Pérez Adriana, Bluestein Meagan, Chen Baojiang, Perry Cheryl L, Harrell Melissa B
Department of Biostatistics and Data Science, the University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX 78701.
Michael & Susan Dell Center for Healthy Living, the University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX 78701.
J Biom Biostat. 2020;11(4). Epub 2020 May 19.
There is a lack of research that prospectively estimates the age of initiation of electronic cigarette use in U.S. youth. Younger ages of initiation of tobacco product use are associated with greater exposure to nicotine, and recently e-cigarette use has been associated with subsequent cigarette initiation. This study sought to estimate the distribution of the age of first reporting of e-cigarette use outcomes among youth never e-cigarette users overall, by sex and by race/ethnicity, prospectively.
Secondary analysis of the Population Assessment of Tobacco and Health (PATH) youth dataset (ages 12-17) across waves 1 (2013-2014), 2 (2014-2015), 3 (2015-2016), and 4 (2016-2017) were conducted. Four outcomes are presented, age of first report of: (i) susceptibility to use, (ii) ever use, (iii) past 30-day use, and (iv) "fairly regular" e-cigarette use. Each outcome was prospectively estimated using participant age when they entered the study and the number of weeks between the last report of never use and the first report of each outcome across waves. Weighted survival analyses for interval censoring accounting for the complex survey design were implemented.
Among youth non-susceptible to e-cigarettes, 50.2% became susceptible to e-cigarette use by age 18. There were no statistically significant differences in the age of first report of susceptibility to e-cigarette use by sex or by race/ethnicity in this nationally representative sample of U.S. youth. Among never users, 41.7%, 23.5% and 10.3% initiated ever, past 30-day and "fairly regular" e-cigarette use by the age of 18, respectively. Less than 10% initiated ever e-cigarette use between the ages of 18 and 21. Boys had a higher risk of first reporting ever, past 30-day and "fairly regular" e-cigarette use at earlier ages than girls. Non-Hispanic Blacks and Other racial/ethnic groups were less likely than Non-Hispanic Whites to initiate ever e-cigarette use at earlier ages, and there was no difference between Non-Hispanic Whites and Hispanics. Hispanic, Non-Hispanic Black and Other racial/ethnic youth were less likely to first report past 30-day use and "fairly regular" e-cigarette use at earlier ages than Non-Hispanic White youth.
This paper provides information on specific ages of the first report of e-cigarette use behaviors by sex and by race/ethnicity that can be used to culturally tailor e-cigarette interventions on specific windows of opportunity before youth begin using e-cigarettes or escalating their use.
缺乏前瞻性估计美国青少年开始使用电子烟年龄的研究。开始使用烟草产品的年龄越小，接触尼古丁的机会就越大，最近，使用电子烟与随后开始吸烟有关。本研究旨在前瞻性地估计从未使用过电子烟的青少年总体、按性别和种族/族裔首次报告使用电子烟情况的年龄分布。
对烟草与健康人口评估（PATH）青少年数据集（12 - 17岁）在第1波（2013 - 2014年）、第2波（2014 - 2015年）、第3波（2015 - 2016年）和第4波（2016 - 2017年）的数据进行二次分析。呈现了四个结果，即首次报告的年龄：（i）使用易感性，（ii）曾经使用，（iii）过去30天使用，以及（iv）“相当频繁”地使用电子烟。每个结果都是使用参与者进入研究时的年龄以及各波次中从未使用的最后报告与每个结果的首次报告之间的周数进行前瞻性估计的。针对复杂调查设计进行区间删失的加权生存分析得以实施。
在对电子烟不敏感的青少年中，50.2%在18岁时变得对使用电子烟敏感。在这个具有全国代表性的美国青少年样本中，按性别或种族/族裔划分，首次报告对使用电子烟敏感的年龄没有统计学上的显著差异。在从未使用者中，分别有41.7%、23.5%和10.3%在18岁时开始曾经使用、过去30天使用和“相当频繁”地使用电子烟。不到10%的人在18岁至21岁之间开始曾经使用电子烟。男孩比女孩在更早的年龄首次报告曾经使用、过去30天使用和“相当频繁”地使用电子烟的风险更高。非西班牙裔黑人及其他种族/族裔群体在较早年龄开始曾经使用电子烟的可能性低于非西班牙裔白人，且非西班牙裔白人与西班牙裔之间没有差异。西班牙裔、非西班牙裔黑人及其他种族/族裔的青少年在较早年龄首次报告过去30天使用和“相当频繁”地使用电子烟的可能性低于非西班牙裔白人青少年。
本文提供了按性别和种族/族裔划分的首次报告电子烟使用行为的具体年龄信息，可用于在青少年开始使用电子烟或增加使用量之前，根据文化特点针对特定的机会窗口制定电子烟干预措施。
