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. Author manuscript; available in PMC: 2024 Apr 1.
Published in final edited form as: Addict Behav. 2022 Dec 17;139:107588. doi: 10.1016/j.addbeh.2022.107588

Use of electronic nicotine delivery system (ENDS) devices among U.S. youth and adults: Findings from the Population Assessment of Tobacco and Health Study Waves 1–5

Nan Jiang 1,*, Shu Xu 2, Le Li 3, Charles M Cleland 4, Raymond S Niaura 5
PMCID: PMC9840694  NIHMSID: NIHMS1860056  PMID: 36549101

Abstract

Introduction:

Electronic nicotine delivery system (ENDS) devices evolve rapidly and impact nicotine dependence. This study described the type of ENDS devices used most frequently by U.S. youth and adults from 2013/14 to 2018/19.

Methods:

We analyzed Waves 1–5 data of the Population Assessment of Tobacco and Health Study. Among current ENDS users, descriptive statistics summarized the most frequently used ENDS devices (i.e., disposable cigalike, refillable cartridge, nonrefillable cartridge, tank, mod, prefilled pod, disposable pod) among youth (12–17 years), young adults (18–34 years), and older adults (≥35 years) for each wave.

Results:

The proportion of current ENDS users who reported they most frequently used disposable cigalikes and cartridge-based devices declined over time across all age groups. At Waves 1–4, tank was generally the most popular type for all ages and an increasing proportion of ENDS users reported they most frequently used tanks. The primary use of mods decreased among youth, and fluctuated among young and older adults. At Wave 5, prefilled pods became the dominant type (youth: 55.0%; young adults: 44.7%; older adults: 42.7%), and 4.2–10.0% of ENDS users reported using disposable pods most often. The popularity of tanks, mods, and prefilled pods was more evident in youth and young adults, and primary use of disposable pods was more common in older adults.

Conclusions:

The primary use of ENDS devices changed over the years and varied by age. More research is warranted to continuously monitor the characteristics of ENDS devices in youth and adults to inform product regulations and intervention efforts.

Keywords: electronic nicotine delivery system, e-cigarette, device type

1. INTRODUCTION

The use of electronic nicotine delivery systems (ENDS) has increased considerably, particularly among youth and young adults (Dai & Leventhal, 2019; Gentzke et al., 2019). The increasing popularity of ENDS is attributed to multiple factors, including the availability of a substantial variety of devices (Kong, Morean, Cavallo, Camenga, & Krishnan-Sarin, 2015). First-generation devices (known as “cigalikes”) resemble the look of conventional cigarettes and are not rechargeable or refillable. Second-generation pen-shaped devices (also called “vape-pens”) use prefilled or refillable cartridges. These cartridge-based devices are rechargeable but power output is often unadjustable. Hence, users cannot adjust the temperature to which e-liquid is heated, and puff volume and aerosol density are not variable. Third-generation devices (tanks and mods) have more customizable features. The devices are rechargeable, and users can adjust the power to generate greater aerosol production and increase nicotine yield. The devices are refillable, and users can choose from a wide range of nicotine concentrations and flavors (Zhu et al., 2014). Users can customize e-liquids by adding accessories and mixing e-liquids to change nicotine concentrations (Centers for Disease Control and Prevention, 2021). The fourth-generation pod-based system launched in the U.S. in 2015 (Truth Initiative, 2019). Pod devices feature various designs, including rechargeable prefilled pods (e.g., JUUL, Phix), rechargeable refillable pods (e.g., Suorin), and the latest disposable pods which entered the U.S. market in 2019 (Delnevo, Giovenco, & Hrywna, 2020) (e.g., Puff Bar, Vuse).

In 2019 and 2020, prefilled pods were the most commonly used type with JUUL the most commonly used brand among middle and high school students in the U.S. (Cullen et al., 2019; Wang et al., 2021a; Wang et al., 2020). In 2021 and 2022, disposable pods became the dominant type with Puff Bar the leading brand in youth (Cooper et al., 2022; Park-Lee et al., 2021). Among U.S. adults, data from the Population Assessment of Tobacco and Health (PATH) Study showed that “open systems” (i.e., tanks and mods) were used more commonly than “close systems” (i.e., disposable cigalikes and cartridge-based devices) in 2015–2016 (Coleman et al., 2019). There is a lack of recent nationally representative estimates of ENDS device types used by adults.

