A longitudinal analysis of e-cigarette susceptibility and use among U.S. adolescents: Evidence from 7 waves of PATH data

Objectives: E-cigarette use among adolescents remains a significant public health concern, with substantial risks associated with nicotine exposure. This study aimed to examine the longitudinal association between e-cigarette susceptibility and subsequent e-cigarette use among U.S. adolescents. Study design: Longitudinal study. Methods: Utilizing seven waves (2013–2023) of the Population Assessment of Tobacco and Health (PATH) Study, a longitudinal, multi-wave design tracked transitions in past 12-month and 30-day e-cigarette use among 12-17 year-old never-users (n = 16,107). At each wave (t), participants were classified as “susceptible” or “non-susceptible,” and individuals were tracked across subsequent waves. Weighted proportions of transitions to e-cigarette use/non-use at t+1 were estimated. Generalized Estimating Equations were employed to assess the associations between susceptibility and subsequent past 12-month and past 30-day e-cigarette use, adjusting for demographic, socioeconomic, and behavioral covariates. Results: Longitudinal analyses revealed that susceptible youth were significantly more likely to initiate e-cigarette use over time compared to non-susceptible youth. Transitions across multiple waves showed higher e-cigarette use among those initially classified as susceptible, while non-susceptible youth largely remained non-users. Adolescents classified as susceptible had significantly higher odds of reporting both past 12-month (OR = 3.56, 95 % CI: 3.27–3.87) and past 30-day (OR = 3.62, 95 % CI: 3.15–4.15) e-cigarette use. Conclusions: E-cigarette susceptibility, defined as a combination of curiosity, anticipated use, and peer influence, is a significant predictor of subsequent e-cigarette use among U.S. adolescents. These findings underscore the importance of targeted prevention strategies that address the distinct dimensions of susceptibility among youth.