Adolescent Tobacco Users Research Articles

Risk perceptions and changes in tobacco use in relation to Coronavirus Disease 2019 pandemic: A qualitative study on adolescent tobacco users in Hong Kong.

Tobacco use is associated with an increased risk of Coronavirus Disease 2019 (COVID-19) infection, severe COVID-19 outcomes requiring intensive care, and mortality. We investigated the perceived risk of and changes in cigarette, e-cigarette (EC) and heated tobacco product (HTP) use in relation to COVID-19 in Hong Kong adolescent tobacco users. We conducted semi-structured telephone interviews from January to April 2021 and in February 2022 on 40 adolescents (65% boys, Secondary school grades 2-6) who participated in our previous smoking surveys and were using cigarettes, ECs or HTPs before the first wave of the COVID-19 pandemic in January 2020. Adolescents generally perceived higher risks of contracting and having more severe COVID-19 from using cigarettes than ECs/HTPs, but they had limited knowledge of COVID-19 risks from EC/HTP use, particularly. Both increased and reduced consumption were found in tobacco, with EC use being the less affected product. Changes also included switching to ECs for convenience and lower cost and shifting from smoking cigarettes outside to mainly at home or in hidden areas. COVID-related policies, fear of infection, non-COVID-related health concerns, less social opportunities and pocket money, and limited access to tobacco products were barriers to tobacco use. In contrast, greater freedom at home versus school and negative emotions due to social distancing were facilitators. Family/peer influence had mixed impacts. Adolescent tobacco users perceived lower COVID risks associated with HTPs and ECs than cigarettes, and various changes in tobacco use were found amid the pandemic in Hong Kong. COVID-19 and related social changes may both facilitate or deter adolescent tobacco use.

An Epidemiological Study of Addictive Behavior Pattern Among Adolescent Tobacco Users.

The risk of developing tobacco-related cancer and chronic heart and lung disease is greater if addiction starts in adolescence. Even experimental use of tobacco in adolescents significantly increases the risk of addiction in adulthood. This study intends to collect valuable data regarding sociodemographic characteristic of tobacco use, pattern of dependence among adolescent tobacco users, which will be essential for formulating recommendations, and their possible intervention aimed at reducing the problem of tobacco use. A community-based cross-sectional study was done where 400 subjects were enrolled. Nonprobability Snowball sampling technique was used to locate adolescents aged 12-18 years, who were practicing tobacco use. Face-to-face interviews were taken for data collection. Fragerstorm dependency test for tobacco was used to classify dependency of tobacco product into high and low dependency. Data was analyzed using Chi-square test and proportions using SPSS software version 21. Majority of the subjects were in the age group of 16-18 years; mean age for initiation of tobacco was 15.6 years. Gutkha was the predominant form of tobacco product being used. Peer pressure 192 (48.0%) was the major reason for initiation of tobacco use. A significant association was found between dependency on tobacco and age, literacy, and socioeconomic status. Tobacco use starting from early age has many health implications. There is a need for stringent laws against the selling of tobacco to adolescents and targeted health awareness program against tobacco.

Exploring the perceived sociocultural factors in the initiation of smokeless tobacco among adolescents: a qualitative systematic review protocol.

The objective of the review is to identify and explore the perceived sociocultural factors leading to smokeless tobacco initiation among the adolescent population. Smokeless tobacco use is associated with oral cancer and premalignant lesions. The initiation of smokeless tobacco often occurs in adolescence, with multiple sociocultural factors facilitating the commencement of this habit. An in-depth understanding of the factors influencing smokeless tobacco uptake can assist policymakers and tobacco-control units in establishing global policies and implementing control strategies to prevent adolescents' taking up smokeless tobacco. This review will consider qualitative studies conducted within the last 20 years on adolescent smokeless tobacco users, focusing on sociocultural factors influencing smokeless tobacco initiation. Studies involving cigarette smoking, other alternative forms of smoking, and any form of tobacco cessation intervention will be excluded. A systematic search will be conducted in MEDLINE, Scopus, CINAHL, Embase, PsycINFO, and the Cochrane CENTRAL databases, using a 3-step search process. ProQuest Dissertations, OAIster, and Google will be searched for unpublished studies. Only studies published from January 2002 until the present and in English will be considered. Study screening, extraction, and critical appraisal will be performed by 2 independent reviewers using the standardized JBI qualitative appraisal and data extraction tools. Data synthesis will involve aggregation of the review findings to generate a set of statements based on similarity of meaning. PROSPERO CRD42021240588.

