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Importance The prevalence of electronic nicotine delivery systems (ENDS) use, including e-cigarettes, among US young adults (YAs) has raised questions about how these products may affect future tobacco and nicotine use among YAs. Given this prevalence and that young adulthood is a critical period for the establishment of tobacco and nicotine use, it is important to consider the association between ENDS use and cigarette smoking specifically in this age group. Objective To examine whether ENDS use frequency or intensity is associated with changes in cigarette smoking among US YA ever smokers during 1 year. Design, Setting, and Participants This cohort study used 3 waves of data (2013-2014, 2014-2015, and 2015-2016) from the Population Assessment of Tobacco and Health (PATH) Study, an ongoing longitudinal cohort study of adults and youth. Unweighted 1:6 propensity score matching was used to match participants on wave 1 risk factors for ENDS use at wave 2. The changes in smoking between wave 2 and wave 3 were assessed using the matched sample. In total, 1096 ENDS-naive, ever cigarette–smoking YAs (18-24 years of age) at wave 1 who participated in wave 2 and wave 3 and who had complete data in the PATH Study were included in the analyses, which were conducted from August 2018 to October 2019. Exposures Never ENDS use (n = 987), any previous 30-day ENDS use (n = 109), 1 to 5 days of ENDS use in the previous 30 days (n = 75), and 6 or more days ENDS use in the previous 30 days at wave 2 (n = 34). Main Outcomes and Measures The analytic sample was selected using multiple variables based on peer-reviewed literature supporting associations with ENDS use. The main outcomes—changes in cigarette smoking behavior between wave 2 and wave 3—were defined using 2 measures: (1) change in smoking frequency, defined as the number of smoking days in the previous 30 days at wave 3 vs wave 2, and (2) change in smoking intensity, defined as the number smoking days in the previous 30 days multiplied by the mean number of cigarettes consumed on smoking days at wave 3 vs wave 2. Results The present cohort analyses included 1096 YA ever smokers who were ENDS naive at wave 1. The majority of the sample were women (609 [55.6%]) and White individuals (698 [63.7%]), and the mean (SD) age was 21.4 (1.9) years. In wave 1, 161 YAs (14.7%) were daily smokers in the previous 30 days. After propensity score matching, no statistically significant associations were observed between any definition of wave 2 ENDS use and changes in either the frequency or intensity of smoking at wave 3. Conclusions and Relevance In this cohort study of US YA ever smokers, ENDS use was not associated with either decreased or increased cigarette smoking during a 1-year period. However, it is possible that the rapidly evolving marketplace of vaping products may lead to different trajectories of YA cigarette and ENDS use in the future.

Adolescents commonly misuse alcohol, with 24.2% reporting current binge drinking in surveys of US high school students.1 Early-onset drinking raises risks for drinking-related morbidity2 and alcohol dependence. The alcohol industry spent $1.7 billion in media advertising in 2009 (The Nielsen Co, unpublished data, 2009. Ratings and other data contained herein are the copyrighted property of The Nielsen Co. Unauthorized use of this copyrighted material is expressly prohibited. Violators may be subject to criminal and civil penalties under Federal Law [17 USC 101 et seq.]. All rights reserved.), operating only under voluntary limits regarding youth. Moreover, in 1996, the Distilled Spirits Council of the United States ended its ban on television advertising. If such advertising is reaching adolescents, brands with larger ad expenditures may be chosen as favorites, and adolescents might choose a distilled spirit as their favorite brand to drink. We report favorite brand and its association with ad expenditures and binge drinking in a population survey of underage adolescents.