Award Title: ESRC Postdoctoral Fellowship 2020 - Electronic cigarettes: role in smoking cessation and potential risks for children and young people
Funder: Economic and Social Research Council

Abstract: My five specific objectives for the fellowship are to:

1. Publish two additional papers containing further findings from my PhD, one based on my survey data from 2,000 smokers and one using my 46 qualitative interviews with smokers and local stop smoking service (SSS) staff.

2. Take forward a practical implication arising from my PhD by working with colleagues from PHE, ASH and NCSCT to target my relevant findings at key SSS and local authority audiences.

3. Undertake focused, structured training in statistics (LSHTM's 'Statistical Methods in Epidemiology' and 'Advanced Statistical Methods in Epidemiology' modules and UCL's 'Meta-analyses with R' short course) to further cement my quantitative capabilities, and in clinical leadership skills (the Kings Fund's 'Emerging Clinical Leaders' course), to help me create my own research team in the coming years.

4. Build a network of international collaborators to increase my impact and independence as a postdoctoral researcher through mentoring by Professor Martin McKee - who is undoubtedly one of the most effective and prolific creators of collaborations in my field - and through attendance at the two foremost international conferences for tobacco research (the World Conference on Tobacco or Health and the Society for Research on Nicotine & Tobacco Annual Meeting).

5. Develop funding applications, building on my PhD research, to expand my future focus to include the potentially 'game-changing' impact of Juul's recent arrival into the UK e-cigarette marketplace, given this company's products have been shown to be the primary cause of the adolescent 'vaping epidemic' experienced in the United States. This future research would explore the ways in which Juul and other key e-cigarette products are influencing adolescent smoking and vaping habits within England, including whether this varies between youngsters from different sociodemographic backgrounds. Specifically, I aim to apply for an ESRC New Investigator Grant and an NIHR Advanced Fellowship.

Lay Abstract: My PhD investigated why e-cigarettes have proved to hold such a broad appeal across society, and whether this could be at the cost of smokers using more effective ways to try to quit tobacco. E-cigarettes are now by far the most common choice of quit route for smokers who do not wish to simply
go 'cold turkey' when trying to end their addiction to conventional tobacco cigarettes. However, in contrast to the huge rise in e-cigarettes' popularity, attendances at local stop smoking services (SSSs, which offer one-to-one support from trained smoking cessation advisors) have declined for seven
consecutive years. Given these services have repeatedly been shown to be considerably more effective than any other routes for quitting smoking, my PhD sought to better understand whether the rise of e-cigarettes could be influencing this drop in service attendance, as well as investigating what kinds of issues influenced smokers when they were weighing up which quit route to use.

I have already published two papers of PhD findings. My systematic review filled an important research gap by collating the worldwide scientific literature on which demographic groups were most likely to use e-cigarettes. Meanwhile, a qualitative paper with the results of my 46 interviews delineated the complex range of factors that play a role in smokers' decision-making about whether to use quit routes such as e-cigarettes or SSSs. It also highlighted the diverse attitudes towards e-cigarettes shown by different SSSs and how this influenced the kinds of support offered to their clients.

This fellowship would allow me the opportunity to publish two further papers of findings, helping to maximise the potential of my PhD research. The first would be a further quantitative paper showing what kinds of knowledge and beliefs amongst the 2000 smokers that I surveyed were related to their use of
SSSs and e-cigarettes. This would therefore provide a natural complement to my already-published interview findings, giving my research more reach to those audiences who are most comfortable with quantitative analyses. The second would be a further piece of analysis from my qualitative dataset. In
light of my finding that SSSs offer very varying levels of support and advice around e-cigarettes, my second paper would drill down further into my interview data to tease out what the key influences are that determine what policy a service arrives at regarding e-cigarettes. This would thus provide important insights for PHE, ASH, NCSCT and other organisations with an interest in ensuring equal provision of support to smokers in different parts of the country.

Finally, the fellowship would also allow me to develop a funding proposal to move my investigations on to crucial, related research questions in the years following. Specifically, this future bid would involve analysing the impact of 'Juul' e-cigarette devices on vaping and smoking habits amongst children and
young people, an age group whose attitudes and behaviours fundamentally determine the health harms caused by smoking within society. Most smokers, after all, take up the habit in adolescence, when they have less understanding about the tenacity of nicotine addiction; in previous research, 90% of smokers had started by age 18 and 95% by age 21. The manufacturer Juul have dominated the vaping market for years in the US but have only arrived on UK shores much more recently. These specific devices have been shown to be driving the far higher rates of teenage vaping seen in the US but, as yet, their impact on UK youngsters' vaping and smoking habits are unknown. This line of enquiry has been sparked both by my PhD's systematic review, which showed the highest rates of vaping were amongst older adolescents and younger adults, and by my qualitative fieldwork, where younger interviewees often relayed experiences of feeling targeted by e-cigarette marketing or spoke of the popularity of vaping amongst their peer groups.

Research Activity Codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health Categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;RESPIRATORY;STROKE