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Correlates of tobacco product reuptake and relapse among youth and adults in the USA: findings from the PATH Study Waves 1–3 (2013–2016)
  1. Kathryn C Edwards1,
  2. Karin A Kasza2,
  3. Zhiqun Tang1,
  4. Cassandra A Stanton1,3,
  5. Eva Sharma1,
  6. Michael J Halenar1,
  7. Kristie A Taylor1,
  8. Elisabeth A Donaldson4,
  9. Lynn C Hull4,
  10. Maansi Bansal-Travers2,
  11. Jean Limpert4,
  12. Izabella Zandberg4,
  13. Lisa D Gardner4,
  14. Nicolette Borek4,
  15. Heather L Kimmel5,
  16. Wilson M Compton5,
  17. Andrew Hyland2
  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 Department of Oncology, Georgetown University Medical Center, Washington, DC, 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 Kathryn C Edwards, Behavioral Health and Health Policy, Westat, Rockville, MD 20850, USA; KatyEdwards{at}


Objective This study examines sociodemographic and tobacco use correlates of reuptake and relapse to tobacco use across a variety of tobacco products (cigarettes, electronic nicotine delivery systems, cigars, hookah and smokeless tobacco) among the US population.

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 (ages 12–17) and adults (ages 18+). Reuptake (past 30-day use among previous tobacco users) and relapse (current use among former established users; adults only) were examined among previous users of at least one type of tobacco product at Wave 1 (W1) or Wave 2 (W2) (n=19 120 adults, n=3039 youth). Generalised estimating equations were used to evaluate the association between demographic and tobacco use characteristics at baseline, with reuptake/relapse at follow-up, over two 1-year periods (W1–W2 and W2–Wave 3).

Results Any tobacco product reuptake occurred in 7.8% of adult previous users and 30.3% of youth previous users. Correlates of any tobacco reuptake included being male, non-Hispanic black and bisexual in adults, but race and sexual orientation were not consistent findings in youth. Among recent former users, relapse rates were greater (32.9%). Shorter time since last use and greater levels of tobacco dependence showed the strongest association with any tobacco relapse.

Discussion Continued clinical and public health efforts to provide adults with tools to cope with tobacco dependence symptoms, especially within the first year or two after quitting, could help prevent relapse.

  • electronic nicotine delivery devices
  • non-cigarette tobacco products
  • surveillance and monitoring
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  • Contributors KCE and KAK led the conceptual design of the work. KCE 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 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 may be obtained from a third party and are not publicly available: Application instructions and conditions of use are available at the website above.

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