Transitions between cigarette, ENDS and dual use in adults in the PATH study (waves 1-4): multistate transition modelling accounting for complex survey design.

Introduction:
This text presents a study that aimed to estimate the transition rates between different types of tobacco use, including cigarette use, electronic nicotine delivery systems (ENDS) use, and dual use, among adults in the USA. The study used data from the Population Assessment of Tobacco and Health (PATH) study and incorporated complex survey design to increase the accuracy of the estimates. The study also compared the transition rates between different sociodemographic groups.

Key points:

* The study used data from the PATH study, which includes repeated observations of individuals' tobacco product use over multiple years.
* The study estimated transition rates between different tobacco use states, including never use, non-current use, exclusive cigarette use, exclusive ENDS use, and dual use.
* The study used a Markov multistate transition model, which is a mathematical framework for estimating underlying transition rates between states from longitudinal data on individuals.
* The study incorporated complex survey design, including sample weights, clustering, and strata, to increase the accuracy of the estimates.
* The study found that cigarette use was persistent among adults, with the majority of exclusive cigarette users and dual users remaining cigarette users after one wave. In contrast, ENDS use was less persistent, with a lower proportion of exclusive ENDS users and dual users remaining ENDS users after one wave.
* The study also found that transition rates varied among sociodemographic groups, with some groups being more or less likely to transition between tobacco use states.

Main message:
The study highlights the importance of using complex survey design when estimating transition rates between tobacco use states. The findings suggest that cigarette use is more persistent than ENDS use among adults, and that transition rates vary among sociodemographic groups. This information can be useful for informing tobacco control and public health policy. The study also demonstrates the potential of using Markov multistate transition models to estimate underlying transition rates between states from longitudinal data on individuals.

Brouwer AF, Jeon J, Hirschtick JL, et al. Transitions between cigarette, ENDS and dual use in adults in the PATH study (waves 1-4): multistate transition modelling accounting for complex survey design. Tobacco control. Published online November 16, 2020. doi:10.1136/tobaccocontrol-2020-055967