Patterns of youth tobacco and polytobacco usage: The shift to alternative tobacco products

• Published in: The American journal of drug and alcohol abuse 2017-11, Vol.43 (6), p.694-702
• Main Authors: Harrell, Paul T., Naqvi, Syeda Mahrukh H., Plunk, Andrew D., Ji, Ming, Martins, Silvia S.
• Format: Article
• Language: English
• Subjects: addiction; Adolescent; Adolescent Behavior - psychology; Adolescents; Child; Cigarettes; Cigars; co-substance use; Electronic cigarettes; electronic nicotine delivery systems; Ethnicity; Female; Hispanic Americans; Humans; Latent class analysis; Male; Minors; Non-cigarette tobacco products; priority/special populations; Public health; Risk Factors; Smoking; Sociodemographics; Surveys and Questionnaires; Tobacco; Tobacco products; Tobacco Products - statistics & numerical data; Tobacco Use - epidemiology; Tobacco Use - psychology; Tobacco Use Disorder - epidemiology; United States - epidemiology; Young Adult; Youth
• ISSN: 0095-2990; 1097-9891
• DOI: 10.1080/00952990.2016.1225072

Background: Despite significant declines in youth cigarette smoking, overall tobacco usage remains over 20% as non-cigarette tobacco product usage is increasingly common and polytobacco use (using 1+ tobacco product) remains steady. Objectives: The present study was designed to identify patterns of youth tobacco use and examine associations with sociodemographic characteristics and tobacco dependence. Methods: The current analysis uses Latent Class Analysis (LCA) to examine the 6,958 tobacco users (n = 2,738 female) in the National Youth Tobacco Survey (2012 and 2013). We used as indicators past month use of tobacco products (cigarettes, cigars, smokeless tobacco, e-cigarettes, hookah, snus, pipes, bidis, and kreteks) and regressed resulting classes on sociodemographic characteristics and tobacco dependence. Results: Nine classes emerged: cigarette smokers (33.4% of sample, also included small probabilities for use of cigars and e-cigarettes), cigar smokers (16.8%, nearly exclusive), smokeless tobacco users (12.3%, also included small probabilities for cigarettes, cigars, snus), hookah smokers (11.8%), tobacco smokers/chewers (10.7%, variety of primarily traditional tobacco products), tobacco/hookah smokers (7.2%), tobacco/snus/e-cig users (3.3%), e-cigarette users (2.9%,), and polytobacco users (1.7%, high probabilities for all products). Compared to cigarette smokers, tobacco/hookah smokers and hookah smokers were more likely to report Hispanic ethnicity. Polytobacco users were more likely to report dependence (AOR:2.77, 95% CI:[1.49-5.18]), whereas e-cigarette users were less likely (AOR:0.49, 95% CI:[0.24-0.97]).Conclusion: Findings are consistent with other research demonstrating shifts in adolescent tobacco product usage towards non-cigarette tobacco products. Continuous monitoring of these patterns is needed to help predict if this shift will ultimately result in improved public health.