Intention to Quit Tobacco Use and its Determinants Among Adolescent Tobacco Users Residing in Slum Areas of Bhubaneswar, India: A Cross-Sectional Study

Abstract Introduction Intention to quit is the initial step and a strong predictor of quitting tobacco use. Objective The aim of this study was to estimate the prevalence and determinants of intention to quit tobacco use among adolescent tobacco users residing in the slum areas of Bhubaneswar, India. Materials and Methods A community-based cross-sectional study was performed during the year 2017–2018 involving 152 adolescent tobacco users residing in the slums of Bhubaneswar. Multistage cluster random sampling was used to select the study areas. Results Ninety-three (61.2%) adolescents had the intention to quit tobacco use. Multivariate logistic regression analysis revealed that the odds of intention to quit tobacco use was significantly higher in adolescents who used it for less than 5 years' duration (adjusted odds ratio (aOR): 2.59; 95% confidence interval [CI]: 1.14–5.87), those used first tobacco of the day between 31 and 60 minutes after waking up in the morning (aOR: 2.60; 95% CI: 1.17–5.79) or more than 60 minutes after waking up (aOR: 6.69; 95% CI: 2.28–19.61), and those who noticed anti-tobacco messages in any media in the past 30 days (aOR: 2.70; 95% CI: 1.02–7.14). Conclusion The prevalence of intention to quit tobacco use among slum adolescents of Bhubaneswar is 61.2%, which can be enhanced by incorporating the determinants of the intention to quit tobacco use in the existing anti-tobacco schemes.

Positive Affect and Multiple-tobacco Product Use among Youth: A 3-year Longitudinal Study.

Objectives: Multiple-tobacco product (MTP) use is common among adolescent tobacco users. Low positive affect is a risk factor for e-cigarette use and combustible tobacco smoking. In this study, we examine the longitudinal relationship between positive affect and MTP use in a diverse cohort of adolescents in Texas. Methods: We analyzed 6 waves of biennial data (fall 2014-spring 2017) from the Texas Adolescent Tobacco and Marketing Surveillance (TATAMS) system. Participants were 3868 sixth-, eighth-, and tenth-grade students in urban Texas, at enrollment. Multinomial logistic regression models examined the longitudinal relationship between positive affect and categories of MTP use, controlling for sex, race/ethnicity, past 30-day alcohol use, cohort, survey wave, and peer tobacco use. Results: The sample was comprised of 4.6% single-product users, 1.7% dual-users, and 0.7% poly-users. Each unit decrease in positive affect was associated with increased risk for single- (RRR: 1.29; 95% CI: 1.16-1.44), dual- (RRR: 1.35; 95% CI: 1.11-1.64), and poly- (RRR: 1.98; 95% CI: 1.54-2.54) use, relative to non-use. Similarly, each unit decrease in positive affect was also associated with increased risk for poly-tobacco use relative to single- (RRR: 1.53; 95% CI: 1.19-1.97) and dual- (RRR: 1.47; 95% CI: 1.11-1.95) use. Positive affect did not differentiate between single- and dual-use. Conclusion: We observed a gradient relationship between low positive affect and greater number of tobacco products used. Findings reinforce the association between poor mental health and tobacco use during adolescence. Prevention efforts may need to incorporate methods of addressing low positive affect.

Geographic isolation predicts tobacco product use among youth: A latent class analysis.

The purpose of the current study was to evaluate associations between geographic rurality and tobacco use patterns among adolescents. High school students (N = 566) from north-central Appalachia reported on their lifetime and/or current use of cigarettes, electronic cigarettes (ECIGs), cigars, and smokeless tobacco. Geographic rurality was measured via the Isolation scale, whereby residential ZIP Codes determined the degree to which respondents have access to health-related resources. Latent class analysis (LCA) was used to identify discrete classes of adolescent tobacco users based on their use of tobacco products. Then, associations between participants' geographic rurality and class membership were evaluated using a series of multinomial logistic regressions. LCA classified participants as Nonusers, Current ECIG Users, Cigarette/ECIG Experimenters, and Polytobacco Users. Individuals with higher Isolation scores were more likely to be Polytobacco Users and Cigarette/ECIG Experimenters than Nonusers, and were more likely to be Polytobacco Users than Current ECIG Users. The continuous Isolation scale used in the present study predicted polytobacco use patterns among adolescents in a manner that is consistent with, while simultaneously expanding upon, prior work. Tobacco control practices and policies should be viewed through a lens that considers the unique needs of geographically isolated areas.