ENDS devices impact dependence because product design affects nicotine delivery (El-Hellani et al., 2018; Leventhal, Mason, Kirkpatrick, & Anderson, 2020; Talih et al., 2015). Advanced models deliver nicotine faster than older models and therefore, are more effective in rapidly reducing withdrawal symptoms (Farsalinos et al., 2014; Lechner et al., 2015). This in part explains why newer-generation devices are perceived to be more satisfying to vapers (Chen, Zhuang, & Zhu, 2016; Etter, 2016). Pod devices, particularly the recent disposable pods, contain considerably high concentrations of nicotine compared to early devices and typically use nicotine salts in e-liquids, allowing high nicotine concentrations to be delivered with less throat irritation (Goniewicz, Boykan, Messina, Eliscu, & Tolentino, 2019; Leventhal et al., 2021; Talih et al., 2022). For young people, the most often cited reasons for pod use are high nicotine concentration and efficient nicotine delivery in addition to discreteness of vaping (Keamy-Minor, McQuoid, & Ling, 2019; Lee, Rees, Yossefy, Emmons, & Tan, 2020; McKelvey & Halpern-Felsher, 2020). Laboratory research shows that JUUL relieves urges to smoke with a speed similar to conventional cigarettes and faster than cigalikes, tanks, and mods (Hajek et al., 2020). Disposable pods including Puff Bar emit significantly higher levels of nicotine and toxicant constituents (e.g., carbonyls) than JUUL (Talih et al., 2022). Adolescent and young adult pod users report higher levels of dependence (Boykan, Goniewicz, & Messina, 2019; Tackett et al., 2021) and exhibit higher urinary cotinine values (Boykan et al., 2019) than non-pod users, and those who initiated ENDS use with mods (third-generation) and pods (fourth-generation) are more likely to report dependence and progress to higher frequency of ENDS use than users who started with pen-shaped devices (second-generation) (Sargent et al., 2022). Longitudinal data indicate that adults who use earlier-generation models are likely to transition to using later-generation devices instead of using same models continuously (Yingst, Foulds, Veldheer, & Du, 2019), and youth and young adults who use pods are likely to remain as pod users instead of using early devices (Lin, Baiocchi, & Halpern-Felsher, 2020).

Considering the rapidly evolving ENDS devices and the addiction potential, appropriate regulations on product design are warranted. Today, Vuse, NJOY, and Logic (among the top 10 most commonly used brands for youth (Cooper et al., 2022)) are legally marketed in the U.S. (U.S. Food and Drug Adminitration, 2022b). JUUL and Puff Bar remain on the market without marketing authorization from the U.S. Food and Drug Administration (FDA) (U.S. Food and Drug Adminitration, 2022a). Puff Bar claimed their products as tobacco-free using synthetic nicotine formula in order to evade FDA’s regulation on the halt of sales of Puff Bar products (U.S. Food and Drug Administration, 2020a). Since April 2022, FDA has had the jurisdiction over tobacco products containing nicotine from any source, including synthetic nicotine (U.S. Food and Drug Adminitration, 2022c). In February 2020, FDA enforced a flavor ban on prefilled pods/cartridges (except tobacco- or menthol-flavored products) (U.S. Food and Drug Administration, 2020b). However, the ban does not apply to disposable pods or refillable devices such as tanks and mods. A recent study found there is no significant change in the use of unauthorized flavors among youth before and after the flavor ban was implemented (Hammond et al., 2022). Along with this finding, it concluded that the primary use of disposable devices such as Puff Bar increased considerably and the use of prefilled pods/cartridges such as JUUL decreased, suggesting the partial ban has limited impact due to the loophole in that some but not all device types are included.

Monitoring the characteristics of ENDS devices used by youth and adults is critical to inform regulatory policies and intervention programs that combat the rise of ENDS use. The PATH Study provides longitudinal estimates of ENDS use, including the types of devices, in a nationally representative sample of U.S. youth and adults. Using currently available PATH data (Waves 1–5; 2013/14 – 2018/19), a period that ENDS products were rapidly evolving, this study delineated the primary device types used by current ENDS users among youth, young adults, and older adults.

