Youth Patterns of Use of Electronic Nicotine Delivery Systems (ENDS) Use, Population Assessment of Tobacco and Health (PATH) Waves 4 – 5.5

Abstract

INTRODUCTION: Youth use of electronic nicotine delivery systems (ENDS) is a continuing concern, making it important to assess evolving patterns, especially as non-tobacco, non-menthol (NTM) flavors were withdrawn for pod-based (but not disposable) ENDS in February 2020. METHODS: Trends in past-30-day (P30D) ENDS use and smoking prevalence, usual device type, flavor (tobacco, mint/menthol, or fruit/sweet/other), and regular/last-used brand in PATH Waves 4 (2017), 4.5 (2018), 5 (2019), and 5.5 (2020) were examined. Shifts between 2019-2020 in flavor use for pods and disposables were examined. Wave 5.5 is uninformative regarding brand use because common disposable brands were not queried. RESULTS: P30D ENDS use peaked in 2019 at 8.6% of all youth, subsequently declining by nearly half to 4.5% in 2020. Meanwhile, P30D cigarette smoking declined to an all-time low (1.3%) in 2020. Within this overall decline, consumption shifted to disposable ENDS, which increased nearly 10-fold (from 5.0% to 49.2% of P30D ENDS users). Relatedly, use of fruit/sweet/other flavors remained similar overall between 2019 and 2020 (approximately 75%-80% of P30D ENDS users), but the use of these flavors became concentrated in disposable ENDS in 2020 (a 12-fold increase from 4.4% to 58.4% of fruit/sweet/other-flavor users). CONCLUSIONS: PATH results show similar trends to other US national surveys in youth ENDS trends. The removal of non-tobacco, non-menthol flavors in pod-based ENDS (while remaining available in disposables) has likely driven youth towards disposable devices, resulting in continued high use of fruit/sweet/other flavors, which are now predominant in users of disposable ENDS.