Analysis of multidimensional factors in attempts to quit using tobacco by Korean adolescents

BackgroundThis study aims to understand the extent of adolescents’ attempts to quit using tobacco and the factors influencing such attempts in Korea, using a descriptive, cross-sectional design and secondary data analysis with the 2019 Youth Health Behavior Survey.MethodsThe participants were 4028 adolescent tobacco users who had used tobacco for 1 day or more in the past 30 days. The data analysis was performed using IBM SPSS/WIN 26.0 program, and multivariable logistic regression analysis was conducted using the complex sampling method module.ResultsA total of 68.2% of the participants attempted to quit using tobacco. We analyzed the factors for adolescents’ attempts to quit using tobacco by dividing them into psychological, physical, behavioral, and environmental dimensions. The factors influencing adolescents’ attempts to quit using tobacco, identified through multivariable logistic regression analysis, are as follows: participation in sports activities (OR = 1.20, 95% CI 1.01–1.41), vigorous physical activity (OR = 1.24, 95% CI 1.06–1.46), and type of tobacco product used (OR = 1.65, 95% CI 1.24–2.21) in the behavioral dimension; pictorial cigarette pack warnings (perceived smoking as unhealthy) (OR = 1.91, 95% CI 1.56–2.36), and the presence of secondhand smoking at home (OR = 1.18, 95% CI 1.01–1.38) in the environmental dimension.ConclusionsSchools and public healthcare providers must consider multidimensional factors when providing support for successful tobacco cessation in adolescents and focus particularly on elements relating to physical activity and environmental factors.

Acceptance of Drug Use Mediates Future Hard Drug Use Among At-Risk Adolescent Marijuana, Tobacco, and Alcohol Users.

Alternative high school (AHS) students typically report higher levels of alcohol and other drug use compared to students attending traditional high schools. Greater use of such drugs as heroin, methamphetamines, and cocaine in this at-risk population may be driven, in part, by a greater latitude of acceptance toward substance use in general, which may accelerate the transition from gateway drugs to hard drugs. Seven hundred seventy-seven adolescents (mean age 16.6; 56% female) were recruited from alternative high schools throughout Southern California. To understand the factors that may lead AHS students to use hard drugs, a model was tested in order to determine if AHS students' latitude of acceptance toward substance use was a mediator between the relationship of past use of gateway drugs and future use of hard drugs. Latitude of acceptance was found to be a statistically significant mediator of future hard drug use (b = 0.03, 95% confidence intervals = 0.01 to 0.05) among gateway drug users. An individual's latitude of acceptance to various drug use behaviors may be consistent with societal norms. However, after exposure to, or use of, gateway drugs, attitudes that are more permissive toward hard drug use may be encountered, the acceptance of hard drugs may expand, and the use of hard drugs may escalate. Interventions designed to reduce the use of hard drugs among at-risk youth may be more persuasive by crafting messages that are within the latitude of acceptance of the target population and prevent the acceptance of hard drug use.

Tobacco use and dental fear among 15-16 year-old adolescents in Finland.

The aim of this cross-sectional study was to evaluate the association between tobacco use and dental fear when adjusting for gender, parent's level of education and oral health habits. This secondary analysis used questionnaire data from 15- and 16-year-old adolescents and their parents (n=2486). Ninety-four percent of the adolescents and 73% of the parents responded. For logistic regression analysis, variables were categorized as follows: dental fear (dependent) 0=not at all to somewhat afraid, 1=quite or very afraid; tobacco use (independent) 0=never, 1=occasionally or more often; and for confounders: tooth-brushing 0=at least twice a day, 1=once a day or less often; xylitol products 0=at least three times a day, 1=two times a day or less often; and parents' occupation: 0=both low, 1=high+low, and 2=both high. 2223 adolescents were included in the final analyses resulting in a 89% response rate. Those using tobacco at least occasionally were more likely to have dental fear than those who reported they had never used tobacco, also when adjusting for oral health habits, gender and parents' occupation (OR=1.74, 95% CI=1.31-2.33). Adolescent tobacco users were more likely to have dental fear than non-users. Dental teams should consider this when meeting adolescents who have dental fear and/or are using tobacco. The possible common vulnerability factors for dental fear and tobacco use needs further study.