2. METHODS

We analyzed Waves 1–5 public-use data from the PATH Study, a national longitudinal cohort study on tobacco use and tobacco-related health among a representative household sample of U.S. youth (12–17 years) and adults (≥18 years). The PATH Study (Wave 1: Sep 2013 – Dec 2014, 13651 youth / 32320 adults; Wave 2: Oct 2014 – Oct 2015, 12172 youth / 28362 adults; Wave 3: Oct 2015 – Oct 2016, 11814 youth / 28148 adults; Wave 4: Dec 2016 – Jan 2018, 14798 youth / 33822 adults; Wave 5: Dec 2018 – Nov 2019, 12098 youth / 34309 adults) employed a 4-stage stratified area probability sample design and included tobacco users and non-users (U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse, & U.S. Department of Health and Human Services Food and Drug Administration Center for Tobacco Products, 2021). The weighted response rates for individual participants ranged from 72.3% to 87.3% for youth and from 69.4% to 83.2% for adults.(U.S. Department of Health and Human Services et al., 2021) Further details regarding the PATH Study are published elsewhere (Hyland et al., 2017).

2.1. Sample

Our youth sample (12–17 years) included those who had used an electronic nicotine product more than once in lifetime, reported past 30-day use, and had no missing value on the weighting variable. Those who only had a few puffs were not asked to indicate the type of ENDS devices and therefore, were not included in analyses. The sample size of youth current ENDS users ranged from 285 to 831 for the 5 waves.

The adult sample included those who had used an electronic nicotine product at least once in lifetime, reported now using “every day” or “some days”, and had no missing value on the weighting variable. Adult participants were classified as young adults (18–34 years) or older adults (≥35 years). The sample size ranged between 1259 and 2092 for young adult ENDS users, and between 552 and 1376 for older adult ENDS users. Table 1 displays sample characteristics by age group for each wave.

Table 1.

