E-Cigarette Use among U.S. Adolescents and Young Adults: Longitudinal Associations with Tobacco Use and Health and Dimensions of Risk and Protection

项目摘要/摘要 三分之一的美国青少年和年轻人(AYA)报告使用电子烟(EC)，使其成为领先的 AYA使用的尼古丁/烟草产品。大多数关于电子烟使用的纵向研究只关注短期 结果1-3年后，没有全面检查新一代电子烟产品与旧一代电子烟产品，也没有 考虑性别、年龄、种族/民族、教育程度或性取向的潜在差异。 随着时间的推移，电子烟估计可能存在的偏差还没有得到很好的理解。这些差距需要更长期的努力。 在不同国家的AYA样本中进行临床相关措施的前瞻性调查。这个项目 将确定电子烟使用的纵向轨迹及其与吸烟的关系，其他 尼古丁/烟草产品、其他物质使用、烟草使用障碍症状、尼古丁/烟草 戒烟和与尼古丁/烟草使用相关的健康后果。我们的研究目标是：(1) 比较在轨迹估计中减少无响应偏差的最新统计方法和 EC因不同的自然损耗而使用的生存模型，并评估与自身相关的报告偏差 使用生物标志物数据的EC使用报告；(2)检查电子烟使用的启动和与其他电子烟的过渡 尼古丁/烟草制品的使用和其他物质的使用超过4年和7年的纵向时间段 数据；(3)确定EC、香烟和其他烟草使用的轨迹及其纵向关系 通过调查测量不良健康后果(例如，TUD症状、健康问题)和 4年和7年AYA中的生物标志物数据，并确定轨迹或结果是否不同 按年龄、性别、种族/民族、教育程度、性取向或新旧电子烟产品分类；以及(4) 基于社会生态模型，评估多个级别的风险和保护因素(以及相互作用 不同级别)EC使用轨迹及其与其他尼古丁/烟草使用、戒烟、 和4年和7年的健康后果，并检查EC是否使用轨迹及其 与其他尼古丁/烟草使用、戒烟和健康后果的关系因年龄、性别、 种族/民族、教育程度、性取向或较新的EC产品与较旧的EC产品。一支经验丰富的团队将进行 监测未来(MTF)和人口评估的纵向数据的二次分析 烟草与健康(PATH)研究。这两项流行病学研究是最新也是规模最大的。 具有全国代表性的纵向研究，允许确定长期轨迹和 在AYA中使用EC的后果。该项目将使用来自全国代表的纵向数据 在MTF研究中，对2014至2020年间测量的9,800名中学生进行了抽样，并对 全国代表性样本13,651名青少年(12-17岁)，9,802名青壮年(18-25岁)，以及 在Path研究(2013/2014-2020)中，对22,506名成年人(26岁及以上)进行了六次浪潮的测量。

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).