Transitions in hookah (Waterpipe) smoking by U.S. sexual minority adults between 2013 and 2015: the population assessment of tobacco and health study wave 1 and wave 2

Trends and Disparities in Waterpipe Tobacco Smoking Among US Adolescents and Adults: PATH Study 2013-2021

Background

Waterpipe tobacco smoking (WTS) is a popular mode of nicotine delivery among young people. We examined the trends and disparities in WTS from 2013 to 2021 among US adolescents and adults.

Methods

Data were from Wave 1 (initially conducted among 32 320 adults and 13 651 adolescents) to Wave 6 (2013-2021) of the Population Assessment of Tobacco and Health Study. We assessed the weighted prevalence of ever and current (past 30-day) WTS for adults and adolescents across waves stratified by demographics.

Results

From 2013-2021 among adolescents, the prevalence of ever and current WTS decreased by 86.5% (7.4% to 1.00%; p = 0.0364) and 97.1% (1.65% to 0.05%; p = 0.0012), respectively. Despite the decreasing trends among adolescents across all waves, females had a higher prevalence of ever and current WTS compared to males (p 's < 0.001 for all trends). Hispanics had the highest prevalence of ever WTS compared to other races/ethnicities (p 's < 0.001). Adolescents aged 15-17 had a higher (except Wave 6) prevalence of ever and current WTS than 12-14 years old (p 's < 0.001). For adults, the prevalence of ever WTS increased by 27.4% (16.39% to 20.92%; p = 0.0006), and current WTS decreased by 45.5% (2.19% to 1.24%; p = 0.0012). Young adults aged 18-24 experienced increasing trends in WTS and had the highest prevalence of ever and current WTS compared to other age groups (p 's < 0.001) across all waves.

Conclusions

Our study indicates a notable decrease in adolescent WTS prevalence from 2013 to 2021 but an increase of ever WTS among adults. Demographic differences underscore disparities in WTS, calling for tailored interventions.

Longitudinal transitions in e-cigarette and cigarette use among US adults: prospective cohort study

Background

To support tobacco control efforts, this study sought to characterize longitudinal transitions in use of electronic nicotine delivery systems (ENDS) and cigarettes.

Methods

Participants were nationally representative samples of 53,729 US adults from Waves 3-5 (2015-2019) of the Population Assessment of Tobacco and Health Study. We examined behavioral transitions (initiation, relapse, progression, and cessation) in ENDS and cigarette use across waves. Weighted generalized estimating equation models adjusted for sociodemographic variables.

Findings

Of never ENDS users at baseline, an estimated 1.7% reported initiating ENDS use by follow-up. Of former ENDS users, an estimated 12.1% relapsed into ENDS use. Of periodic ENDS users at baseline, 13% progressed to established ENDS use. Of baseline current ENDS users, 46.3% discontinued ENDS use. The corresponding transitions for cigarette smoking were 1.6% (initiation), 4.8% (relapse), 21.1% (progression), and 14% (discontinuation). Adults aged 18-24 (vs. older age), Hispanics (vs. non-Hispanic white), and past 12-month cannabis users were more likely to initiate ENDS or cigarettes (all p < 0.05). Having any internalizing mental health symptoms increased the odds of ENDS initiation, while externalizing symptoms increased the odds of cigarette initiation. Those who perceived nicotine as very harmful (vs. none/low harm) were more likely to discontinue ENDS. Current cigarette users (vs. non-users) at baseline were more likely to initiate, relapse, or discontinue ENDS (all p < 0.05) and vice versa.

Interpretation

We observed high changeability in ENDS and cigarette use among US adults over time. In absolute terms, ENDS use grew, while smoking fell. Tobacco control programs should focus on priority populations, including young adults and people with internalizing and externalizing mental health symptoms.

Funding

National Institutes of Health, R01-CA246606-01A1, R01-DA048390.