Sample characteristics

Wave 1 Wave 2 Wave 3 Wave 4 Wave 5
n (%a) n (%a) n (%a) n (%a) n (%a)
Youth N = 285 N = 332 N = 385 N = 495 N = 831
Age
 12–14 46 (15.0) 68 (19.3) 70 (17.0) 80 (15.0) 127 (17.1)
 15–17 239 (85.0) 264 (80.7) 315 (83.0) 415 (85.0) 704 (82.9)
Gender
 Male 184 (65.1) 203 (60.3) 205 (53.4) 282 (56.6) 421 (50.3)
 Female 101 (34.9) 109 (39.7) 180 (46.6) 213 (43.4) 406 (49.7)
Race/ethnicity
 Non-Hispanic white 175 (67.6) 209 (70.1) 221 (67.4) 327 (72.7) 486 (67.7)
 Non-Hispanic black 16 (5.3) 12 (4.3) 27 (6.9) 14 (2.8) 54 (5.5)
 Hispanic 65 (18.7) 78 (18.6) 87 (17.6) 101 (15.5) 180 (18.8)
 Other 29 (8.4) 29 (7.0) 40 (8.1) 53 (9.0) 74 (8.0)
Household income level
 < $10,000 - - 25 (7.5) 28 (6.8) 25 (4.8) 39 (4.2)
 $10,000–24,999 - - 58 (16.7) 58 (13.8) 58 (10.4) 105 (12.3)
 $25,000–49,999 - - 65 (21.5) 101 (26.9) 111 (22.2) 200 (24.2)
 $50,000–99,999 - - 84 (28.0) 90 (24.7) 129 (28.1) 223 (28.1)
 ≥ $100,000 - - 71 (26.3) 90 (27.8) 151 (34.5) 237 (31.2)
Parents’ education attainment
 Less than high school 59 (18.2) 50 (13.5) 39 (8.4) 46 (7.7) 68 (7.1)
 High school graduate or equivalent 56 (20.0) 87 (25.9) 101 (25.3) 106 (20.1) 145 (17.2)
 Some college or associate degree 98 (34.5) 105 (33.3) 152 (41.1) 169 (34.0) 305 (35.0)
 Bachelor’s degree or advanced degree 70 (27.3) 77 (27.3) 86 (25.2) 169 (38.2) 308 (40.7)
Young adults N = 1463 N = 1375 N = 1259 N = 1342 N = 2092
Age
 18–24 791 (41.9) 791 (45.6) 796 (51.6) 887 (53.8) 1514 (61.0)
 25–34 672 (58.1) 584 (54.4) 463 (48.4) 455 (46.2) 578 (39.0)
Gender
 Male 887 (63.0) 838 (65.1) 710 (59.4) 784 (61.7) 1109 (55.2)
 Female 576 (37.0) 536 (34.9) 548 (40.6) 558 (38.3) 981 (44.8)
Race/ethnicity
 Non-Hispanic white 950 (67.7) 909 (71.0) 734 (63.3) 790 (62.5) 1214 (64.4)
 Non-Hispanic black 110 (7.3) 89 (6.2) 135 (10.5) 136 (10.6) 224 (10.9)
 Hispanic 258 (15.6) 234 (13.6) 259 (17.0) 292 (18.8) 441 (16.4)
 Other 145 (9.4) 137 (9.2) 122 (9.2) 123 (8.1) 198 (8.3)
Household income level
 < $10,000 347 (22.9) 298 (21.6) 286 (19.8) 285 (20.4) 353 (16.4)
 $10,000–24,999 353 (25.6) 349 (25.1) 323 (27.1) 289 (23.4) 432 (21.7)
 $25,000–49,999 320 (25.4) 295 (24.0) 264 (25.0) 291 (25.0) 425 (23.6)
 $50,000–99,999 210 (17.3) 226 (19.9) 181 (17.8) 219 (18.6) 397 (21.2)
 ≥ $100,000 102 (8.8) 108 (9.4) 111 (10.3) 161 (12.6) 331 (17.1)
Education attainment
 Less than high school 191 (11.5) 191 (11.3) 164 (9.5) 174 (11.6) 214 (8.6)
 High school graduate or equivalent 564 (37.3) 488 (34.0) 478 (36.5) 540 (37.9) 795 (35.5)
 Some college or associate degree 572 (40.5) 570 (44.0) 497 (42.3) 519 (41.6) 865 (42.3)
 Bachelor’s degree or advanced degree 125 (10.7) 115 (10.7) 111 (11.7) 100 (8.9) 211 (13.6)
Older adults N = 1376 N = 1136 N = 773 N = 607 N = 522
Age
 35–44 510 (35.7) 457 (40.2) 296 (36.6) 250 (41.2) 241 (43.8)
 45–54 426 (30.5) 349 (28.6) 238 (30.2) 192 (31.2) 148 (27.6)
 55–64 321 (24.3) 251 (22.8) 174 (22.7) 112 (18.9) 87 (17.6)
 ≥ 65 119 (9.5) 79 (8.4) 65 (10.5) 53 (8.8) 46 (11.0)
Gender
 Male 600 (46.6) 476 (46.4) 321 (46.8) 272 (47.9) 209 (43.6)
 Female 776 (53.4) 660 (53.6) 452 (53.2) 335 (52.1) 313 (56.4)
Race/ethnicity
 Non-Hispanic white 1031 (77.4) 856 (78.2) 572 (77.9) 425 (71.7) 353 (71.6)
 Non-Hispanic black 132 (9.7) 97 (8.6) 83 (9.8) 79 (13.2) 73 (11.8)
 Hispanic 111 (7.3) 84 (7.4) 70 (8.9) 52 (9.2) 56 (11.7)
 Other 102 (5.6) 81 (5.8) 40 (3.4) 50 (5.9) 31 (4.9)
Household income level
 < $10,000 180 (13.3) 199 (18.2) 130 (15.6) 101 (17.5) 92 (18.5)
 $10,000–24,999 333 (26.1) 252 (22.4) 168 (20.8) 147 (24.8) 113 (20.3)
 $25,000–49,999 320 (25.9) 275 (25.2) 198 (27.7) 152 (25.0) 113 (22.7)
 $50,000–99,999 297 (23.3) 243 (22.4) 155 (23.0) 126 (22.0) 113 (23.5)
 ≥ $100,000 137 (11.4) 116 (11.8) 85 (12.9) 58 (10.7) 69 (15.0)
Education attainment
 Less than high school 151 (10.7) 140 (12.5) 114 (14.1) 91 (14.6) 69 (12.4)
 High school graduate or equivalent 417 (34.7) 357 (35.1) 230 (33.1) 190 (37.7) 167 (37.1)
 Some college or associate degree 584 (39.1) 463 (38.0) 307 (37.8) 240 (35.0) 208 (35.9)
 Bachelor’s degree or advanced degree 215 (15.5) 169 (14.4) 115 (15.0) 84 (12.7) 77 (14.6)
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Notes.

