Abstract
Although cigarette use by adolescents is declining, emerging tobacco products are becoming increasingly popular and youth may use more than one type of tobacco product. The purposes of this study were: (1) to assess patterns of poly-tobacco use among a representative sample of high school students and (2) to determine how beliefs correlate with poly-tobacco use. Data came from the 2013 North Carolina Youth Tobacco Survey (n = 4092). SAS logistic regression survey procedures were used to account for the complex survey design and sampling weights. Among all high school students in NC in 2013, 29.7% reported current any tobacco use, with 19.1% reporting current poly-tobacco use, and 10.6% reporting current use of only one product. Among poly-tobacco users, 59.3% reported that one of the products they currently used was cigarettes. Positive tobacco product beliefs were found to be significantly associated with poly-tobacco use. Communication campaigns, policy efforts, and future research are needed for prevention, regulation, and control of poly-tobacco use among adolescents, which represents a significant public health problem.
Highlights
The substantial decline in adolescent cigarette use over the past few decades is a notable public health achievement [1]
This study found that adolescents who believed that breathing smoke from tobacco products caused harm were less likely to be poly-tobacco users, but there was no association between dual and poly-tobacco product use and agreement with the statement “all tobacco products are dangerous” [6]
This study indicates that a high percentage of high school students in North Carolina report using more than one tobacco product (19.1%) and that this prevalence is significantly greater than single tobacco use (10.6%)
Summary
The substantial decline in adolescent cigarette use over the past few decades is a notable public health achievement [1]. This decline is threatened by a recent increase in use of emerging tobacco products, such as e-cigarettes, hookah, and snus. In a 2012 national study, 71.6% of high school students were aware, 21.7% had ever used, and 8.8% had currently used one or more emerging products in the past month [2] These prevalence rates, for e-cigarettes [3] and hookah [4], were considerably higher than in previous years. A web-based survey of 448 adolescents aged 16–24 in 2012 and 2013 found that among current users of tobacco, the prevalence of dual use (defined as use of two tobacco products in the past 30 days) was 25% and the prevalence of multiple use (defined as use of three or more tobacco products in the past 30 days) was 21% [5]
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