The role of ENDS use in changing rates of escalation and quitting of cigarette smoking in those under age 35 years in US population

摘要 最近，年轻人广泛使用电子尼古丁递送系统(END) 美国(US)。这些产品有可能显著降低年轻人的比例。 吸烟成瘾的人，要么通过影响日常吸烟的比例上升 吸烟或增加35岁以下戒烟者的比例。之前的研究已经 展示了有两组自动扶梯每天吸烟：1)早期的自动扶梯是谁 每日吸烟者年龄在20岁之前，2)在自动扶梯之后(21岁以上成为每日吸烟者)。这项建议 将探讨Ends在改变吸烟升级和戒烟方面的长期作用，使用 前四波全国人口烟草与健康评估(PATH)纵向研究。这个 这项研究使用了四阶段分层区域概率设计，纳入了大约26,000名35岁以下的人 几年了，其中一半是女性。前两个浪潮的公共使用数据是可用的，包括 纵向加权变量。第三波预计将于2018年春季公开上市，第四波第一波将于 预计一年后。第二波的加权应答率在12-17岁为87%，在成年人为83%。 通过这些路径数据，我们将探索两个科学前提：1)END的广泛推广具有 催生了新一代的尼古丁使用者，他们依赖末端使用，而不是每天都使用尼古丁 成年后吸烟的人；和2)在年轻的烟草使用者中传播的目的将 导致对尼古丁的依赖程度降低，进而与更高的成功率相关 35岁前停止吸烟。在这种情况下的显著的方法论弱点 复杂的纵向分析涉及大量时变混杂因素的考虑 可预测烟草使用行为变化并与结果相关的变量 感兴趣的人。一些流行病学方法允许实现不同性别之间的协变量平衡 暴露组。在这些方法中，感兴趣的结果的持续差异直接归因于 例如，结束使用。在这种情况下，我们利用倾向分数匹配(PSM)和边际 结构模型(MSM)，以针对时变混杂进行调整。我们还将探索目标最大 用于优化PSM性能的似然估计(TMLE)技术。我们将单独进行 分析早期自动扶梯、晚期自动扶梯和35岁之前放弃自动扶梯的人。这项建议将回答一个 与使用末端相关的长期潜在利益有关的紧急公共卫生问题，而 也为烟草研究领域提供了一种先进的流行病学方法 纵向分析。

Abstract Recently, there has been extensive use of Electronic Nicotine Delivery Systems (ENDS) by young people in the United States (US). These products have the potential to significantly reduce the proportion of young adults who are addicted to cigarette smoking, either by influencing the proportion who escalate to daily cigarette smoking or by increasing the proportion who quit under the age of 35 years. Previous research has demonstrated that there are two groups of escalators to daily cigarette smoking: 1) early escalators who are daily smokers before age 20 years, and 2) later escalators (become daily smokers at 21+ years). This proposal will explore the long-term role of ENDS in changing the escalation and quitting of cigarette smoking using the first four waves of the national Population Assessment of Tobacco and Health (PATH) longitudinal study. The study used a four stage stratified area probability design and has enrolled ~26,000 people under the age of 35 years, half of whom were female. The public use data for the first two waves are available and include longitudinal weighting variables. Wave 3 is expected to be publicly available in Spring 2018, and Wave 4 one is expected year later. The weighted response for Wave 2 was 87% for 12-17 year olds, and 83% for adults. With these PATH data, we will explore two scientific premises: 1) that widespread promotion of ENDS has resulted in a new generation of nicotine users who rely on ENDS usage and who did not escalate to daily cigarette smokers when becoming adults; and 2) that the diffusion of ENDS among young tobacco users will result in lower nicotine dependence that, in turn, will be associated with higher rates of successful discontinuance of cigarette smoking before age 35 years. A significant methodological weakness in such complex longitudinal analyses is related to the consideration of a large number of time-varying confounding variables that are prognostic for changes in tobacco use behaviors and are also associated with the outcome of interest. Some epidemiological methods allow the achievement of covariate balance between different exposure groups. With these methods, ongoing differences in outcomes of interest are directly attributable to ENDS usage, for example. In this context, we leverage Propensity Score Matching (PSM), and Marginal Structural Models (MSMs) to adjust for time-varying confounding. We will also explore Targeted Maximum Likelihood Estimation (TMLE) techniques to optimize the performance of PSM. We will conduct separate analyses for early escalators, late escalators, and quitters before age 35 years. This proposal will answer an urgent public health question in regards to the long-term potential benefits associated with ENDS usage, while also providing an example to the tobacco research field of state-of-art epidemiological methods for complex longitudinal analyses.