a

Weighted percentages

-

Not assessed by the PATH Study

2.2. Measures

At Waves 1–4, current ENDS users reported their primary device type by answering a series of questions regarding “the electronic nicotine product you use/used most of the time”: (1) “Is it rechargeable? [Yes/No]”, (2) “Does it use cartridges? [Yes/No]”, (3) “Can you refill it with ‘e-liquid’? [Yes/No]”, and (4) “Does it use a tank system? [Yes/No]”. (The 4th item was not assessed in Wave 1). Following the PATH guidelines (U.S. Department of Health and Human Services et al., 2021), responses were classified into 5 mutually exclusive groups at Wave 1 (i.e., “disposable cigalike”, “refillable cartridge”, “prefillable cartridge”, “tank”, and “unknown”), and 6 mutually exclusive groups in Waves 2–4 with an additional type of “mod”. Table 2 displays the coding of device types at Waves 1–4.

Table 2.

Coding of ENDS device types: Waves 1–4 of the PATH Study

ENDS device type Rechargeable Use cartridges Refillable Use a tank system
Disposable cigalikea No No No No
Refillable cartridgea Yes Yes Yes No
Prefillable cartridgea Yes Yes No No
Tanka,b Yes No Yes Yes
Modc Yes No Yes No
Unknowna Other combinations of responses
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Notes.

a

ENDS devices were coded based on 3 items (“rechargeable?” “use cartridges?” “refillable?”) at Wave 1 and all the 4 items at Waves 2–4.

b

The PATH survey did not differentiate between tanks with mods at Wave 1, because the item “use a tank system?” was not assessed at Wave 1. Hence, the “tank” category at Wave 1 also included ENDS users who used mods most often.

c

”Mod” was coded based on all the 4 items at Waves 2–4.

At Wave 5, the device type was assessed by one question (“Think about the electronic nicotine product you use most often. What kind of electronic nicotine product is it?”) with answer options of “a disposable device”, “a device that uses replaceable prefilled cartridges”, “a device with a tank that you refill with liquids”, “a mod system”, “something else”, and “don’t know”. The response option “a disposable device” could not distinguish between first-generation disposable cigalikes and fourth-generation disposable pods. Nevertheless, it was coded as “disposable pod” because cigalikes had been rarely available in the market since later-generation devices became popular (Williams, 2020). Similarly, the answer option “a device that uses replaceable prefilled cartridges” could not distinguish between second-generation cartridge-based devices and fourth-generation prefilled pods, but was coded as “prefilled pod” because second-generation devices were less prevalent since tanks and mods were introduced to the market. We combined “something else” and “don’t know” as “unknown”. Hence, 5 mutually exclusive types of ENDS devices at Wave 5 included “disposable pod”, “prefilled pod”, “tank”, “mod”, and “unknown”.

2.3. Statistical analysis

We conducted repeated cross-sectional analyses using SAS version 9.4. For each wave, we described the primary device type used by current ENDS users for each of the three age groups (i.e., youth, young adults, and older adults). Specifically, for each device type, we calculated the weighted proportion of current ENDS users who reported using the type most often. Cross-sectional weights (Waves 1–3: cross-sectional weights for Wave 1 cohort; Waves 4–5: cross-sectional weights for Wave 4 cohort) were applied to account for complex sampling design and non-response.

3. RESULTS

Table 1 shows the demographic characteristics of the sample by wave. Figures 1–3 display the most frequently used ENDS device types among current ENDS users by wave for each age group. Overall, the proportion of current ENDS users who reported disposable cigalikes and prefillable cartridges as their usual devices declined over time for all age groups. We observed a steep drop in the primary use of refillable cartridge devices from Wave 2 to Wave 3, but the proportion of ENDS users who most frequently used refillable cartridge devices remained relatively constant at Waves 3–4.

Figure 1.

Figure 1.

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ENDS devices used most often among youth current ENDS users by wave

Figure 3.

Figure 3.

