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

项目总结/摘要 三分之一的美国青少年和年轻人（AYAs）报告使用电子烟（EC），使其成为主要的吸烟者。 尼古丁/烟草产品使用的AYA。大多数关于电子烟使用的纵向研究只关注短期 1-3年后的结果，不完全检查新一代与老一代电子烟产品， 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，电子烟估计的潜在偏差还没有得到很好的理解。这些差距保证了长期的 在不同国家的AYA样本中进行前瞻性研究和临床相关测量。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， 尼古丁/烟草制品、其他物质使用、烟草使用障碍（TUD）症状、尼古丁/烟草 戒烟，以及美国AYA中与尼古丁/烟草使用相关的健康后果。本研究的目的是：（1） 比较最先进的统计方法，以减少轨迹估计中的无应答偏倚， 由于差异损耗，EC使用的生存模型，并评估与自我相关的报告偏倚。 使用生物标志物数据的EC使用报告;（2）检查电子烟使用的开始和与其他 尼古丁/烟草制品使用和其他物质使用在AYAs超过4年和7年的纵向时间段， 数据;（3）确定EC，卷烟和其他烟草使用的轨迹及其纵向关系 具有不利的健康后果（例如，TUD症状、健康问题）， AYA中4年和7年时间段内的生物标志物数据，并确定轨迹或后果是否不同 按年龄，性别，种族/民族，教育，性取向，或较新与较旧的电子烟产品;以及（4） 根据社会生态模型，评估多个风险和保护因素（以及相互作用）水平 不同水平）的EC使用轨迹及其与其他尼古丁/烟草使用，戒烟， 和健康后果超过4年和7年的时间段，并检查如果欧共体使用轨迹和他们的 与其他尼古丁/烟草使用、戒烟和健康后果的关联因年龄、性别 种族/民族、教育、性取向或较新与较旧的EC产品。一个经验丰富的团队将 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和规模最大的 具有国家代表性的纵向研究，可以确定长期轨迹， AYA中使用EC的后果。该项目将使用具有全国代表性的纵向数据 在MTF研究中，对2014年至2020年期间测量的9，800名中学生进行了抽样调查， 全国代表性样本包括13，651名青少年（12-17岁），9，802名年轻人（18-25岁），以及 22，506名成年人（26岁及以上）在PATH研究（2013/2014-2020）的六个波中进行了测量。

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).