Behavioral Precursors of Nicotine Product Use Trajectories Among Youth

Abstract

Introduction: Preventing nicotine use among youth is a public health priority. Nicotine use emerges from complex relationships between numerous factors. This project used network analysis to model behavioral precursors of nicotine use (knowledge, attitudes, perceptions, intentions) among youth who had never used nicotine and determine which predicted future trajectories of use across multiple nicotine products. Methods: Data were from the Population Assessment of Tobacco and Health study (2013–2018; analyzed 2023–2024), youth ages 12–17, who reported never using nicotine at Wave 1. Network structure was determined for behavioral precursors at Wave 1 and central network nodes were identified (N=5,087). Central nodes were then tested as predictors of trajectories of use across multiple nicotine products during Waves 1–4 (N=3,851). Results: Central nodes of the Wave 1 network were harm perception, expectancy that tobacco would calm anger/reduce stress, and intention to try. Those with lower intent to try at Wave 1 had lower odds of being in an Experimentation or Use class versus a Nonuse class during Waves 1–4 (p<0.0001). Those with more accurate harm perception had lower odds of being in an Experimentation versus Nonuse class (p=0.004). Those with positive expectancies had higher odds of being in an Experimentation versus Nonuse or Use class (p=0.04, 0.02). Conclusions: Findings suggest a network model of behavioral precursors of nicotine use that can be tested, including central nodes that predicted trajectories of use across multiple nicotine products, and therefore may be priority intervention targets.