Methodology Differences Impacting Prevalence Estimates of Youth Use of Electronic Nicotine Delivery Systems (ENDS) across Waves 5-7 of the Population Assessment of Tobacco and Health

Background : The Population Assessment of Tobacco and Health (PATH) is a commonly-used longitudinal survey on nicotine/tobacco product use. Accurate surveillance to prevent youth use of electronic nicotine delivery systems (ENDS) requires understanding the impact of methodological differences in Wave 6 (~2021), specifically older ages (14–17 vs. usual 12–17) and survey mode (some telephone interviews vs. usual self-completed). Methods : Changes in past-30-day (P30D) youth ENDS prevalence and patterns of use (i.e., frequency, device type, flavors, and brand) were examined year-over-year and for the 3-year period (2019–2022) . Analyses compared combined age groups and survey modes (i.e. among all youth in each wave regardless of survey mode) with methodologically-comparable subgroups (i.e. same age range and survey mode). The impact of age on point estimates and trends (i.e. interaction with wave) was examined. Results : Youth P30D ENDS prevalence significantly declined over the prior 3 years, but not over the prior 1 year in either the naïve or methodologically-comparable analyses. However, 14-17-year olds reported higher prevalence and steeper declines (age-wave interaction p <0.0001) over the past 3 years (12.2% to 7.5%) than 12-13-year olds (1.7% to 1.2%). Age differences had more modest impacts on patterns of ENDS use. Discussion : Methodological differences in PATH Wave 6 introduced artifacts in estimates of prevalence, and to a lesser extent, patterns of youth ENDS use. Waves 5 and 7 are approximately comparable with respect to these differences. Future research examining prevalence trends over these waves should account for differences in survey mode and age range.