PROSPECTIVELY ESTIMATING THE AGE OF INITIATION OF E-CIGARETTES AMONG U.S. YOUTH: FINDINGS FROM THE POPULATION...

Area of Science:

• Public Health
• Adolescent Health
• Tobacco Control

Background:

• Limited prospective data exists on the age of electronic cigarette (e-cigarette) initiation among U.S. youth.
• Early initiation of tobacco product use is linked to increased nicotine exposure and later cigarette use.
• E-cigarette use initiation is associated with subsequent cigarette smoking.

Purpose of the Study:

• To prospectively estimate the age distribution of e-cigarette use initiation among U.S. youth.
• To analyze initiation by sex and race/ethnicity for susceptibility, ever use, past 30-day use, and "fairly regular" use.
• To identify age-specific patterns for tailored public health interventions.

Main Methods:

• Secondary analysis of the Population Assessment of Tobacco and Health (PATH) youth dataset (ages 12-17) across four waves (2013-2017).
• Utilized weighted survival analyses for interval censoring to estimate age of first report for four e-cigarette use outcomes.
• Accounted for complex survey design in nationally representative U.S. youth sample.

Main Results:

• By age 18, 50.2% of non-susceptible youth became susceptible to e-cigarette use; no significant sex or race/ethnicity differences were found for susceptibility initiation.
• Among never users, 41.7% initiated ever use, 23.5% initiated past 30-day use, and 10.3% initiated "fairly regular" use by age 18.
• Boys initiated earlier than girls; Non-Hispanic Black and Other youth initiated "ever use" later than Non-Hispanic White youth, while all minority groups initiated "past 30-day" and "fairly regular" use later than Non-Hispanic Whites.

Conclusions:

• Provides crucial age-specific data on e-cigarette use initiation behaviors among diverse U.S. youth.
• Identifies critical age windows for developing culturally tailored e-cigarette prevention and intervention strategies.
• Informs targeted efforts to prevent youth e-cigarette uptake and escalation of use.