Prof. Luke Clancy TobaccoFree Research Institute Ireland (TFRI) TU Dublin Email: lclancy@tri.ie Website: www.tri.ie Prevalence of smoking in 16-year olds in Ireland in 2019 has increased for the first time since 1995. E-cigarette ever-use and current use associated with increased teen smoking. Tobacco Free Ireland’s endgame strategy is under threat. TobaccoFree Ireland endgame threatened by increase in Smoking and E-cigarette use among Adolescents Salome Sunday MPH, Joan Hanafin PhD, Luke Clancy, MD, PhD TobaccoFree Research Institute Ireland, TU Dublin, www.tri.ie 21st SRNT-Europe Annual Conference, September 15-17 2021 | Virtual Current smoking increased significantly in 2019 compared to 2015 with an adjusted odds ratio (AOR of 1.64 (CI 1.13,2.39)) for boys. This was accompanied by an increase in ever-used e- cigarettes AOR of 2.06 (CI 1.50,2.83) overall with a greater increase in AOR for girls. Mother’s education at college /university level was also associated with an increased AOR of 2.30 (CI 1.14,4.65) for boys but not for girls and father’s education was not significant. Truancy was also significantly linked with current smoking AOR 5.31 (CI 3.21,8.78) and the highest association was with easy access to cigarettes AOR 6.40 (CI 4.16,9.86) Ever-smoking slightly reduced overall but ever e-cigarette use was positively linked with ever smoking In boys and girls. Mother’s higher education was also linked positively with ever-smoking but only in boys. Access to cigarettes was also the highest association with ever-smoking AOR 4.39 (CI 3.43,5.6) This trend analysis showed an association between adolescent cigarette smoking and perceived risk, truancy, and peer smoking, factors which did not deteriorate between 2015 and 2019. While access to cigarettes was the strongest association the negative impact which observed increased youth e-cigarette use had on teenage cigarette smoking is worrying. In Ireland, as in many European countries, teenage smoking has declined from the very high prevalence of the 1990s. Prevalence of current smoking decreased significantly between 1995 and 2019 from 32% to 20% (1,2) in ESPAD countries and from 41% in 1995 to 13% in 2015 in Ireland (3), accounted for by tobacco control measures (4). But in 2019 Irish teenage boys’ smoking increased (2). We attempt to explain this unexpected finding by looking at two comparable (ESPAD) samples from 2015 and 2019. INTRODUCTION METHODS AND MATERIALS CONCLUSIONS RESULTS REFERENCES WHAT THIS STUDY ADDS CONTACT 1. Hanafin J, Sunday S, Keogan S, Clancy L. Gender difference results in increase in adolescent smoking in 2019 in Ireland- European trend analysis of current smoking prevalence 1995-2019. Irish Journal of Medical Science. 2021 Jan 7;190:3.11. 2. Sunday S, Keogan S, Hanafin J, Clancy L. ESPAD 2019: European Schools Project on Alcohol and Other Drugs in Ireland. Dublin: TFRI; 2020. 3. Li S, Keogan S, Taylor K, Clancy L. Decline of adolescent smoking in Ireland 1995-2015: trend analysis and associated factors. BMJ Open. 2018 Apr 27;8(4):e020708–e020708. 4. Li S, Keogan S, Clancy L. Does smoke-free legislation work for teens too? A logistic regression analysis of smoking prevalence and gender among 16 years old in Ireland, using the 1995–2015 ESPAD school surveys. BMJ Open. 2020 Aug 1;10(8):e032630. TFRI for the Department of Health, Ireland.; 2016. • The ESPAD (European School Survey Project on Alcohol and other Drugs survey is a cross-sectional survey conducted every four years in 35 European countries with the aim of collecting comparable data on substance use among students aged 15–16 years in Europe. Data • We used data from two waves (2015 and 2019) of the Irish arm of the ESPAD survey. Our sample for this study comprised 1,493 students in 2015 and 1,949 students in 2019. Sample • A multivariable logistic regression analysis was performed to examine the prevalence of smoking, and to understand the factors associated with the change in adolescent smoking. A