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Correlates of tobacco product initiation among youth and adults in the USA: findings from the PATH Study Waves 1–3 (2013–2016)
  1. Karin A Kasza1,
  2. Kathryn C Edwards2,
  3. Zhiqun Tang2,
  4. Cassandra A Stanton2,3,
  5. Eva Sharma2,
  6. Michael J Halenar2,
  7. Kristie A Taylor2,
  8. Elisabeth Donaldson4,
  9. Lynn C Hull4,
  10. Hannah Day4,
  11. Maansi Bansal-Travers1,
  12. Jean Limpert4,
  13. Izabella Zandberg4,
  14. Lisa D Gardner4,
  15. Hoda T Hammad4,
  16. Nicolette Borek4,
  17. Heather L Kimmel5,
  18. Wilson M Compton5,
  19. Andrew Hyland1
  1. 1 Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
  2. 2 Behavioral Health and Health Policy Practice, Westat, Rockville, MD, USA
  3. 3 Department of Oncology, Georgetown University Medical Center, Washington, DC, USA
  4. 4 Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
  5. 5 National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
  1. Correspondence to Dr Karin A Kasza, Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; karin.kasza{at}


Objective To report on demographic and tobacco product use correlates of tobacco product initiation (cigarettes, electronic nicotine delivery systems (ENDS), cigars, hookah and smokeless tobacco) among the US population.

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 (aged 12–17 years) and adults (aged 18+ years). Never users of at least one type of tobacco product at Wave 1 (W1, 2013/14) or Wave 2 (W2, 2014/15) were included (n=12 987 youth; n=25 116 adults). Generalised estimating equations were used to evaluate the association between demographic and tobacco product use characteristics at baseline, and tobacco product initiation at follow-up (ever, past 30 day (P30D), frequent (use on 20 or more of thepast 30 days)) over two 1-year periods (W1–W2 and W2–Wave 3).

Results Youth aged 15–17 years were more likely than youth aged 12–14 years and adults aged 18–24 years were more likely than older adults to initiate P30D tobacco use across products; non-heterosexuals were more likely than heterosexuals to initiate P30D cigarette and ENDS use. Older adults were more likely than young adults, and males were more likely than females, to be frequent users of ENDS on initiation. Ever use of another tobacco product predicted P30D initiation of each tobacco product.

Discussion Other tobacco product use and age predict P30D tobacco initiation across products whereas associations with other demographic characteristics vary by product. Continued contemporary evaluation of initiation rates within the changing tobacco product marketplace is important.

  • disparities
  • electronic nicotine delivery devices
  • non-cigarette tobacco products
  • prevention
  • surveillance and monitoring

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  • Contributors KAK and KCE led the conceptual design of the work. KAK drafted the initial manuscript and all authors critically revised it. ZT conducted the statistical analyses and all authors contributed to the interpretation of results. All authors approved the work for journal publication and agreed to be accountable for all aspects of the work.

  • Funding This study is supported by 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 respondents ages 18 and older provided informed consent, with youth respondents ages 12 to 17 providing assent and each youth’s parent/legal guardian providing consent.

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

  • Data availability statement Data from the PATH Study Wave 1 and Wave 3 may be obtained from a third party and are not publicly available ( Applications instructions and conditions of use are available at the website above.

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