National Youth Tobacco Survey Research Articles

Marketing Exposure Recall is Associated With Past 30-Day Single, Dual, Polytobacco Use Among US Adolescents.

IntroductionThis study assesses the relationship between tobacco/e-cigarette marketing exposure and single, dual, and polytobacco product use, among adolescents. Given the increased use of noncigarette tobacco products (eg, cigars, e-cigarettes, hookah) among youth, it is imperative to understand if marketing exposure is associated with dual and polytobacco product use.MethodsData were obtained from the 2014 National Youth Tobacco Survey and weighted to be representative of US middle and high school students. Multivariable multinomial logistic regression models were used to assess the relationships between product marketing (via internet, print, retail, and TV/movies) and past 30-day single, dual, and poly (three or more) tobacco product use. Three analyses were conducted using different categories as referent groups to allow for comprehensive examination of the relationships between all groups.ResultsMarketing exposure was significantly correlated with a greater risk of single, dual, and polytobacco product use relative to nonusers. Relative to single product users, product marketing exposure was significantly correlated with a greater relative risk of dual and polytobacco use. There was no statistical difference in the association of marketing exposure between dual and polytobacco use, in any model.ConclusionA positive relationship between tobacco product marketing exposure and number of tobacco products used was observed. The magnitude of the relationship grew from single product to dual/poly use. Restrictions of marketing of all tobacco products, similar to cigarettes, particularly in the retail setting, should be considered.ImplicationsThis study has two primary public health implications. First, self-reported exposure to tobacco/e-cigarette marketing is widespread among adolescents of all tobacco product categories. Second, this widespread exposure to tobacco/e-cigarette marketing appears to not only be correlated with use of a single tobacco product (eg, cigarettes, e-cigarettes), but also multiple tobacco products. While longitudinal studies are needed to further investigate the relationships observed in this study, findings justify further study given the known relationship between tobacco marketing exposure and subsequent cigarette use.

Social Aspects of Hookah Smoking Among US Youth

Data were from the 2016 National Youth Tobacco Survey of US sixth- to 12th-graders (n = 20 675). Hookah smoking frequency was classified as never, former, current occasional, and current frequent. Places where past 30-day hookah smoking occurred and students' perceptions of their classmates' hookah smoking prevalence were assessed. Descriptive and multivariable analyses were performed (P < .05). Overall, 10.5% reported smoking hookah ≥1 time in their lifetime. Of these, 65.8% were former, 26.3% were current occasional, and 7.9% were current frequent smokers. Overall, 59.3% of students overestimated hookah smoking prevalence in their grade. Current occasional smoking was predicted by female sex (adjusted odds ratio [aOR] = 1.54) and peer hookah-smoking overestimation (aOR = 9.30). Current frequent smoking was most strongly predicted by living with a hookah smoker (aOR = 20.56), speaking a second language other than English (aOR = 2.17), and co-use of mentholated cigarettes (aOR = 19.94) or other flavored noncigarette tobacco products (aOR = 17.59). The top 3 places hookah was smoked were a friend's house (47.7%), the respondent's own house (31.8%), and another family member's house (20.8%). The home environment was the most common place for youth hookah smoking. Home-tailored interventions that encourage voluntary smoke-free rules and warn about the dangers of social smoking could help denormalize hookah smoking.

Trends in Healthcare Provider Advice on Youth Tobacco Use, 2011–2015

The American Academy of Pediatrics issued a policy statement to recommend screening all adolescents for tobacco and other drug use in 2011. This study sought to evaluate the trends of health professional screening and advice on youth tobacco use since then. Data from the 2011, 2013, and 2015 National Youth Tobacco Survey were analyzed to report the changes in tobacco screening and advice among 46,554 U.S. middle and high school students. Logistic regressions were used to assess trends and factors associated with screening or advice on tobacco use and to examine whether screening or advice on tobacco use was associated with quit behaviors. Analyses were conducted in 2017. Overall, the prevalence of tobacco screening significantly increased from 32.0% in 2011 to 37.9% in 2013 but had no significant change after that. The increase was largest among females and blacks, but there was no significant increase among e-cigarette users. By contrast, the prevalence of being advised not to use tobacco significantly decreased from 31.4% in 2011 to 26.9% in 2015. The decrease was largest among females, younger students, and e-cigarette users. Current cigarette smokers were more likely than nonsmokers to be advised on tobacco use, but no significant difference was found between e-cigarette only users and noncurrent users. Being advised not to use tobacco was associated with higher odds of planning to quit tobacco use among current tobacco users and current e-cigarette users, respectively. Continued efforts to increase tobacco use interventions by healthcare providers are needed.

