National longitudinal tobacco product discontinuation rates among US youth from the PATH Study: 2013-2019 (waves 1-5)

Abstract

Objective: Determine longitudinal tobacco product discontinuation rates among youth (ages 12-17 years) in the USA between 2013 and 2019.

Methods: The Population Assessment of Tobacco and Health Study, a nationally representative, longitudinal cohort study, was used to determine annual/biennial rates of tobacco product discontinuation behaviours among youth across 2013-2019: (1) discontinuing product use (transition from past 30-day use to no past 30-day use), (2) attempting to quit product use and (3) discontinuing product use among those who attempted to quit. Discontinuing use was evaluated separately for cigarettes, electronic nicotine delivery systems (ENDS), cigars, hookah, smokeless tobacco and any tobacco. Attempting to quit and discontinuing use among those who attempted were each evaluated for cigarettes and ENDS. Generalised estimating equations were used to evaluate linear and non-linear trends in rates across the study period.

Results: Between 2013 and 2019, biennial rates of discontinuing tobacco product use among youth increased for cigarettes from 29% to 40%, increased for smokeless tobacco from 39% to 60%, and decreased for ENDS from 53% to 27%. By 2018/2019, rates of discontinuing use among attempters were 30% for those who used ENDS and 30% for those who smoked cigarettes.

Conclusions: Findings show decreasing rates of discontinuing ENDS use among youth in the USA alongside the changing ENDS marketplace and increasing rates of discontinuing cigarette smoking and smokeless tobacco use. Findings will serve as benchmarks against which future tobacco product discontinuation rates can be compared with evaluating impacts of subsequent tobacco regulatory policies, ENDS product development and public education campaigns.

Keywords: Cessation; Electronic nicotine delivery devices; Non-cigarette tobacco products; Prevention; Surveillance and monitoring.

Figure 1

Discontinuing past 30-day use among those ages 12–17 years at baseline wave. ‘Any tobacco’ refers to use of cigarettes, ENDS, any cigars (ie, traditional cigars, cigarillos and filtered cigars), hookah, or any smokeless tobacco (ie, loose snus, moist snuff, dip, spit, chewing tobacco and snus pouches). (A) Weighted annual rates of discontinuing past 30-day use: significant linear trends were found for any tobacco and cigarettes; a significant non-linear trend was found for any tobacco. (B) Weighted biennial rates of discontinuing past 30-day use to include the 2016/2017–2018/2019 (W4–W5) interval: significant linear trends were found for any tobacco, cigarettes, ENDS and any smokeless tobacco; significant non-linear trends were found for any tobacco and ENDS. Hookah 2016/2017–2018/2019 estimate should be interpreted with caution because it has low statistical precision. It is based on a denominator sample size of less than 50, or the coefficient of variation of the estimate or its complement is larger than 30%. ENDS, electronic nicotine delivery system; PATH, Population Assessment of Tobacco and Health; W, wave.

Figure 2

Making a quit attempt among those ages 12–17 years at baseline wave. (A) Weighted annual rates of making a quit attempt: there were no significant linear or non-linear trends found. ENDS data for W1–W2 were not included due to key changes in the questionnaire. (B) Weighted biennial rates of making a quit attempt to include the 2016/2017–2018/2019 (W4–W5) interval: a significant linear trend was found for ENDS; a significant non-linear trend was found for ENDS. ENDS, electronic nicotine delivery system; PATH, Population Assessment of Tobacco and Health; W, wave.

Figure 3

Discontinuing use among attempters ages 12–17 years at baseline wave. (A) Weighted annual rates of discontinuing use among attempters: there were no significant linear or non-linear trends found. ENDS data for W1–W2 were not included due to key changes in the questionnaire. (B) Weighted biennial rates of discontinuing use among attempters to report on the 2016/2017–2018/2019 (W4–W5) interval: there were no significant linear or non-linear trends found. ENDS, electronic nicotine delivery system; PATH, Population Assessment of Tobacco and Health; W, wave.