Adolescents’ Response to a Text Message-Delivered Tobacco Use Intervention by Depressive Symptoms and Sex

Introduction Adolescent female tobacco users are more likely to have a depression disorder relative to tobacco using adolescent males. Less is known about how sex interacts with depression within the context of text-messaged delivered randomized controlled trials addressing tobacco use. Understanding the variation of treatment response based on sex and depression symptomatology would inform targeted, personalized adolescent tobacco use treatments. Methods To address this issue, a secondary data analysis was conducted from a text message-delivered clinical trial targeting 198 tobacco-using adolescents. The sample was 53% female and 91% African American with a mean age of 16.2. A three-way moderation analysis was used to determine if the treatment’s effect on tobacco use was moderated by depressive symptoms, which in turn, was moderated by sex. Results The analyses demonstrated that female adolescents were significantly more sensitive to the effects of depressive symptoms compared to male adolescents, such that those with elevated depressive symptoms did no better than controls on past 30-day tobacco use. However, for those females with fewer depressive symptoms, the treatment was effective in significantly reducing tobacco use. For males, treatment effects were not dependent on depressive symptoms. Conclusions These findings contribute to the clinical science on treatment response to text-delivered adolescent tobacco use interventions. Results support the need to provided targeted, individualized tobacco treatment that concurrently addresses depression for female adolescents.

Effectiveness of School based Awareness Programmes against Tobacco among Users and Non- Users– A Cross- Sectional Study from Rural Kerala, India

Background:Known is the fact that adult tobacco users mostly had their initiation into the habit during the adolescence period. The current study was conducted to evaluate the impact of awareness programmes among adolescent students in rural Kerala, India, in terms of knowledge enhancement on tobacco hazards. Methods:A total of 10 high schools and higher secondary schools from one educational sub district were selected using multi stage sampling design. Male students in the age group 13-19 years studying in class IX and X (high school category) and class XI and XII (higher secondary school) were included in the study. The effectiveness was assessed using pre and post training evaluation forms based on mean knowledge scores. Results:1,114 students participated by filling both the forms (mean age 15.6, SD 1.3). The response rate was 92.8%. The prevalence of ‘current users’ in the study was 4.3% (95% CI 3.11- 5.49). Overall difference in mean knowledge scores among study subjects was evident when pre and post training responses were compared (p<0.001). The difference in knowledge scores was evident among ‘never users’ of tobacco before and after the awareness programmes (p<0.0001). However, no significant difference in mean scores was observed among ‘ever users’ of tobacco (p = 0.584), age groups of ever users (p=0.208), students of high schools (p = 0.242) and higher secondary schools (p= 0.994). Comparison of never, ever and current users revealed significant difference between ‘never’ and ‘current’ users (p = 0.001). However, no such difference was observed between ‘ever’ and ‘current’ users (p =0.138) and ‘ever’ versus ‘never’ users (p =0.099). Conclusion:The study was useful to improve knowledge among school students in general. However, newer strategies have to be tested to understand the best possible measures for tobacco awareness training among adolescent tobacco users.

Physical activity among adolescent tobacco and electronic cigarette users: Cross-sectional findings from the Population Assessment of Tobacco and Health study

Research examining relationships between protective health behaviors and tobacco use offers valuable insight regarding the behavior profiles of product users. In particular, protective health behavior trends among adolescent e-cigarette users have not been examined thoroughly to date. This study investigates physical activity patterns among adolescent e-cigarette users, smokers, and dual users of both products, as compared with never users of tobacco products.Data were collected from 8383 youth participants (12–17 years of age) enrolled in Wave 2 (2014–2015) of the nationally-representative Population Assessment of Tobacco and Health Study. Relationships between use of tobacco products and physical activity were examined via weighted multivariable logistic regression procedures. Compared with never users, each product use group demonstrated an increased likelihood to abstain from moderate-vigorous physical activity. While dual users (aOR = 0.52; 95% CI: 0.30–0.85) and smokers (aOR = 0.53; 95% CI: 0.35–0.71) were less likely than never users to participate in vigorous physical activity, no differences were observed between e-cigarette and never users (aOR = 1.04; 95% CI: 0.74–1.47). Dual users consistently demonstrated the lowest likelihood of physical activity participation.In conclusion, e-cigarette users were more likely to abstain from moderate-vigorous physical activity participation than never users. However, results did not indicate differences in vigorous or muscle-strengthening physical activity participation between e-cigarette users and never users. Though findings specific to moderate-vigorous physical activity demonstrate a behavioral similarity between e-cigarette users and smokers, key differences in vigorous physical activity were observed. Comparatively low physical activity among dual users suggests existence of a behavior profile gradient according to product use.

