||5R21CA260423-02 Interpret this number
||New York University School Of Medicine
||Impact of E-Cigarette Characteristics and Marketing on Tobacco Use and Health: a Longitudinal Study Among U.S. Youth and Adults
E-cigarette use has increased rapidly, particularly among youth and young adults. The appealing flavors are a
primary reason for young people to initiate and continue to use e-cigarettes. Young adult nonsmokers are more
likely to initiate e-cigarette use with non-tobacco and non-menthol (NTM) flavors rather than tobacco and
menthol (TM) flavors compared to current smokers, which is worrisome because e-cigarette use leads to
cigarette initiation. The types of e-cigarette may also contribute to the surge in e-cigarette use. Advanced
generation (open-system) devices deliver nicotine faster than old generation (closed-system) devices and can
rapidly reduce withdrawal symptoms. Understanding if and how e-cigarette flavors and device types affect
tobacco use behaviors is fundamental to developing regulatory activities that address the epidemic of e-
cigarette use. In addition, e-cigarettes have been marketed aggressively using strategies that are appealing to
young people. Youth exposure to e-cigarette advertising leads to e-cigarette initiation and greater
susceptibility. But the underlying mechanism has not been fully explored. A potential mechanism is that
advertising exposure reduces perceived harms and addictiveness of e-cigarettes, which in turn, lead to e-
cigarette initiation and susceptibility. Last, e-cigarette use is associated with elevated risks for cardiopulmonary
and periodontal diseases. However, evidence has been predominantly from cross-sectional data or on
relatively small samples. To fill the knowledge gap, we will use longitudinal data (Waves 1-4) from the
Population Assessment of Tobacco and Health (PATH) Study to accomplish three specific aims: (1) identify the
impact of e-cigarette flavors and types on e-cigarette use among youth (12-17 years), young adults (18-34
years), and older adults (35 years and older). We will perform multivariate logistic regression with propensity
score weights to assess the overall impact of e-cigarette flavors (NTM vs. TM) and types (open vs. closed-
system) on e-cigarette use frequency. We will perform causal mediation analysis to test the hypothesis that,
compared to TM flavors, NTM flavored e-cigarette use reduces harm and addiction perceptions of e-cigarettes,
which lead to more frequent e-cigarette use; (2) determine the impact of exposure to e-cigarette advertising on
e-cigarette initiation, use frequency, and susceptibility. Similar to Aim 1, we will perform multivariate logistic
regression to assess the effect of e-cigarette advertising exposure on the outcomes, and conduct causal
mediation analyses to assess the mediating effect of harm and addiction perceptions of e-cigarettes; and (3)
identify the effect of e-cigarette use on cardiovascular, respiratory, and periodontal health, and compare the
effects among different types of tobacco users (e.g., exclusive e-cigarette users never cigarette smokers,
exclusive e-cigarette users former cigarette smokers, dual users, and cigarette-only smokers). Findings from
our study will be directly relevant to regulatory decision-making that address e-cigarette flavors, product design
and marketing practices, and will inform future interventions that tackle the epidemic of e-cigarette use.
Youth E-Cigarette Use and Functionally Important Respiratory Symptoms: The Population Assessment of Tobacco and Health (PATH) Study Waves 3 and 4.
, Xu S.
, Niaura R.
, Cleland C.M.
, Sherman S.E.
, Mai A.
, Karey E.
, Jiang N.
International journal of environmental research and public health, 2022-11-19; 19(22), .