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Adolescent Use of Different E-cigarette Products

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journal contribution
posted on 07.11.2018 by Robert McMillen, Susanne Tanski, Karen Wilson, Jonathan D. Klein, Jonathan P. Winickoff
BACKGROUND: Little is known about the characteristics of electronic cigarettes (e-cigarettes) used by adolescents. Understanding the product landscape of adolescent e-cigarette use may inform counseling and policy strategies. METHODS: Results are from 13 651 adolescents in wave 1 and 12 172 adolescents in wave 2 of the Population Assessment of Tobacco and Health Study, a nationally representative longitudinal study. Past 30-day regular e-cigarettes users were asked about the characteristics of the e-cigarette they used most of the time. RESULTS: In waves 1 and 2, 2.1% and 2.8% of adolescents were regular users in the past 30 days, respectively. These adolescents more often used rechargeable rather than disposable devices (wave 1: 76.0%; wave 2: 82.9%) and refillable rather than nonrefillable devices (wave 1: 66.6%; wave 2: 84.4%) and tended not to use cartridge systems (wave 1: 33.7%; wave 2: 30.5%). Most adolescent past 30-day users (wave 1: 87.5%; wave 2: 89.4%) reported using flavored e-cigarettes. An increased frequency of use was associated with the use of rechargeable (wave 1 adjusted odds ratio [aOR]: 2.7; wave 2 aOR: 2.7) and refillable e-cigarettes (wave 1 aOR: 2.0; wave 2 aOR: 2.7; P < .05). Most users in wave 1 did not continue regular use in wave 2 (70.2%). Among those who continued to use and had reported using closed systems (nonrechargeable and/or nonrefillable) in wave 1, most had progressed to open systems (rechargeable and refillable) in wave 2. CONCLUSIONS: Most adolescents use open-system e-cigarettes, and frequent users are even more likely to use open-system e-cigarettes. The majority of regular users use rechargeable devices that are refillable. A change in product preferences across waves suggests a starter product phenomenon, with a graduation to products that have weaker quality controls and may increase health risks.




This work was supported by the Flight Attendant Medical Research Institute grant number 052302. The information, views, and opinions contained herein are those of the authors and do not necessarily reflect the views and opinions of this organization.


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McMillen, R., Tanski, S., Wilson, K., Klein, J. D., & Winickoff, J. P. (2018). Adolescent Use of Different E-cigarette Products. Pediatrics, 142(4). doi:10.1542/peds.2018-0260





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