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ENDS devices used most often among older adult current ENDS users by wave

From Wave 1 to Wave 4, tank became increasingly popular across all age groups. Tank was the most commonly used type, except for older adults at Wave 1 where nonrefillable cartridge devices were most popular. The use of mods as primary devices declined among youth, but fluctuated among young and older adults. The popularity of tanks and mods was more evident in youth and young adults than among older adults.

At Wave 5, prefilled pods became the most commonly used type for all age groups. Among current ENDS users, 55.0% of youth, 44.7% of young adults, and 42.7% of older adults reported using prefilled pods most of the time. And a range of 4.2–10.0% of ENDS users (youth: 4.2%; young adults: 6.3%; older adults: 10.0%) reported using disposable pods most often.

4. DISCUSSION

This study is among the first to delineate the use of ENDS devices in a nationally representative sample of U.S. youth and adults over the years. It is not surprising that the primary use of first-generation disposable cigalikes and second-generation cartridge-based devices declined over time. From Wave 1 through Wave 4, tank was generally the most commonly used type for all age groups. The popularity of tanks over early-generation devices may be explained by the product design: the adjustable power makes it more efficient in nicotine delivery (Farsalinos et al., 2014; Lechner et al., 2015). and the wide variety of e-liquids in flavors and nicotine concentrations makes it more appealing to vapers.

Interestingly, as with third-generation devices, mods were far less popular than tanks, and the primary use of mods decreased among youth. The results may be related to the relatively large size and bulkiness of mods which make it inconvenient to carry. Our findings align with national youth data showing that mod use is significantly less prevalent than tank use for middle and high school students, and the proportion of mod users in youth vapers declined during 2019 and 2020 (10.6% to 8.2% in middle school; 10.0% to 4.2% in high school; (Wang et al., 2021b)). Research among Connecticut high school students also illustrates a decrease in mod use from 2017 to 2019 (Bold et al., 2021). Research is warranted to better understand what factors influence user decision-making in choosing specific ENDS devices in order to inform intervention efforts that address ENDS use.

In 2018/19 (Wave 5), prefilled pods surpassed tanks as the most popular type across all age groups. This finding is consistent with national data collected in 2019 and 2020 indicating that prefilled pods were the dominant type among middle and high school students (Cullen et al., 2019; Wang et al., 2021a). The shift from tanks to pods as the usual device type is again related to product design: the sleek shape and small size of pods make it convenient to carry and easy to conceal, and the non-traditional youth-friendly flavors and innovative delivery of high nicotine concentrations increase vapers’ sensory experiences (Keamy-Minor et al., 2019; Wagoner, King, Alexander, Tripp, & Sutfin, 2021). Pod use has raised pressing concerns about high nicotine exposure, especially for youth, because pod devices often use nicotine salts to facilitate rapid and easy inhale of high nicotine concentrations (Centers for Disease Control and Prevention, 2021). Although a federal flavor ban has been enforced (other than tobacco and menthol flavors) (U.S. Food and Drug Administration, 2020b), important loopholes exist since disposable pods and refillable devices (e.g., tanks and mods) are exempted.

Notably at Wave 5, 4.2–10.0% of current ENDS users reported they most often used disposable pods. Disposable pods have become increasingly popular since 2019 when JUUL suspended its flavored products (excluding menthol and tobacco flavors). During 2019 and 2022, the proportion of youth vapers using disposable pods as primary devices increased from 3.0% to 45.8% in middle schools and from 2.4% to 57.2% in high schools in the U.S. (Cooper et al., 2022; Park-Lee et al., 2021; Wang et al., 2021b). Since 2021, the dominant device type shifted from prefilled pods to disposable pods, and Puff Bar overtook JUUL becoming the leading brand in middle and high school students (Park-Lee et al., 2021). Aligned with surveillance data, sales data illustrate that, of total national ENDS sales, the proportion of disposable product sales increased from 10.3% to 30.0% between August 2019 and June 2021, while the market share of prefilled pods/cartridges decreased from 89.4% to 61.9% during the same time (Ali et al., 2020; CDC Foundation, 2021). The alarming uptick in the popularity of disposable pods is attributed to their diverse spectrum of pleasant flavors (due to the loophole that ENDS industry has used to circumvent the partial flavor ban) and relatively low prices of disposable pods compared to prefilled pods (Galimov et al., 2021; Ramamurthi et al., 2022; Williams, 2020). Educational campaigns need to inform the public about the addiction potential of pod (and other ENDS) products, including those claimed to contain synthetic nicotine. Surveillance efforts need to continuously monitor the characteristics of ENDS use including the type of devices. More research is warranted to explore how ENDS devices, particularly new emerging products such as disposable pods, affect ENDS use patterns and nicotine dependence.

