Abstract
INTRODUCTIONSmokeless tobacco (SLT) use, across all age groups, is most prevalent among young adults in the US. A study estimating the age of initiation of SLT use among young adults is needed amid the changing landscape of tobacco products.METHODSSecondary analyses of PATH young adults across waves 1–4 were conducted. A total of 10595 young adults who were never SLT users at their first wave of adult participation in PATH (waves 1–3) were included in the analysis. Age of initiation outcomes of ever, past 30-day, and fairly regular SLT use, were assessed prospectively in waves 2–4. Interval censoring Cox regression models were used to assess differences in the age of initiation of each outcome by sex and race/ethnicity, adjusting for other tobacco product use.RESULTSBy the age of 27 years, 4.9%, 3.0%, and 1.9% of young adults reported initiating ever, past 30-day, and fairly regular SLT use, respectively. After controlling for demographic factors and other tobacco use, males initiated each of the SLT outcomes at earlier ages than females; non-Hispanic Blacks initiated each of the SLT use at later ages than non-Hispanic Whites; and Hispanic and non-Hispanic others initiated ever use at later ages than non-Hispanic Whites.CONCLUSIONSThese data suggest that three young adult groups are more likely to initiate use of SLT at earlier ages: males, non-Hispanic Whites, and poly-tobacco users. Knowing the age of SLT initiation outcomes among young adults will educate the public domain, inform SLT use prevention campaigns, and provide a baseline to measure the success of the Tobacco 21 legislation from December 2019.
Highlights
Smokeless tobacco (SLT) use, across all age groups, is most prevalent among young adults in the US
One potential explanation for the shift in the prevalence of SLT use from young adults aged 18–24 years to adults aged 25–44 years could be the increase in e-cigarette use by young adults aged 18–24 years. These findings show that young adults in particular are still vulnerable to SLT use
Since young adulthood is a developmental period that is distinct from youth and older adulthood, we examined young adult never SLT users as a subpopulation
Summary
Smokeless tobacco (SLT) use, across all age groups, is most prevalent among young adults in the US. A study estimating the age of initiation of SLT use among young adults is needed amid the changing landscape of tobacco products. US residents (median age: 26.3 years) from 1985– 2011 who never used cigarettes, cigars, and pipes, found that current SLT users had a higher mortality risk from coronary heart disease (HR=1.24; 95% CI: 1.05–1.46) compared to never tobacco users[2]. In an analysis of 11 US case-control studies between 1981–2006 including 6772 cases and 8375 controls (aged 17–94 years), never cigarette users had higher odds of developing oral cavity cancers if they ever used snuff compared to those who had never used snuff (OR=3.01; 95% CI: 1.63–5.55)[3]. The US has seen a sharp increase between 2013 and 2019 in the total amount of sales of SLT products, increasing from $3.26 billion in 2013 to $4.53 billion in 20195
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