CONFERENCE PROCEEDING
Patterns in tobacco use transitions among adolescents and young adults who use e-cigarettes alone or with other products
1
Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, , USA
2
Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, USA
3
Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, , USA
4
Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, , USA
5
Department of Psychiatry, College of Medicine, The Ohio State University, Columbus, , USA
Tob. Prev. Cessation 2026;12(Supplement 1):A14
ABSTRACT
BACKGROUND-AIM:
Electronic cigarettes (ECs) can be gateway products for combustible tobacco use among adolescents and young adults (AYAs) in the United States (US). Oral nicotine products (ONPs) are still new to the US market and their potential to influence other tobacco use behaviors has not yet been established. This study examined six-month transitions to combustible tobacco among AYAs who either exclusively used ECs or ECs+ONPs and/or combustible products at baseline.
METHODS:
Baseline and six-month follow-up data from AYAs who were enrolled in The Generation Z Health Study were examined. This is a longitudinal cohort of AYAs who recently began using nicotine products and/or ECs and live in the US. Data were limited to participants who reported past-30-day exclusive EC, EC+ONP, EC+combustible, or EC+ONP+combustible use at baseline and completed the six-month follow-up survey (N=186, 58% female, ages 15-25). Tobacco use at six months was categorized as: 1) no longer using; 2) using same product(s) as baseline or no increase in risk (e.g., EC+combustible to combustible only); 3) using a product that is less harmful (e.g., EC+combustible to EC exclusive); or 4) using a product that is more harmful (e.g., EC exclusive to EC+combustible tobacco). A chi-square test was used to test the association between baseline tobacco use category and transition at six months.
RESULTS:
Across all participants, 9% quit, 63% did not change, 13% completely switched to a lower risk product, and 15% switched to a riskier product at follow-up. Among AYAs who used ECs only at baseline, 12% quit, 53% did not change, 0% switched to a lower risk product, and 35% switched to a riskier product. Among AYAs who used ECs and ONPs only, 4% quit, 62% did not change, 16% switched to a lower risk product, and 18% switched to a riskier product. Among AYAs who used EC+combustible, 12% quit, 76% did not change, and 12% switched to a lower risk product. Among AYAs who used EC+ONP+combustible, 7% quit, 64% did not change, and 29% switched to a lower risk product. The chi-square test was significant (p<0.001), indicating that patterns in transitions were different by product use at baseline. In post-hoc chi-square tests, AYAs who used EC+combustible and EC+ONP+combustible did not differ in their transitions at six months. All other groups significantly differed in their transitions.
CONCLUSIONS:
Most AYAs did not change their tobacco use behaviors six months after enrolling into The Generation Z Health Study. Participants who used ONPs+ECs at baseline had a higher prevalence of switching to a lower risk product compared to exclusive EC use (16% vs. 0%) and a lower prevalence of switching to a higher risk product (18% vs. 35%). Follow-up in this study will continue through a 24-month timepoint. It will be important to continue monitoring transitions to determine if ONPs modify risk among AYAs who use ECs at baseline.
Electronic cigarettes (ECs) can be gateway products for combustible tobacco use among adolescents and young adults (AYAs) in the United States (US). Oral nicotine products (ONPs) are still new to the US market and their potential to influence other tobacco use behaviors has not yet been established. This study examined six-month transitions to combustible tobacco among AYAs who either exclusively used ECs or ECs+ONPs and/or combustible products at baseline.
METHODS:
Baseline and six-month follow-up data from AYAs who were enrolled in The Generation Z Health Study were examined. This is a longitudinal cohort of AYAs who recently began using nicotine products and/or ECs and live in the US. Data were limited to participants who reported past-30-day exclusive EC, EC+ONP, EC+combustible, or EC+ONP+combustible use at baseline and completed the six-month follow-up survey (N=186, 58% female, ages 15-25). Tobacco use at six months was categorized as: 1) no longer using; 2) using same product(s) as baseline or no increase in risk (e.g., EC+combustible to combustible only); 3) using a product that is less harmful (e.g., EC+combustible to EC exclusive); or 4) using a product that is more harmful (e.g., EC exclusive to EC+combustible tobacco). A chi-square test was used to test the association between baseline tobacco use category and transition at six months.
RESULTS:
Across all participants, 9% quit, 63% did not change, 13% completely switched to a lower risk product, and 15% switched to a riskier product at follow-up. Among AYAs who used ECs only at baseline, 12% quit, 53% did not change, 0% switched to a lower risk product, and 35% switched to a riskier product. Among AYAs who used ECs and ONPs only, 4% quit, 62% did not change, 16% switched to a lower risk product, and 18% switched to a riskier product. Among AYAs who used EC+combustible, 12% quit, 76% did not change, and 12% switched to a lower risk product. Among AYAs who used EC+ONP+combustible, 7% quit, 64% did not change, and 29% switched to a lower risk product. The chi-square test was significant (p<0.001), indicating that patterns in transitions were different by product use at baseline. In post-hoc chi-square tests, AYAs who used EC+combustible and EC+ONP+combustible did not differ in their transitions at six months. All other groups significantly differed in their transitions.
CONCLUSIONS:
Most AYAs did not change their tobacco use behaviors six months after enrolling into The Generation Z Health Study. Participants who used ONPs+ECs at baseline had a higher prevalence of switching to a lower risk product compared to exclusive EC use (16% vs. 0%) and a lower prevalence of switching to a higher risk product (18% vs. 35%). Follow-up in this study will continue through a 24-month timepoint. It will be important to continue monitoring transitions to determine if ONPs modify risk among AYAs who use ECs at baseline.
| eISSN: | 2459-3087 |
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