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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)
  1. Cassandra A Stanton1,2,
  2. Eva Sharma1,
  3. Kathryn C Edwards1,
  4. Michael J Halenar1,
  5. Kristie A Taylor1,
  6. Karin A Kasza3,
  7. Hannah Day4,
  8. Gabriella Anic4,
  9. Lisa D Gardner4,
  10. Hoda T Hammad4,
  11. Maansi Bansal-Travers3,
  12. Jean Limpert4,
  13. Nicolette Borek4,
  14. Heather L Kimmel5,
  15. Wilson M Compton5,
  16. Andrew Hyland3
  1. 1 Behavioral Health and Health Policy Practice, Westat, Rockville, MD, USA
  2. 2 Department of Oncology, Georgetown University Medical Center, Washington, DC, United States
  3. 3 Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
  4. 4 Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, United States
  5. 5 National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, United States
  1. Correspondence to Dr Cassandra A Stanton, Behavioral Health and Health Policy, Westat, Rockville, MD 20850, USA; cassandrastanton{at}


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.

  • electronic nicotine delivery devices
  • non-cigarette tobacco products
  • prevention
  • surveillance and monitoring
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  • Contributors CAS and ES led the conceptual design. CAS drafted initial manuscript and all authors critically revised it. ES and MJH conducted statistical analysis and all authors contributed to interpretation of results. All authors approved the work for journal publication and agree to be accountable for all aspects of the work.

  • Funding This manuscript is supported with federal funds from the National Institute on Drug Abuse, National Institutes of Health, and the Center for Tobacco Products, Food and Drug Administration, Department of Health and Human Services, under a contract to Westat (Contract No HHSN271201100027C).

  • Disclaimer The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Department of Health and Human Services or any of its affiliated institutions or agencies.

  • Competing interests WMC reports long-term stock holdings in General Electric Company, 3M Company, and Pfizer Incorporated, unrelated to this manuscript. No financial disclosures were reported by the other authors of this paper.

  • Patient consent for publication Not required.

  • Ethics approval The study was conducted by Westat and approved by the Westat Institutional Review Board. All participants ages 18 and older provided informed consent, with youth participants ages 12 to 17 providing assent while their parent/legal guardian provided consent.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement Data from the PATH Study Wave 1 to Wave 3 are available for download as Public Use Files in a public, open access repository ( Conditions of use are available at the website above.

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