Flavored tobacco use is associated with dual and poly tobacco use among adolescents

ObjectivesThis study examines the relationships between flavored tobacco use and single, dual, and poly tobacco product use, among adolescents. Given the increased use of flavored tobacco products, it is vital to understand if flavored products are associated with dual and poly tobacco product use. MethodsData were obtained from the 2017 National Youth Tobacco Survey. Participants were 2042 adolescent past 30-day tobacco users. Multivariable multinomial logistic regression models were used to assess the relationship between flavored tobacco use and past 30-day single, dual, and poly (three or more) tobacco product use. Two analyses were conducted using different categories as referent groups to allow for a comprehensive examination of the relationship between all groups. Covariates included sex, grade level, race/ethnicity and exposure to tobacco marketing. ResultsApproximately half of all adolescent tobacco users (45.7%) reported use of more than one product. The majority of adolescent tobacco users reported using flavors (69.4%). Flavored tobacco use was significantly correlated with a greater risk of dual (RRR: 2.09) and poly (RRR: 5.54) tobacco use, relative to single product use, controlling for covariates. Similarly, flavored tobacco use was significantly correlated with a greater risk of poly (RRR: 2.66) tobacco use, relative to dual tobacco use, controlling for covariates. ConclusionsA positive relationship was observed for flavored tobacco use and multiple tobacco product use. Findings suggest the need to consider stronger regulations of flavored tobacco products. Similarly, as most adolescent tobacco users reported using flavors, findings suggest the need to emphasize flavored tobacco use in prevention and education programs.

Prevalence patterns and profile of adolescent tobacco users findings from a youth survey: A cross-sectional study.

Aim:To assess the prevalence of smoking and smokeless tobacco use among 16--19-year-old government and private college student of Bhubaneswar city.Materials and Methods:A cross-sectional descriptive study was designed and data on tobacco usage was collected from 906 students aged 16--19-year old government and private college students of Bhubaneswar city using modified youth tobacco survey (YTS) closed-ended questionnaire. Data was analyzed using descriptive statistics and Chi-square tests were used to determine the significant differences in the variables of interest.Results:Out of 906 study subjects, mean age of initiation of use of tobacco product was found to be 14.8 among males and 15.3 among females. The responses of study subjects upon there believe that tobacco companies try to lure young people to use tobacco products, 54.7% males, 45.3% females reported as yes. 63 (9.9%) of students from private college reported using smokeless tobacco whereas 27 (10%) of students from government college used chewing tobacco. The results were statistically significant. A total of 84 (16.9%) males followed by 18 (4.4%) females reported to have ever tried smoking. The results were statistically significant.Conclusion:It was encouraging to find that during the period of the survey, majority of students did not use tobacco of any form. Regular and systematic education programs catering to teachers, children, and also their parents should be undertaken. Enabling teachers to educate the young impressionable minds regarding lifestyle disorders should be a cornerstone activity in preventing the establishment of lifestyle disorders like tobacco and alcohol use within the community.

Patterns and Profiles of Adolescent Tobacco Users: Results From the Virginia Youth Survey

