Longitudinal transitions of exclusive and polytobacco electronic nicotine delivery systems (ENDS) use among youth, young adults and adults in the USA: findings from the PATH Study Waves 1-3 (2013-2016)

Abstract

Objective: Electronic nicotine delivery systems (ENDS; including e-cigarettes) are rapidly evolving in the US marketplace. This study reports cross-sectional prevalence and longitudinal pathways of ENDS use across 3 years, among US youth (12-17 years), young adults (18-24 years) and adults 25+ (25 years and older).

Design: Data were from the first three waves (2013-2016) of the Population Assessment of Tobacco and Health Study, a nationally representative, longitudinal cohort study of US youth and adults. Respondents with data at all three waves (youth, n=11 046; young adults, n=6478; adults 25+, n=17 188) were included in longitudinal analyses.

Results: Weighted cross-sectional ever use of ENDS increased at each wave. Across all three waves, young adults had the highest percentages of past 12-month, past 30-day (P30D) and daily P30D ENDS use compared with youth and adults 25+. Only about a quarter of users had persistent P30D ENDS use at each wave. Most ENDS users were polytobacco users. Exclusive Wave 1 ENDS users had a higher proportion of subsequent discontinued any tobacco use compared with polytobacco ENDS users who also used cigarettes.

Conclusions: ENDS use is most common among young adults compared with youth and adults 25+. However, continued use of ENDS over 2 years is not common for any age group. Health education efforts to reduce the appeal and availability of ENDS products might focus on reducing ENDS experimentation, and on reaching the smaller subgroups of daily ENDS users to better understand their reasons for use.

Keywords: electronic nicotine delivery devices; non-cigarette tobacco products; prevention; surveillance and monitoring.

Figure 1:

Cross-sectional weighted percent of ever, P12M, P30D and daily P30D electronic nicotine delivery systems (ENDS) use among youth, young adults and adults 25+ in W1, W2 and W3 of the Population Assessment of Tobacco and Health (PATH) Study. Abbreviations: P12M = past 12-month; P30D = past 30-day; ENDS* = electronic nicotine delivery system; W1 = Wave 1; W2 = Wave 2; W3 = Wave 3 W1/W2/W3 ever ENDS use unweighted Ns: youth (ages 12–17) = 1,451/1,715/1,930; young adults (ages 18–24) = 3,887/3,968/4,702; adults 25+ (ages 25 and older) = 7,634/8,065/8,634W1/W2/W3 P12M ENDS use unweighted Ns: youth = 1,193/1,130/1,296; young adults = 3,356/2,777/2,802; adults 25+ = 6,062/4,957/3,741W1/W2/W3 P30D ENDS use unweighted Ns: youth = 418/415/454; young adults = 1,516/1,180/1,630; adults 25+ = 2,914/2,199/2,163W1/W2/W3 daily P30D ENDS use unweighted Ns: youth = 20/37/29; young adults =170/240/280; adults 25+ = 619/639/642 X-axis shows four categories of ENDS use (ever, P12M, P30D, and daily P30D). Y-axis shows weighted percentages of W1, W2, and W3 users. Sample analyzed includes all W1, W2, and W3 respondents at each wave. All respondents with data at one wave are included in the sample for that wave's estimate and do not need to have complete data at all three waves. The PATH Study cross-sectional (W1) or single-wave weights (W2 and W3) were used to calculate estimates at each wave. Ever ENDS use is defined as having ever used ENDS, even once or twice in lifetime. P12M ENDS use is defined as any ENDS use within the past 12 months. P30D ENDS use is defined as any ENDS use within the past 30 days. Daily P30D ENDS use is defined as use of ENDS on all 30 of the past 30 days. All use definitions refer to any use that includes exclusive or polytobacco use of ENDS. a denotes significant difference at p<0.0167 (Bonferroni corrected for three comparisons) between W1 and W2 b denotes significant difference at p<0.0167 (Bonferroni corrected for three comparisons) between W1 and W3 c denotes significant difference at p<0.0167 (Bonferroni corrected for three comparisons) between W2 and W3 *Respondents were asked about “e-cigarettes” at W1 and “e-products” (i.e., e-cigarettes, e-cigars, e-pipes, and e-hookah) at W2 and W3. The logit-transformation method was used to calculate the 95% confidence intervals. Analyses were run on the W1, W2, and W3 Public Use Files (https://doi.org/10.3886/ICPSR36498.v8).

Figure 2:

Patterns of W1-W2-W3 persistent any P30D ENDS use, discontinued any P30D ENDS use and reuptake of any P30D ENDS use among W1 any P30D ENDS users. Abbreviations: W1 = Wave 1; W2 = Wave 2; W3 = Wave 3; P30D = past 30-day; ENDS* = electronic nicotine delivery system; CI = confidence interval Wave 1 any P30D ENDS use weighted percentages (95% CI) out of total U.S. population: youth (ages 12–17) = 3.0% (2.6–3.4); young adults (ages 18–25) = 12.5% (11.6–13.5); adults 25+ (ages 25 and older) = 5.8% (5.5–6.1)Analysis included W1 youth, young adults, and adults 25+ P30D ENDS users with data at all three waves. Respondent age was calculated based on age at W1. W3 longitudinal (all-waves) weights were used to calculate estimates. These rates vary slightly from those reported in Figure 1 or Supplemental Table 1 because this analytic sample in Figure 2 includes only those with data at each of the three waves to examine weighted longitudinal use and non-use pathways. Any P30D ENDS use was defined as any ENDS use within the past 30 days. Respondent could be missing data on other P30D tobacco product use and still be categorized into the following three groups:1) Persistent any P30D ENDS use: Defined as exclusive or ENDS polytobacco use at W2 and W3.2) Discontinued any P30D ENDS use: Defined as any non-ENDS tobacco use or no tobacco use at either W2 and W3 or just W3.3) Reuptake of any P30D ENDS use: Defined as discontinued ENDS use at W2 and any ENDS use at W3. a denotes significant difference at p<0.0167 (Bonferroni corrected for three comparisons) between youth and young adults b denotes significant difference at p<0.0167 (Bonferroni corrected for three comparisons) between youth and adults 25+ c denotes significant difference at p<0.0167 (Bonferroni corrected for three comparisons) between young adults and adults 25+ *Respondents were asked about “e-cigarettes” at W1 and “e-products” (i.e., e-cigarettes, e-cigars, e-pipes, and e-hookah) at W2 and W3. The logit-transformation method was used to calculate the 95% CIs. Analyses were run on the W1, W2, and W3 Public Use Files(https://doi.org/10.3886/ICPSR36498.v8).