Background: Adolescent tobacco use remains a major public health concern (World Health Organization, 2024).
In recent years, electronic cigarettes have become a frequent pathway to nicotine initiation, posing new challenges
for traditional school-based tobacco prevention strategies.
Methods: A repeated cross-sectional observational study was conducted with 5,658 students aged 11 to 18 years
from secondary schools in Burgos (Spain), corresponding to six academic cohorts between 2010 and 2023. The
study was carried out within the framework of a universal school-based prevention program targeting tobacco
and electronic cigarette use, delivered during the first year of compulsory secondary education. Following the
intervention, students voluntarily and anonymously completed an evaluation questionnaire. Trends in experimentation
across cohorts and associations between self-reported program participation and psychosocial and
program evaluation variables were examined using logistic regression models and interpreted as observational
associations without causal attribution.
Results: Experimentation with conventional cigarettes showed a marked decline in the earlier cohorts and a
subsequent stabilization in more recent years. Electronic cigarette use was assessed from 2021 onwards, with
relevant prevalence levels observed in the most recent cohorts. In the subsample with detailed consumption data
(n = 2,206), electronic cigarettes were the most commonly used product in the past 30 days (10.4%), followed by
conventional cigarettes (7.2%).
Social exposure to tobacco use was high, with more than 80% of students reporting at least one smoker in their
immediate environment. In bivariate regression analyses, self-reported participation in the program was associated
with experimentation with electronic cigarettes (OR = 0.66; p = 0.006), although this association did not
remain significant after adjustment for age, gender, school type, and social exposure. By contrast, program
participation showed consistent associations with indicators of program evaluation, including positive appraisal
of the sessions (AOR = 5.25; 95% CI: 3.85–7.16) and discussion of program content within the family (OR =
1.92; p < 0.001).
Conclusions: In this repeated cross-sectional series, adolescent use patterns were characterized by the increasing
prominence of electronic cigarettes. Self-reported program participation was associated with indicators of
engagement and appraisal, which should be interpreted within the limits of the observational design. Overall, the
findings highlight the relevance of prevention approaches that
