Date of Award

Spring 5-2019

Degree Name

Master of Public Health (MPH)

Advisor(s)

ANNA V. WILKINSON, PHD

Second Advisor

MELISSA HARRELL, PHD

Third Advisor

STEPHANIE CLENDENNEN, Dr. PH

Abstract

The aims of the study were to determine whether ENDS device types (i.e., disposable devices, replaceable cartridges, and refillables) at initial, or first ENDS use is longitudinally associated with subsequent initiation of combustible tobacco products (cigarettes, hookah, cigars) and continued, past 30-day use of combustible and ENDS products. This study is a secondary analysis of data from the Texas Adolescent Tobacco and Marketing Surveillance system (TATAMS) study, a longitudinal cohort study of students who were in the 6th, 8th, and 10th grades (n = 3907) during the 2014-2015 academic year. Data were collected every 6 months, from 2014-2018. Using data from all 8 waves of the study, descriptive statistics were computed for initial ENDS device type (disposables, cartridges, and refillables), initial and past 30-day use of combustible tobacco products (subsequent to ENDS use), and past 30-day ENDS use (among ever ENDS users). Unadjusted and adjusted logistic regression models were computed to assess the likelihood of (a) initiation of combustible tobacco products in subsequent waves, (b) continued use of combustible tobacco products (past 30-day use) and (c) continued use of ENDS products (past 30-day use) in the same or subsequent waves, by initial ENDS device type. After adjusting for the sociodemographic variables, compared to participants initiating with Refillables, participants initiating ENDS use with Cartridges and Disposables were 58% (AOR = 0.42; 95% CI = 0.18 – 0.98; p = 0.05) and 53% (AOR = 0.47; 95% CI = 0.21-1.07; p = 0.07) less likely to initiate combustible tobacco use in a subsequent wave. Compared to participants initiating with Disposables, participants initiating ENDS use with Cartridges were 12% (AOR = 0.89; 95% CI = 0.32 – 2.50; p = 0.89) less likely to initiate combustible tobacco use in a subsequent wave. Compared to participants initiating with Disposables, participants initiating ENDS use with Cartridges were 12% (AOR = 0.88; 95% CI = 0.21 – 3.68; p = 0.86) less likely to have reported combustible tobacco use in the past 30-days. Compared to participants initiating with Disposables, participants initiating ENDS use with Cartridges were 62% (AOR = 0.38; 95% CI = 0.16 – 0.92; p = 0.03) less likely to have reported ENDS use in the past 30-days. The study provides an insight into the impact device types can have on future smoking behavior and the implication it can have on policy and regulation.

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