PROJECT SUMMARY/ABSTRACT
One-third of U.S. adolescents and young adults (AYAs) report e-cigarette (EC) use, making it the leading
nicotine/tobacco product used by AYAs. Most longitudinal studies of e-cigarette use only focus on short-term
outcomes 1-3 years later, do not fully examine newer vs. older generation e-cigarette products, and do not
consider potential differences by sex, age, race/ethnicity, educational attainment, or sexual orientation.
Potential bias in e-cigarette estimates over time is not well understood. These gaps warrant longer-term
prospective investigations with clinically relevant measures in diverse national samples of AYAs. This project
will identify longitudinal trajectories of e-cigarette use and their relationships with cigarette smoking, other
nicotine/tobacco products, other substance use, tobacco use disorder (TUD) symptoms, nicotine/tobacco
cessation, and health consequences related to nicotine/tobacco use among U.S. AYAs. Our study aims to: (1)
Compare state-of-the-art statistical approaches for reducing nonresponse bias in estimates of trajectories and
survival models for EC use due to differential attrition, and evaluate the reporting bias associated with self-
reports of EC use using biomarker data; (2) Examine the initiation of e-cigarette use and transitions with other
nicotine/tobacco product use and other substance use in AYAs over 4- and 7-year time periods of longitudinal
data; (3) Identify the trajectories of EC, cigarette, and other tobacco use and their longitudinal relationships
with adverse health consequences (e.g., TUD symptoms, health problems) measured with survey and
biomarker data in AYAs over 4- and 7-year time periods, and determine if trajectories or consequences differ
by age, sex, race/ethnicity, education, sexual orientation, or newer vs. older e-cigarette products; and (4)
Based on the Social Ecological Model, assess multiple levels of risk and protective factors (and interactions
across levels) for EC use trajectories and their associations with other nicotine/tobacco use, tobacco cessation,
and health consequences over 4- and 7-year time periods, and examine if EC use trajectories and their
associations with other nicotine/tobacco use, tobacco cessation, and health consequences differ by age, sex,
race/ethnicity, education, sexual orientation, or newer vs. older EC products. An experienced team will conduct
secondary analyses of longitudinal data from the Monitoring the Future (MTF) and Population Assessment of
Tobacco and Health (PATH) studies. These two epidemiological studies are the most recent and largest
nationally representative longitudinal studies that allow for the identification of long-term trajectories and
consequences of EC use among AYAs. This project will use longitudinal data from a nationally representative
sample of 9,800 secondary students measured between 2014 and 2020 in the MTF study, and a prospective
nationally representative sample of 13,651 adolescents (12-17 years), 9,802 young adults (18-25 years), and
22,506 adults (26 and older) measured across six waves in the PATH study (2013/2014-2020).
