=1,194 young people, cotinine levels consistent with active smoking at 15 years were associated with increased odds of e-cigarette ever use at 22 years (OR=7.24, 95% CI 3.29 to 15.93) even when self-reported active smoking status at age 16 (OR=3.14, 95% CI 1.32 to 7.48) and latent classes of smoking behaviour from 14 to 16 (OR=2.70, 95% CI 0.98 to 7.44) were included in the model. Conclusions Cotinine levels consistent with smoking in adolescence were strongly associated with increased odds of later e-cigarette use, even after adjusting for reported smoking behaviour at age 16 and smoking transitions from 14 to 16. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The UK Medical Research Council and Wellcome (Grant ref: 102215/2/13/2) and the University of Bristol provide core support for ALSPAC. This publication is the work of the authors who will serve as guarantors for the contents of this paper. A comprehensive list of grants funding is available on the ALSPAC website ( The authors are supported by the UK Medical Research Council Integrative Epidemiology Unit at the University of Bristol (MC_UU_00011/7, MM_UU_00011/5). This work was also supported by CRUK (grant numbers C18281/ A19169 and C57854/A22171), Wellcome Trust and the UK Medical Research Council (grant number: 092731). RCR is a de Pass Vice Chancellor Research Fellow at the University of Bristol. ### Author Declarations All relevant ethical guidelines have been followed and any necessary IRB and/or ethics committee approvals have been obtained. Yes All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes Any clinical trials involved have been registered with an ICMJE-approved registry such as and the trial ID is included in the manuscript. Not Applicable I have followed all appropriate research reporting guidelines and uploaded the relevant Equator, ICMJE or other checklist(s) as supplementary files, if applicable. Not Applicable The study website contains details of all the data that is available through a fully searchable data dictionary: Data access is restricted but can be requested via the study website. <> <>
Cold Spring Harbor Laboratory Press
Appears in Collections:Artículos científicos

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