ENDS use trajectories from adolescence through young adulthood: A longitudinal study of risk factors and profiles

摘要 本研究的主要目的是识别，描述和区分稳定和持久的模式， 使用ENDS的轨迹，从11岁到22岁。百分之七十的青少年从不使用者将 易受ENDS和其他烟草使用的17岁，22岁，在年轻的成年人，同样 比例将使用ENDS或烟草。了解是什么加速了这种快速发展， 烟草使用行为及其相关后果（例如，尼古丁依赖）将有助于告知 制定有效的干预措施。关于电子商务的作用存在着相当大的争议， 尼古丁输送系统（ENDS）在可燃烟草的摄取、进展和/或停止中起作用 产品使用，以及衡量和建模的适当方法。迄今为止，几乎所有关于ENDS的研究都使用 行为是横截面的或限于短期的（例如，1年）随访，这对于 确定ENDS的持续模式使用整个生命过程的轨迹，因为烟草的转变 使用行为（即，开始持续使用或戒烟）和烟草产品之间（例如，端和 香烟）是频繁和不稳定的。对ENDS使用轨迹模式的长期研究至关重要， 它们将需要更多的数据收集工作，特别是在区域一级。采用队列序贯设计，我们 建议跟踪并连接3个现有的、基于人群的青少年队列（第1波11-15岁， 2014-15年）到青年期（2021年第14波时的18-22岁），以代表 ENDS在生命过程中的这些关键阶段使用行为。在第一波，在2014-15学术 2010年，样本包括79所中学6年级、8年级和10年级的3,907名学生（N=461,069）， 高中（N=1969）在得克萨斯州的4个最大的都市地区：休斯顿，达拉斯/英尺。沃思，圣安东尼奥， 还有奥斯汀在第8波（2018年6月），保留率仍然很高，为85%;最老的队列现在是1年后的高点 学校我们建议对这些队列进行额外的6波数据收集，每6个月， 跟踪他们所有通过高中（1，3，和5年毕业后），到青年成年。我们基于网络的 调查包括ENDS使用和其他烟草使用行为的强有力措施;尼古丁依赖;以及 广泛的潜在风险因素，包括个人、人际和环境影响。 生长混合模型应适用于这些数据，以经验性地确定稳定的发展模式， ENDS使用行为，从11岁到22岁;我们预计他们会有很大的异质性。 我们将能够确定开始于青春期的ENDS使用的持续模式对年轻人的影响; 青少年期的风险因素预测ENDS的轨迹持续到成年早期。使用 因此，将考虑在青少年和青年期使用可燃烟草产品。几乎所有 （>95%）现有的ENDS使用队列和研究关注青少年或年轻人。很少， 像我们一样，能够跟踪青少年到年轻的成年期，以调查风险的发展轨迹。

ABSTRACT The primary objective of this study is to identify, describe, and differentiate stable and persistent patterns in trajectories of ENDS use, from 11 to 22 years of age. Seventy percent of adolescent never users will be susceptible to ENDS and other tobacco use by the age of 17 – and, by age 22, in young adulthood, the same proportion will have ever used ENDS or tobacco. Understanding what accelerates this rapid progression in tobacco use behaviors and related outcomes from them (e.g., nicotine dependence) will help inform the development of effective interventions. Considerable controversy exists regarding the role that electronic nicotine delivery systems (ENDS) play in the uptake, progression, and/or cessation of combustible tobacco product use, and appropriate ways to measure and model this. To date, almost all studies of ENDS use behaviors are either cross-sectional or limited to short-term (e.g., 1 year) follow-up, which is inadequate for identifying sustained patterns in ENDS use trajectories across the life course, given that transitions in tobacco use behaviors (i.e., initiation to sustained use or quitting) and between tobacco products (e.g., ENDS and cigarettes) are frequent and erratic. Longer-term studies of patterns in ENDS use trajectories are critical, but they will require additional data collection efforts; especially, regionally. Using a cohort-sequential design, we propose to follow and connect 3 existing, population-based cohorts of adolescents (11-15 years old at Wave 1, 2014-15) through young adulthood (18-22 years old at Wave 14, 2021), to represent developmental changes in ENDS use behaviors across these critical stages in the life course. At Wave 1, during the 2014-15 academic year, the sample included 3,907 (N=461,069) students in the 6th, 8th, and 10th grades in 79 middle schools and high schools (N=1969) in the 4 largest metropolitan areas of Texas: Houston, Dallas/Ft. Worth, San Antonio, and Austin. At Wave 8 (June, 2018), retention remained high, at 85%; the oldest cohort is now 1 year post high school. We propose to follow these cohorts for an additional 6 waves of data collection, every 6 months, to track them all through high school (1, 3, and 5 years post-graduation), into young adulthood. Our web-based surveys include robust measures of ENDS use and other tobacco use behaviors; nicotine dependence; and a broad spectrum of potential risk factors, including intrapersonal, interpersonal, and environmental influences. Growth mixture models shall be applied to these data to empirically identify stable developmental patterns in ENDS use behaviors, from 11 to 22 years of age; we anticipate there will be substantial heterogeneity in them. We will be able to identify young adult outcomes of persistent patterns in ENDS use that begin in adolescence; and risk factors in adolescence that predict ENDS use trajectories that persist into young adulthood. The use of combustible tobacco products in adolescence and young adulthood will be considered, accordingly. Almost all (>95% of) existing cohorts and studies of ENDS use focus on either adolescents or young adults. Very few, like ours, are able to track adolescents into young adulthood to investigate developmental trajectories of risk.