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Longitudinal pathways of exclusive and polytobacco smokeless use among youth, young adults and adults in the USA: findings from the PATH Study Waves 1–3 (2013–2016)
  1. Eva Sharma1,
  2. Kathryn C Edwards1,
  3. Michael J Halenar1,
  4. Kristie A Taylor1,
  5. Karin A Kasza2,
  6. Hannah Day3,
  7. Lisa D Gardner3,
  8. Gabriella Anic3,
  9. Maansi Bansal-Travers2,
  10. Jean Limpert3,
  11. Hoda T Hammad3,
  12. Nicolette Borek3,
  13. Heather L Kimmel4,
  14. Wilson M Compton4,
  15. Andrew Hyland2,
  16. Cassandra A Stanton1,5
  1. 1 Behavioral Health and Health Policy Practice, Westat, Rockville, MD, United States
  2. 2 Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
  3. 3 Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, United States
  4. 4 National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, United States
  5. 5 Department of Oncology, Georgetown University Medical Center, Washington, DC, United States
  1. Correspondence to Dr Eva Sharma, Behavioral Health and Health Policy, Westat Inc, Rockville, MD 20850, USA; EvaSharma{at}


Objective Use of smokeless tobacco (SLT) with other tobacco products is growing, yet gaps in understanding transitions among SLT and other product use remain. The aim of this study is to examine cross-sectional prevalence and longitudinal pathways of SLT use among US youth (12–17 years), young adults (18–24 years) and adults 25+ (25 years and older).

Design Data were drawn 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 Young adults had the highest current SLT use compared with other age groups. Among Wave 1 (W1) past 30-day youth and young adult SLT users, most were SLT and cigarette polytobacco users compared with adults 25+, who more often used SLT exclusively. Among W1 exclusive SLT users, persistent exclusive use across all three waves was more common among adults 25+, while transitioning from exclusive SLT use to SLT polytobacco use at Wave 2 or Wave 3 was more common among youth and young adults. Among W1 SLT and cigarette polytobacco users, a common pathway was discontinuing SLT use but continuing other tobacco use.

Conclusions Our results showed distinct longitudinal transitions among exclusive and SLT polytobacco users. Deeper understanding of these critical product transitions will allow for further assessment of population health impact of these products.

  • prevention
  • non-cigarette tobacco products
  • surveillance and monitoring
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  • Contributors ES and CAS led the conceptual design. ES 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).

  • 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 aged 18 and older provided informed consent, with youth participants aged 12–17 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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