Trends in Nicotine Product Use among US adolescents, 1999-2020.

Introduction:
This text provides an analysis of trends in nicotine product use among US adolescents from 1999 to 2020, focusing on the impact of e-cigarettes on exposure and risk. The study uses a new measure called nicotine product days (NPDs) to assess exposure and risk-adjusted NPDs to account for differential health risks associated with different products.

Key Points:

* The study uses 16 years of data from the National Youth Tobacco Survey, including students in grades 6 through 12.
* The study assesses nicotine product exposure by evaluating past 30-day use of 9 products, measuring consumption frequency as the number of days each product was used.
* The study defines NPDs as the number of days that an individual consumed a nicotine product in the past 30 days and records NPDs by product type.
* The study treats all combustible tobacco products as having a risk weight of 1.0 and smokeless tobacco as having a risk weight of 0.1, while varying the risk weight of e-cigarettes from 0.1 to 1.0.
* The study found that NPDs decreased prior to the popularity of e-cigarettes, but the decrease slowed and then reversed due to the upsurge of vaping.
* Risk-adjusted NPDs may have decreased if the risk associated with vaping is sufficiently low compared with that of smoking.
* The study suggests that NPDs represent an improvement in assessing adolescent nicotine product use compared with the CDC standard summary measure of any tobacco product use in the past 30 days.

Main Message:
The study highlights the importance of accounting for frequency of use and product risk implications in assessing adolescent nicotine product use. While e-cigarettes have contributed to an increase in NPDs in recent years, risk-adjusted NPDs may have decreased if the long-term risks associated with vaping are low compared with those of smoking. The study emphasizes the need to closely monitor youth nicotine and tobacco product use patterns and the importance of considering the health consequences associated with different mixes of products over time.

Sun R, Mendez D, Warner KE. Trends in Nicotine Product Use among US adolescents, 1999-2020. JaMa network open. 2021;4(8):1. doi:10.1001/jamanetworkopen.2021.18788