The popularity of later-generation devices (except disposable pods) is more evident among youth and young adults than among older adults. This may be explained by the fact that young people have long been the target of ENDS companies (Grana & Ling, 2014). It is not clear why the primary use of disposable pods is more common in older adults. The Wave 5 PATH data were collected between December 2018 and November 2019, coinciding with the time that disposable pod devices were introduced to the U.S. market. Continued research is warranted to monitor product characteristics among youth and adult vapers. Given the limited research on ENDS use in older adults, a group that may have different preferences for ENDS products and different use patterns with young people, future studies are needed to explore how older adults perceive about the various ENDS devices, and how product design impacts their preferences and use behaviors.

This study is subject to several limitations. First, ENDS marketplace is dynamic and has evolved rapidly. The PATH Study may not capture all the new ENDS products. For example, pod devices were not included in PATH surveys until Wave 5. However, an advantage of the PATH Study is that the data provide longitudinal estimates of use of major devices in a large nationally representative sample of youth and adults. Second, PATH surveys only captured the most frequently used devices but not use of multiple devices. Thus, our results do not reflect the prevalence of use of various devices. Third, findings reported in this study were based on data collected prior to 2020. The COVID-19 pandemic and recent federal regulations on ENDS products may have impacted user preference for ENDS devices, highlighting the need for continued monitoring of device characteristics among ENDS users. Fourth, the Wave 1 PATH surveys did not differentiate between tanks with mods. Hence, estimates for tanks at Wave 1 also included mod devices. Fifth, a significant change was made in the assessment of ENDS devices at Wave 5. The response choice “disposable device” cannot distinguish between disposable cigalikes with disposable pods, and the “replaceable prefilled cartridge” cannot distinguish between second-generation cartridge devices with fourth-generation prefilled pods. We coded the types as “disposable pod” and “prefilled pod” because early-generation devices are rarely seen in the market when pod devices (including disposable and prefilled pods) became available. Last, self-report data are subject to recall bias and reporting error.

Conclusions

This study provided important new information about the type of ENDS devices used most frequently by a nationally representative sample of youth, young and older adults from 2013/14 to 2018/19. While disposable cigalikes and cartridge-based devices decreased in popularity, tank was the most commonly used type and became increasingly popular until 2018/19 when prefilled pods overtook its dominant popularity. This pattern was observed across all age groups, and was more evident among youth and young adults than among older adults. It is critical to continuously monitor the characteristics of ENDS devices in youth and adults. New emerging products such as disposable pods warrant urgent investigations from public health authorities and appropriate regulations (e.g., flavor restrictions that applied to prefilled pod/cartridge devices). More research is warranted to better understand what factors influence user decision-making process in choosing ENDS devices and how device characteristics impact ENDS use behavior and nicotine dependence.

Figure 2.

Figure 2.

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ENDS devices used most often among young adult current ENDS users by wave

Highlights.

  • Use of disposable cigalikes and cartridge devices declined for all ages over time.

  • Tank was generally the most commonly used device type for all ages in Waves 1–4.

  • Prefilled pod was the most frequently used device type for all ages at Wave 5.

  • Popularity of tank, mod and prefilled pod was more evident in youth and young adults.

  • The primary use of disposable pods was more evident in older adults at Wave 5.

Role of Funding Source

This work was supported by the National Cancer Institute (NCI) at the National Institutes of Health (R21CA260423). The NCI played no role in study design, data collection and analysis, manuscript writing, or the decision to submit the paper for publication.

Footnotes

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Conflict of Interest

Authors declared no conflict of interest.

Contributor Information

Nan Jiang, Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave, Room 17-54, New York, NY 10016, USA.

Shu Xu, School of Global Public Health, New York University, New York, NY 10003, USA.

Le Li, Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA.

Charles M. Cleland, Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA.

Raymond S. Niaura, School of Global Public Health, New York University, New York, NY 10003, USA.

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