Transitions across tobacco use profiles among adolescents: results from the Population Assessment of Tobacco and Health (PATH) study waves 1 and 2

Background and Aims To estimate progression to polytobacco use (PTU) over 1 year among a sample of US youth. Design Prospective survey with two waves 1 year apart: wave 1 (2013-14) and wave 2 (2014-15). We conducted latent transition analysis (LTA) to identify latent class transitions and examine socio-demographic predictors of transition types. Setting United States. Participants A total of 11, 996 people who were aged 12-17 years at wave 1. Measurements Publicly available data were used from the Population Assessment of Tobacco and Health (PATH) study, a nationally representative sample of US civilian, non-institutionalized population aged 12 years and older. Tobacco use status was assessed and classified in terms of: never use, non-current (not in the past 30 days) and current (past 30-day) use of cigarettes, cigars, e-cigarettes, hookah and smokeless tobacco. Other nicotine products were excluded because rates of use were either too low to model (e.g. pipe) or the product was not assessed in the PATH youth sample (e.g. nicotine replacement products). Findings We identified three distinct patterns: class 1, non-use (wave 1 prevalence = 86%; wave 2 prevalence = 78%); class 2, ever use of cigarettes and e-cigarettes (wave 1 prevalence = 11%; wave 2 prevalence = 14%); and class 3, current PTU (wave 1 prevalence = 4%; wave 2 prevalence = 7%). Probability of progression from non-use to ever use of cigarettes and e-cigarettes was 0.06 and ever use of cigarettes and e-cigarettes to current PTU was 0.32. Non-users were more likely to transition to ever use of cigarettes and e-cigarettes if they were older (versus younger), white (versus non-white) or if their parental education level was high school or less (versus more than high school); and ever users of cigarettes and e-cigarettes to current PTU if they were older, male or white. Conclusions US youth who had previously tried e-cigarettes and cigarettes at wave 1 (2013-14) had a 32% chance of transitioning to current use of two or more tobacco products within 1 year.