Changing patterns of cigarette and ENDS transitions in the USA: a multistate transition analysis of youth and adults in the PATH Study in 2015–2017 vs 2017–2019

Abstract

IntroductionIt is unknown how recent changes in the tobacco product marketplace have impacted transitions in cigarette and electronic nicotine delivery system (ENDS) use.MethodsA multistate transition model was applied to 24 242 adults and 12 067 youth in waves 2–4 (2015–2017) and 28 061 adults and 12 538 youth in waves 4 and 5 (2017–2019) of the Population Assessment of Tobacco and Health Study. Transition rates for initiation, cessation and product transitions were estimated in multivariable models, accounting for gender, age group, race/ethnicity and daily versus non-daily product use.ResultsChanges in ENDS initiation/relapse rates depended on age, including among adults. Among youth who had never established tobacco use, the 1-year probability of ENDS initiation increased after 2017 from 1.6% (95% CI 1.4% to 1.8%) to 3.8% (95% CI 3.4% to 4.2%). Persistence of ENDS-only use (ie, 1-year probability of continuing to use ENDS only) increased for youth from 40.7% (95% CI 34.4% to 46.9%) to 65.7% (95% CI 60.5% to 71.1%) and for adults from 57.8% (95% CI 54.4% to 61.3%) to 78.2% (95% CI 76.0% to 80.4%). Persistence of dual use similarly increased for youth from 48.3% (95% CI 37.4% to 59.2%) to 60.9% (95% CI 43.0% to 78.8%) and for adults from 40.1% (95% CI 37.0% to 43.2%) to 63.8% (95% CI 59.6% to 67.6%). Youth and young adults who used both products became more likely to transition to ENDS-only use, but middle-aged and older adults did not.ConclusionsENDS-only and dual use became more persistent. Middle-aged and older adults who used both products became less likely to transition to cigarette-only use but not more likely to discontinue cigarettes. Youth and young adults became more likely to transition to ENDS-only use.

Changing patterns of cigarette and ENDS transitions in the USA: a multistate transition analysis of adults in the PATH Study in 2017–2019 vs 2019–2021

“…In previous work, we had identified dramatic increases in the persistence of ENDS-only and dual use of cigarettes and ENDS around the time of the marketplace shift to pod mod products, including JUUL. 7 Here, we found that many of the transition rates that significantly changed from 2015–17 to 2017–19 did not significantly change again in 2017–19 to 2019–21 (Figure S1), including the non-current to cigarette-only use, cigarette-only to non-current use, ENDS-only to dual use, and dual to cigarette-only use transitions. We did find three significant changes in transition rates from 2017–19 to 2019–21: a decline in never-established to cigarette-only use, an increase in ENDS-only to non-current use, and an increase in dual to ENDS-only use.…”

“…Although this analysis primarily focuses on the differences between 2017–19 and 2019–21, we include previous results in 2015–17 in the supplementary material for comparison purposes (Figures S1–S3). 7…”

“…Each participant’s product use was categorized as never established use (of either product), non-current use, cigarette-only use, ENDS-only use, or dual use of cigarettes and ENDS, as in previous work. 6, 7 Established cigarette use was defined as having smoked at least 100 cigarettes in one’s lifetime, and established ENDS use was defined as ever “fairly regularly” using ENDS. Current use of cigarettes and ENDS was defined as any past 30-day use by an established use of that product, and current dual use was defined as current use of both cigarettes and ENDS by established users of both products.…”

“…In previous work, we analyzed transitions in the Population Assessment of Tobacco and Health (PATH) Study Waves 1-5 (2013-19), a nationally representative longitudinal survey of the US, using a multistate transition model. 6,7 Multistate transition models estimate the transition rates that underly observed transitions between product. [22][23][24][25][26][27][28][29][30][31] In this analysis, we extend our models to compare transitions observed in PATH in 2017-19 to 2019-21.…”

“…S3). 7 Follow-up time for participants was approximately two years between Waves 4 and 5 and between Waves 5 and 6, and follow-up time was treated as exactly two years in the model. The multistate transition framework explicitly accounts for the time between observations and for potential unobserved transitions, so one-year transition probabilities can be estimated from two-year data.…”