Cause and effect with vaping and smoking

Browsing through my colleague David McGeorge's latest round-up of research into young people and health (, I came across a paper about how e-cigarettes and tobacco cigarettes may be adopted by young people (
The message from the manufacturers has been that e-cigarettes are intended only to help adult smokers of tobacco cigarettes to quit.  Nonetheless, there have been concerns that e-cigarettes are being adopted by young people who don't use tobacco cigarettes, and might even be a route to trying tobacco cigarettes later.  This has now been shown to happen, and this latest research is a contribution to our understanding of how this works in at least one group of young people.
What can we learn from SHEU surveys?
A question that we have tried in a couple of local authority surveys is this one:

11. Have you ever tried vaping or smoking?

Vaping - includes using an electronic cigarette, e-cig, shisha pen, hookah pen 
Smoking - includes roll-ups & ready-made cigarettes.
Please select one answer

(_) Both
(_) Smoking
(_) Vaping
(_) Neither

(and if they answer Both...)

12. Smoking and Vaping: Which did you try first?

(_) Vaping
(_) Smoking
(_) I tried smoking and vaping at about the same time
(_) I don't remember

This relies on self-report and memory, so is not as good as a longitudinal study of the sort we have just seen, but the answers are interesting nonetheless.

The results looked like this:

    Vaping first      Smoking first I tried smoking and vaping
at about the same time
Other responses/
Area 1 Year 8 20% 44% 7% 29%
  Year 10 22% 59%   7% 11%
Area 2 Year 8 45% 12% 0% 43%
  Year 10 49% 22% 4% 25%

The mix of causes and effects and possible pathways cannot be shown here, but some important points are:

  • where a student has used both e-cigarettes and tobacco, vaping can precede tobacco use (both areas)
  • vaping can precede tobacco use more often than the other way around (area 2 only)
  • young people in different communities may have very different patterns of adoption




Comments about SHEU

"Over the last twenty years you have achieved much. The surveys and subsequent reports have painted the clearest picture we have of what young people are doing and what they think." Tribute from OFSTED to John Balding, presented at his retirement lunch, May 2005


"The data from the 2018/19 survey is still in heavy use here, the physical activity related findings were pivotal in changing the relevant strategy recently to target less active groups like girls towards the end of secondary school, and I’ve three fairly hefty jobs on the to-do list that will use the data with other sources to identify target schools for mental health and physical activity projects, and another looking at community safety. I call it the gift that keeps giving and that certainly seems to be the case!"

Senior Public Health Specialist (Intelligence)

"I really appreciate the professional service which SHEU offers.  We have had a great experience working with Angela on the school surveys." 

Health Improvement Specialist

"One year (following the SHEU survey) responses from our Year 4 cohort caused us concern, so we put in place a number of team building, motivational projects. We then assessed their effectiveness by requesting the SHEU questionnaires for these pupils as Year 5's."

Learning Mentor

"I really think that the HRBQ is a wonderful piece of work in terms of getting useful information for so many different organisations in one go." Healthy Children's Research and Statistics Officer

Research and Statistics Officer

"I have valued greatly the work I have done with the team in Exeter, it has been a highlight of my years here." Health Promotion Specialist

Health Promotion Specialist

"You have made a fantastic contribution to children’s health education and promotion. I am personally grateful to you for helping to kickstart my research career." Prof. Neil Armstrong tribute to John Balding, presented at his retirement lunch, May 2005

Prof Neil Armstrong

"The Unit has a unique historical and contemporary archive of young people." Prof. Ted Wragg 1938-2005

Prof Ted Wragg, 1938-2005

"Within the curriculum, we are part of the Healthy Schools programme - and the local, Director of Public Health Award. We cover many facets of health from emotional intelligence to safety education and our very strong, Anti-Bullying and Child Protection programmes. You can imagine our delight when the Local Authority and our school nurse made the following comments after we took part in the regional Schools Health Education Unit Survey: " Head Teacher.
“This was an amazing set of outcomes and really good evidence that (your school) is doing a wonderful job in prioritizing the health and well-being of its pupils … Well done to staff, governors and parents for all your work on this through the Director of Public Health award and other strategies. It is very clear that pupils feel happy, safe and involved at the school and your caring ethos shines through this data.”
Healthy Schools Coorduinator.


Headteacher & Healthy Schools Coordinator

"As a result of the survey we reviewed and amended PSHE schemes of work, we are currently working on a "Green Travel Plan", a morning breakfast club was established and we further developed 6th Form mentoring."

Health Education Coordinator