BackgroundCigarette smoking has decreased to a record low among youth across the United States, including in Virginia. Rates of alternative tobacco use, however, are rising and polytobacco use is common. A better understanding of the shifting use patterns and associated risk factors is important for informing tobacco prevention, cessation, and policy efforts.MethodsWeighted data from the 2013 Virginia Youth Survey were used. The sample was limited to 1168 youth who reported past 30-day tobacco use of ≥1 product (cigarettes, smokeless tobacco [smokeless], or cigars/little cigars/cigarillos [cigars]). Latent class analysis categorized individuals based on current tobacco use frequency/intensity. Multivariable multinomial logistic regressions compared classes on demographics, other tobacco-related factors, other substance use, and health/psychosocial factors.ResultsThe five-class model indicated the best fit with classes characterized as “Chippers” (28.0%; high probability of low-frequency/intensity cigarette use), “Moderate Poly-Users” (23.6%; low- to high-frequency/moderate intensity cigarette use; moderate probability smokeless/cigar use), “Cigar Users” (20.9%; no–low-probability cigarette/smokeless use; high-probability cigar use), “Smokeless Users” (17.3%; no–low-probability cigarette/cigar use; moderate–high-probability smokeless use), and “Heavy Poly-Users” (10.4%; daily/high-intensity cigarette use, moderate–high-probability smokeless/cigar use). Classes differed significantly by demographics and inconsistently by other tobacco-related factors. Heavy Poly-Users were more likely to engage in other substance use behaviors, report suicidal ideation, and report being bullied because of gender.ConclusionsClasses identified indicate that a large proportion of youth engage in polytobacco use and certain subgroups may be at greater risk for negative health consequences due to elevated psychosocial and behavioral risk factors.ImplicationsThese findings suggest distinct patterns of current tobacco use, including a high proportion of youth engaging in polytobacco use. Heavy polytobacco use co-occurs with other health risk behaviors and may be attributed to psychosocial risk factors. Results underscore the need for detailed monitoring of shifting youth tobacco use patterns as well as targeted prevention, cessation, and policy efforts.

The TOBg Tobacco Treatment Guidelines for Adolescents: A real-world pilot study.

INTRODUCTIONWe conducted a pilot study to: 1) obtain feedback from prevention practitioners in terms of their satisfaction, knowledge, and self-efficacy following exposure to the Tobacco Treatment Guidelines for Adolescents (TOBg Guidelines); and 2) examine the effectiveness of a school-based intervention based on the TOBg Guidelines on quit rates among a sample of adolescent tobacco users.METHODSTwo parallel studies were conducted. In Study 1, prevention practitioners were exposed to a 1-day training in the TOBg Guidelines with assessment occurring before, immediately after, and at 6 months following the training. In Study 2, participating adolescent smokers were exposed to a 3-session group-based smoking cessation intervention that drew on the TOBg Guidelines and was delivered by practitioners trained in Study 1. The primary outcome measure was self-reported smoking status assessed at 1 month and at 6 months following baseline.RESULTSA total of 18 prevention practitioners and 65 adolescent tobacco users participated in the pilot study. The majority of practitioners reported high rates of satisfaction with the TOBg Guidelines and indicated that the guidelines positively influenced the manner in which they addressed tobacco use with adolescents. Prevention practitioners’ self-efficacy for intervening with adolescent smokers was also significantly increased following exposure to the TOBg Guidelines and training. Among adolescents exposed to the school-based intervention, 62.5% and 23.1% had reduced smoking by 50% or more at 1 month and at 6 months follow-up, respectively. No significant change in smoking abstinence was documented.CONCLUSIONSThe TOBg Guidelines for adolescent smokers were well received by prevention practitioners and were feasible to implement in a real-world school setting.

Treatment of Tobacco Use Disorder and Mood Disorders in Adolescents

To update the literature on treatment of tobacco use in the context of comorbid mood disorders among adolescents, focusing on the last 5 years (2013–2017). We review tobacco use prevalence, the association between adolescent tobacco use and mood disorders, and interventions for adolescent tobacco users and those with concurrent mood disorders. Advances were made in behavioral treatments for adolescent tobacco users, but minimal research focused on innovative approaches such as social media, family-based approaches or alternative therapies. There is a dearth of research on adolescents with comorbid mood disorders. Few studies targeted diverse populations. Minimal research was conducted within this patient cohort using nicotine/tobacco products other than cigarette smoking. Research has not been done to clarify the role of depression/mood severity on treatment outcomes. Current gaps in the tobacco treatment science for adolescents with mood disorders are highlighted and directions for future research offered.

Self-Identified Tobacco Use and Harm Perceptions Among US Youth.

