Persistence of Youth Use of Electronic Nicotine Delivery Systems in the Population Assessment of Tobacco and Health, 2017-2021

Youth use of electronic nicotine delivery systems (ENDS) is a concern, but little is known about the proportion that is transient and experimental vs. persistent and problematic. Data were drawn from the Population Assessment of Tobacco and Health, focusing on ENDS-naïve youth at Wave 4 (∼2018), just prior to the US peak in youth ENDS prevalence. Degrees of ENDS use at Waves 5 (∼2019) and 6 (∼2021) were examined: past-year, past-month, and combinations of ever-regular-use with frequency (5, 10, 20, and 30 days in the past month). Changes in degrees of use between Waves 5 and 6 were categorized as “reducing,” “stable,” or “increasing.” Among Wave 4 ENDS-naïve youth, 21.2% tried ENDS by Wave 5, 10.9% used in the past month, and 5.6% reported ever-regular use. Among youth who tried ENDS by Wave 5, over half (52%) discontinued in Wave 6, 31.0% used in the past month, and 12.2% reported ever-regular use and daily use at Wave 6. Cigarette smoking at Wave 5 was associated with higher odds of all W6 ENDS use outcomes. Approximately 60% of youth who tried ENDS by Wave 5 decreased their degree of ENDS use in Wave 6, and 25% remained stable. Most US youth who initiated ENDS during their 2019 peak discontinued their use the following year or otherwise reduced their degree of ENDS use, providing depth and nuance to national survey estimates. Future efforts should prioritize those who escalate (17%) in ENDS use intensity or persist in high-intensity use (5%).