Tobacco Product Use Among Middle and High School Students - United States, 2011-2017.

Tobacco use is the leading cause of preventable disease and death in the United States, and nearly all tobacco use begins during youth and young adulthood (1,2). CDC and the Food and Drug Administration (FDA) analyzed data from the 2011-2017 National Youth Tobacco Surveys (NYTS)* to determine patterns of current (past 30-day) use of seven tobacco product types among U.S. middle school (grades 6-8) and high school (grades 9-12) students and estimate use nationwide. Among high school students, current use of any tobacco product decreased from 24.2% (estimated 3.69 million users) in 2011 to 19.6% (2.95 million) in 2017. Among middle school students, current use of any tobacco product decreased from 7.5% (0.87 million) in 2011 to 5.6% (0.67 million) in 2017. In 2017, electronic cigarettes (e-cigarettes) were the most commonly used tobacco product among high (11.7%; 1.73 million) and middle (3.3%; 0.39 million) school students. During 2016-2017, decreases in current use of hookah and pipe tobacco occurred among high school students, while decreases in current use of any tobacco product, e-cigarettes, and hookah occurred among middle school students. Current use of any combustible tobacco product, ≥2 tobacco products, cigarettes, cigars, smokeless tobacco, and bidis did not change among middle or high school students during 2016-2017. Comprehensive and sustained strategies can help prevent and reduce the use of all forms of tobacco products among U.S. youths (1,2).

E-cigarette openness, curiosity, harm perceptions and advertising exposure among U.S. middle and high school students

Understanding factors associated with youth e-cigarette openness and curiosity are important for assessing probability of future use. We examined how e-cigarette harm perceptions and advertising exposure are associated with openness and curiosity among tobacco naive youth. Findings from the 2015 National Youth Tobacco Survey (NYTS) were analyzed. The 2015 NYTS is a nationally representative survey of 17,711 U.S. middle and high school students. We calculated weighted prevalence estimates of never users of tobacco products (cigarettes, cigars/cigarillos/little cigars, waterpipe/hookah, smokeless tobacco, bidis, pipes, dissolvables, e-cigarettes) who were open to or curious about e-cigarette use, by demographics. Weighted regression models examined how e-cigarette harm perceptions and advertising exposure were associated with openness using e-cigarettes and curiosity about trying e-cigarettes. Among respondents who never used tobacco products, 23.8% were open to using e-cigarettes and 25.4% were curious. Respondents that perceived e-cigarettes cause a lot of harm had lower odds of both openness (OR = 0.10, 95% CI = 0.07, 0.15) and curiosity about e-cigarettes (OR = 0.10, 95% CI = 0.07, 0.13) compared to those with lower harm perception. Respondents who reported high exposure to e-cigarette advertising in stores had greater odds of being open to e-cigarette use (OR = 1.22, 95% CI = 1.03, 1.44) and highly curious (OR = 1.25, 95% CI = 1.01, 1.53) compared to those not highly exposed. These findings demonstrate that youth exposed to e-cigarette advertising are open and curious to e-cigarette use. These findings could help public health practitioners better understand the interplay of advertising exposure and harm perceptions with curiosity and openness to e-cigarette use in a rapidly changing marketplace.

Frequency of Use and Smoking Status of U.S. Adolescent E-Cigarette Users in 2015

E-cigarette use by adolescents is an important issue for public health. This study analyzed the frequency of e-cigarette use and its association with smoking status among U.S. adolescents. The National Youth Tobacco Survey 2015 was analyzed in 2017, focusing on frequency of past 30-day e-cigarette use according to smoking status of participants. Smoking status was classified as never smoker, ever/not a past 30-day smoker, and past 30-day smoker. Infrequent and frequent smoking and e-cigarette use was defined as use for <20 and ≥20 of the past 30 days, respectively. Past 30-day e-cigarette use was reported by 54.5% (95% CI=47.8%, 61.0%) of past 30-day smokers, 26.5% (95% CI=23.2%, 30.1%) of ever/not past 30-day smokers, and 4.6% (95% CI=4.0%, 5.2%) of never smokers (p<0.001). No past 30-day e-cigarette use was reported by 94.5% and frequent e-cigarette use by 0.3% of never smokers. Past 30-day e-cigarette use was reported by 50.4% (95% CI=43.6%, 57.3%) of infrequent and 64.7% (95% CI=54.4%, 73.8%) of frequent past 30-day smokers (p<0.001). E-cigarette use frequency correlated with both smoking status and tobacco cigarette consumption (ρ=0.42, p<0.001 and ρ=0.40, p<0.001, respectively). Past 30-day smokers were more likely to report past 30-day e-cigarette use (OR=11.42, 95% CI=9.06, 14.40) compared with adolescents reporting no past 30-day smoking. E-cigarette use is more prevalent among ever and past 30-day smoking adolescents compared with never smoking adolescents. Frequent e-cigarette use is rare among never smoking adolescents.

