||1R01CA239097-01 Interpret this number
||University Of Texas Hlth Sci Ctr Houston
||Ends Use Trajectories From Adolescence Through Young Adulthood: a Longitudinal Study of Risk Factors and Profiles
The primary objective of this study is to identify, describe, and differentiate stable and persistent patterns in
trajectories of ENDS use, from 11 to 22 years of age. Seventy percent of adolescent never users will be
susceptible to ENDS and other tobacco use by the age of 17 – and, by age 22, in young adulthood, the same
proportion will have ever used ENDS or tobacco. Understanding what accelerates this rapid progression in
tobacco use behaviors and related outcomes from them (e.g., nicotine dependence) will help inform the
development of effective interventions. Considerable controversy exists regarding the role that electronic
nicotine delivery systems (ENDS) play in the uptake, progression, and/or cessation of combustible tobacco
product use, and appropriate ways to measure and model this. To date, almost all studies of ENDS use
behaviors are either cross-sectional or limited to short-term (e.g., 1 year) follow-up, which is inadequate for
identifying sustained patterns in ENDS use trajectories across the life course, given that transitions in tobacco
use behaviors (i.e., initiation to sustained use or quitting) and between tobacco products (e.g., ENDS and
cigarettes) are frequent and erratic. Longer-term studies of patterns in ENDS use trajectories are critical, but
they will require additional data collection efforts; especially, regionally. Using a cohort-sequential design, we
propose to follow and connect 3 existing, population-based cohorts of adolescents (11-15 years old at Wave 1,
2014-15) through young adulthood (18-22 years old at Wave 14, 2021), to represent developmental changes in
ENDS use behaviors across these critical stages in the life course. At Wave 1, during the 2014-15 academic
year, the sample included 3,907 (N=461,069) students in the 6th, 8th, and 10th grades in 79 middle schools and
high schools (N=1969) in the 4 largest metropolitan areas of Texas: Houston, Dallas/Ft. Worth, San Antonio,
and Austin. At Wave 8 (June, 2018), retention remained high, at 85%; the oldest cohort is now 1 year post high
school. We propose to follow these cohorts for an additional 6 waves of data collection, every 6 months, to
track them all through high school (1, 3, and 5 years post-graduation), into young adulthood. Our web-based
surveys include robust measures of ENDS use and other tobacco use behaviors; nicotine dependence; and a
broad spectrum of potential risk factors, including intrapersonal, interpersonal, and environmental influences.
Growth mixture models shall be applied to these data to empirically identify stable developmental patterns in
ENDS use behaviors, from 11 to 22 years of age; we anticipate there will be substantial heterogeneity in them.
We will be able to identify young adult outcomes of persistent patterns in ENDS use that begin in adolescence;
and risk factors in adolescence that predict ENDS use trajectories that persist into young adulthood. The use of
combustible tobacco products in adolescence and young adulthood will be considered, accordingly. Almost all
(>95% of) existing cohorts and studies of ENDS use focus on either adolescents or young adults. Very few,
like ours, are able to track adolescents into young adulthood to investigate developmental trajectories of risk.
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