Abstract
PURPOSE: The objective of this study was to examine the combinations of e-cigarette use, cigarette use, and other tobacco use over time and the relationship these longitudinal use patterns have with symptoms of tobacco use disorder (TUD) and substance use disorders (SUDs) among a sample of adolescents. METHODS: Data from U.S. adolescents (aged 12-17 years) who were surveyed for the Population Assessment of Tobacco and Health Study at baseline, first follow-up, and second follow-up (2013-2014, 2014-2015, and 2015-2016; n = 7,595) was used to analyze symptoms of TUD and SUDs based on longitudinal combinations of tobacco/nicotine use. RESULTS: The most common combination of tobacco/nicotine use across the three waves was "no use of any tobacco/nicotine products" at baseline and first follow-up to "e-cigarette use only" at the second follow-up. Multivariable analyses found that past 30-day cigarette use and other tobacco use at the most recent follow-up was associated with an increase in both current TUD and SUD symptoms, whereas past 30-day e-cigarette use at the most recent follow-up was modestly associated with an increase in current SUD symptoms. CONCLUSIONS: Individuals who transitioned to e-cigarette use were at relatively low risk for increased TUD and SUD symptoms. However, individuals who transitioned or continually used cigarettes were typically at greater risk for indicating more TUD and SUD symptoms. Given the low risk of e-cigarette only users to indicate TUD and SUD symptoms, prevention efforts need to be made to target these youth before they transition to cigarettes and other types of tobacco use.