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Initiation of any tobacco and five tobacco products across 3 years 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. Elizabeth L Seaman1,
  4. Karin A Kasza3,
  5. Kathryn C Edwards1,
  6. Michael J Halenar1,
  7. Kristie A Taylor1,
  8. Hannah Day4,
  9. Gabriella Anic4,
  10. Lynn C Hull4,
  11. Maansi Bansal-Travers3,
  12. Jean Limpert4,
  13. Lisa D Gardner4,
  14. Hoda T Hammad4,
  15. Nicolette Borek4,
  16. Heather L Kimmel5,
  17. Wilson M Compton5,
  18. Andrew Hyland3
  1. 1 Behavioral Health and Health Policy Practice, Westat, Rockville, MD, United States
  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 This study reports weighted cross-sectional prevalence of never use of tobacco, and longitudinal past 12-month (P12M), past 30-day (P30D) and frequent P30D any tobacco or specific tobacco product initiation across three 1-year waves. Longitudinal three-wave pathways are examined to outline pathways of exclusive and polytobacco initiation, as well as pathways of new initiators of electronic nicotine delivery systems (ENDS) or cigarettes.

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 Across the three age groups, weighted cross-sectional analyses revealed never any tobacco use decreased each year from 2013 to 2016, reflecting overall increases in tobacco initiation in the population during this time. Compared with cigarettes, cigars, hookah and smokeless tobacco, ENDS had the highest proportion of P12M initiation from Wave 1 to Wave 3 (W3) for each age group. Among youth Wave 2 P30D initiators of exclusive ENDS or cigarettes, the most common W3 outcome was not using any tobacco (ENDS: 59.0% (95% CI 48.4 to 68.8); cigarettes: 40.3% (95% CI 28.7 to 53.1)).

Conclusions Initiation rates of ENDS among youth and young adults have increased the number of ever tobacco users in the US prevention strategies across the spectrum of tobacco products which can address youth initiation of tobacco products.

  • non-cigarette tobacco products
  • surveillance and monitoring
  • prevention
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  • Contributors CAS and ES led the conceptual design. CAS drafted initial manuscript and all authors critically revised it. ELS 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; externally 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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