Abstract
Over 35% of the adult tobacco-using population regularly use more than one tobacco product. Although rates of tobacco use in the United States have declined over the last decade, rates of multiple tobacco product (MTP) have either remained stable (among adults) or increased (among youth). In this paper, we review the literature and propose a framework for understanding both MTP use and how regulatory actions on any single tobacco product (STP) may influence the use of other tobacco products. Within the framework, Product, Person, and Context/Situational factors (and their interactions) influence product cross-substitution and thus patterns of use of MTPs. In addition, we propose that Context/Situation effects specifically increase the complexity of MTP-use patterns resulting in "dynamic complementarity" in addition to substitution-like relationships between tobacco products. Experimentation with, and use of, various tobacco products results in reinforcement histories that affect which products are used, in what contexts, and by whom, which in turn has downstream impacts on toxicant exposure and health. We conclude our analysis with an examination of how regulation of STPs can have impacts on the use of other STP and MTP use and provide research questions for further examining MTP use. Though rates of tobacco use have declined in the United States, over 35% of the adult tobacco-using population regularly uses more than one tobacco product. This paper provides a framework for understanding MTP use and how regulatory actions on any STP may influence the use of other tobacco products. We conclude our analysis by providing research questions for further examining MTP use.
Highlights
Over 35% of the adult tobacco-using population regularly use more than one tobacco product
Implications:Though rates of tobacco use have declined in the United States, over 35% of the adult tobacco-using population regularly uses more than one tobacco product
This paper provides a framework for understanding multiple tobacco product (MTP) use and how regulatory actions on any single tobacco product (STP) may influence the use of other tobacco products
Summary
Tobacco use is the leading cause of death and disability in the United States. Combusted cigarette (CC) smoking alone accounts for 480 000 deaths annually; whereas, for every person who dies as a result of smoking, at least 30 people (ie, >16 million Americans) are living with smoking-related disease.[1]. Following the enactment of the FSPTCA in 2009, findings from the National Youth Tobacco Survey showed that there was a 17% decreased likelihood of adolescents being current CC smokers and a 58% decrease in the number of CC smoked by current smokers.[96] the ban on characterizing flavors was associated with increases in the use of menthol CC (use increased by 45%), cigars (by 34%), and pipes (by 55%) among current CC smokers, implying substitution toward the remaining legal flavored tobacco products.[96] sales of flavored cigars increased by nearly 50% from 2008 to 2015,97 and sales of clove cigars, increased by 1400% from 2009 to 2012.8 some of these increases may be due to increases in marketing expenditures by tobacco companies intent on replacing lost revenue,[98] they suggest that tobacco users will seek out substitutes following regulation of STPs. Further evidence suggests that increasing the cost of one tobacco product can lead to substitution.[31,99] Delnevo and colleagues[31] observed that increases in CC taxes in New Jersey resulted in significant increases in cigar use among recent quitters of CC smoking. Future and ongoing work will expand upon the findings from these hypothetical tasks by assessing similar questions in laboratory and clinical trials contexts
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