We investigated tobacco-related self-identity and risk perceptions among adolescent tobacco users. Data were analyzed for 20 675 US sixth- to 12th-graders from the 2016 National Youth Tobacco Survey. Students who reported past-30-day use of a specific tobacco product or ≥2 products but denied having used "any tobacco product" in the past 30 days were classified as not self-identifying as tobacco users. Tobacco product harm perceptions were further assessed across products. Descriptive and multivariable logistic regression analyses were performed. Among past-30-day users of ≥1 specific tobacco product type, those denying having used any tobacco products in the past 30 days included single-product users of roll-your-own and/or pipe tobacco (82.2%), electronic cigarettes (e-cigarettes) (59.7%), cigars (56.6%), hookah (44.0%), smokeless tobacco (38.5%), and cigarettes (26.5%) as well as poly-tobacco users (12.7%). The odds of denying using any tobacco products were higher among those without symptoms of nicotine dependence than those with symptoms (adjusted odds ratio = 2.16); and those who access their tobacco products via social sources than those who bought them (adjusted odds ratio = 3.81; all P < .05). Among those believing "all tobacco products" were harmful, single-product users of the following believed their own product was not harmful: e-cigarettes (74.6%), hookah (56.0%), smokeless tobacco (41.8%), and cigarettes (15.5%). Many of those who used certain tobacco products exclusively did not self-identify as tobacco users. Increasing the sensitivity of questions used to assess youth tobacco use in surveys and clinical settings can mitigate nondisclosure or underreporting of true tobacco use status.

Racial and ethnic differences in patterns of adolescent tobacco users: A latent class analysis

BackgroundLittle is known about how tobacco use varies among youth of different racial and ethnic groups and how these patterns are related to levels of nicotine dependence. ObjectivesThis study investigated the tobacco use patterns of White, African American, and Hispanic high school students. We further explored whether tobacco use patterns were associated with levels of nicotine dependence and gender. MethodsData were analyzed from the 2014 National Youth Tobacco Survey (NYTS) of high school students who endorsed at least one form of tobacco use in their lifetime (n=4691). Three separate latent class analysis (LCA) models were estimated using seven different types of tobacco products as indicators. Also, the level of nicotine dependence was compared with one class to another class in three racial/ethnicity groups. ResultsFour classes of White youth were identified: (1) “Non-user” (67%), (2) “Polytobacco” (6%), (3) “Chewing Tobacco” (8%), and (4) “(E-)Cigarettes” (19%) classes. The “Polytobacco” class had the highest nicotine dependence followed by “Chewing Tobacco,” “(E-)cigarettes,” and “Non-user.” Among African American youth, two tobacco patterns were identified: “Non-user” (91%) and “Cigarette/Cigar” (9%). The “Cigarette/Cigar” class had greater nicotine dependence than the “Non-user” class. Among Hispanic youth, three subgroups were identified: “Non-user” (78%), “(E-)Cigarette/Cigar” (14%), and “Hookah” (18%). “(E)Cigarette/cigar” had the highest nicotine dependence in Hispanic youth followed by the “Hookah” and “Non-users” classes. ConclusionWe found distinct classes of youth tobacco use by race/ethnicity. Although poly-tobacco use was common, White, African American, and Latino youth used different tobacco types, suggesting that racially and ethnically targeted prevention strategies may be indicated.

Trends in Perceived Access to Marijuana Among Adolescents in the United States: 2002-2015.

There is concern that changes in marijuana-related policy and public opinion may lead to increased access to marijuana among young people in the United States. However, little research has been conducted on changes in youth's perceptions of marijuana access, and studies have yet to systematically examine trends in perceived access across key sociodemographic and externalizing behavioral subgroups. Using population-based data collected between 2002 and 2015 as part of the National Survey on Drug Use and Health, we examined trends in perceived marijuana access among non-Hispanic White, African American, and Hispanic adolescents (ages 12-17, n = 221,412). Following the trend analysis method outlined by the Centers for Disease Control and Prevention, we conducted logistic regression analyses to test for secular trends. Between 2002 and 2015, we observed a 27% overall reduction in the relative proportion of adolescents ages 12-17-and a 42% reduction among those ages 12-14-reporting that it would be "very easy" to obtain marijuana. This pattern was uniformly observed among youth in all sociodemographic subgroups (i.e., across age, gender, race/ethnicity, household income) and among youth reporting involvement/no involvement in most measures of substance use (alcohol, marijuana) and delinquency (handgun carrying, attacks). However, perceived very easy access remained stable among youth reporting tobacco use and criminal justice system involvement. Despite the legalization of recreational and medical marijuana in some states, our findings suggest that, with the notable exception of adolescent tobacco users and juvenile offenders, perceptions that marijuana would be very easy to obtain are on the decline among American youth.