Abstract
BackgroundWith the increasing changes in tobacco use patterns, “current use” definition and the survey used may have important implications for monitoring population use trends.MethodsUsing three US surveys (2014/15 TUS-CPS, NHIS and PATH), we compared the adult (age 18+) prevalence of four product groups (cigarettes, other combustibles, smokeless tobacco, and e-cigarettes) based on three past 30-day frequency of use thresholds: 1+, 10+, and 25+ days. We also examined mutually exclusive single, dual, and polytobacco users as a percentage of total users for each product group.ResultsRegardless of threshold or product, the prevalence was higher in PATH followed by NHIS and TUS-CPS, in some cases by large percentages. The differences in cigarette and smokeless tobacco use prevalence in going from the 1+ to 10+ days and to the 25+ days threshold were minimal. Applying different frequency thresholds had the largest impact on other combustibles prevalence, with a 60% reduction with the 10+ days threshold and a 80% reduction with the 25+ days threshold, compared to the 1+ days threshold, followed by e-cigarettes with 40 and 60% reductions, respectively. The proportion of dual and polytobacco users decreased considerably when using the 10+ vs. the 1+ days threshold and polytobacco use was almost non-existent with the 25+ days threshold.ConclusionThe estimated prevalence of each tobacco product use depends largely on the survey and frequency of use threshold adopted. The choice of survey and frequency threshold merits serious consideration when monitoring patterns of tobacco use.
Highlights
With the increasing changes in tobacco use patterns, “current use” definition and the survey used may have important implications for monitoring population use trends
Comparison of prevalence estimates across surveys Compared to TUS-CPS cigarette use prevalence estimates (13.6% with the 1+ day, 12.7% with the 10+ days and 11.0% with the 25+ days thresholds), National Health Interview Survey (NHIS) estimates were about 10% higher in relative terms and estimates from Population Assessment of Tobacco and Health (PATH) were nearly 40% higher in relative terms (e.g., 1+ day frequency of cigarette use for PATH = 18.8% and TUS-CPS = 13.6%: 18.8–13.6%/ 13.6% = 38.2%) regardless of the threshold
The prevalence estimates for other combustibles from NHIS and PATH were more than double those from TUS-CPS (2.1% for 1+ day, 0.7% for 10 + days and 0.4% for 25+ days) regardless of the threshold
Summary
With the increasing changes in tobacco use patterns, “current use” definition and the survey used may have important implications for monitoring population use trends. In estimating the use of other non-cigarette tobacco products (e.g., e-cigs, cigars, cigarillos, snus), current use is often defined as use on at least one day in the past 30 days [15] or every day or someday [16] While this measure is likely to be most inclusive, it may not adequately distinguish regular patterns of use from sporadic, shortterm, or experimental use [17, 18]. With increases in use of non-cigarette tobacco products both in terms of exclusive and multiple product (dual; concurrent use of two products and polytobacco; concurrent use of 3+ products) use, in some population subgroups, the choice of frequency of use threshold (minimum number of days used to be considered a frequent user) appropriate for each product’s use pattern may have important implications for monitoring some trends and behaviors. Differences in surveys aim, methodology, sample size and questions asked may affect estimates of product use prevalence [20, 21], and have important implications for surveillance
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