Variation in quantity of puffs per day among U.S. adolescents and young adults using electronic nicotine delivery systems

PURPOSE: The present study examines an underutilized measure of electronic nicotine delivery system (ENDS) use quantity-the number of puffs taken per day (PPD)-and its associations with sociodemographic characteristics, device characteristics, and other tobacco/nicotine use behaviors. METHODS: The U.S. nationally representative Population Assessment of Tobacco and Health Study Wave 7 (2022-23) data were used. The sample was restricted to adolescents and young adults (AYAs; aged 12-30) who reported past-month ENDS use (N = 2606). Using linear regression models, differences by device characteristics (product type and flavor), nicotine use behaviors (other tobacco/nicotine use, nicotine dependence), and sociodemographics (age, sex, race, ethnicity) were examined as predictors of the average number of PPD. Predictors were examined for the full sample and stratified by age (12-20 and 21-20). RESULTS: AYAs reported picking up their ENDS device 26.1 times per day and took 3.9 puffs each time they picked up the ENDS device. The mean number of PPD was 66.9. Greater nicotine dependence (b=32.66; 95% CI=[20.48,35.84]) and use of a tank system (vs disposable devices; b=20.53, 95% CI=[7.39,33.67]) were associated with greater PPD. Average PPD did not vary by legal sales age or sex. CONCLUSIONS: On average, AYAs picked up their ENDS device more than once per hour each day and took multiple puffs each time. No differences were observed by sociodemographic characteristics. Other nicotine use behaviors are associated with more PPD among AYAs.