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.

Exposure to Electronic Cigarette Advertising Among Middle and High School Students - United States, 2014-2016.

Electronic cigarettes (e-cigarettes) are the most commonly used tobacco product among U.S. middle and high school students (1). Exposure to e-cigarette advertisements is associated with higher odds of current e-cigarette use among middle and high school students (2-4). To assess patterns of self-reported exposure to four e-cigarette advertising sources (retail stores, the Internet, television, and newspapers and magazines), CDC analyzed data from the 2014, 2015, and 2016 National Youth Tobacco Surveys (NYTSs). Overall, exposure to e-cigarette advertising from at least one source increased each year during 2014-2016 (2014: 68.9%, 18.3 million; 2015: 73.0%, 19.2 million; 2016: 78.2%, 20.5 million). In 2016, exposure was highest for retail stores (68.0%), followed by the Internet (40.6%), television (37.7%), and newspapers and magazines (23.9%). During 2014-2016, youth exposure to e-cigarette advertising increased for retail stores (54.8% to 68.0%), decreased for newspapers and magazines (30.4% to 23.9%), and did not significantly change for the Internet or television. A comprehensive strategy to prevent and reduce youth use of e-cigarettes and other tobacco products includes efforts to reduce youth exposure to e-cigarette advertising from a range of sources, including retail stores, television, the Internet, and print media such as newspapers and magazines (5).

Harm Perceptions of Intermittent Tobacco Product Use Among U.S. Youth, 2016

PurposeWe aimed to describe U.S. youth harm perceptions of intermittent tobacco use. MethodsUsing data from the 2016 National Youth Tobacco Survey of U.S. students (grades 6–12; N = 20,675), we examined prevalence and correlates of all respondents' perceived harm of using four different tobacco products on “some days but not every day.” Associations between current (past 30-day) use and harm perceptions were assessed using multivariable regression. ResultsPerceiving that intermittent use causes “no” or “little” harm was 9.7% for cigarettes, 12.0% for smokeless tobacco, 18.7% for hookah, and 37.5% for e-cigarettes. Compared with those who reported “a lot” of harm, youth with lower harm perceptions were more likely to report current use. ConclusionsOne in ten youth perceived intermittent cigarette smoking as causing “little” or “no” harm; this perception was higher among current users. Efforts to educate youth about the risks of even intermittent tobacco product use could reduce misperceptions of harm.

Reasons for Electronic Cigarette Use Among Middle and High School Students - National Youth Tobacco Survey, United States, 2016.

Electronic cigarettes (e-cigarettes) were the most commonly used tobacco product among U.S. middle school and high school students in 2016 (1). CDC and the Food and Drug Administration (FDA) analyzed data from the 2016 National Youth Tobacco Survey (NYTS) to assess self-reported reasons for e-cigarette use among U.S. middle school (grades 6-8) and high school (grades 9-12) student e-cigarette users. Among students who reported ever using e-cigarettes in 2016, the most commonly selected reasons for use were 1) use by "friend or family member" (39.0%); 2) availability of "flavors such as mint, candy, fruit, or chocolate" (31.0%); and 3) the belief that "they are less harmful than other forms of tobacco such as cigarettes" (17.1%). The least commonly selected reasons were 1) "they are easier to get than other tobacco products, such as cigarettes" (4.8%); 2) "they cost less than other tobacco products such as cigarettes" (3.2%); and 3) "famous people on TV or in movies use them" (1.5%). Availability of flavors as a reason for use was more commonly selected by high school users (32.3%) than by middle school users (26.8%). Efforts to prevent middle school and high school students from initiating the use of any tobacco product, including e-cigarettes, are important to reduce tobacco product use among U.S. youths (2).

Effect of e-cigarette advertisement exposure on intention to use e-cigarettes in adolescents

IntroductionWith the growth of electronic cigarettes use, curiosity about and experimentation with these products has increased among adolescents. The purpose of the present study was to evaluate the moderating effect of e-cigarette advertisement (ad) exposure on the relation between perceptions of use and intentions to use in youth. MethodsMultiple regression analyses utilizing data from the 2014 National Youth Tobacco Survey (N = 17,286) were used to evaluate the effect of ad exposure, perceived harmfulness, barriers, and benefits of e-cigarette use on intentions to use among youth who had never used e-cigarettes. ResultsModels for non-smokers accounted for 15.5% of the variance in intention to use (R2 = 0.155, F (15) = 187.0, p < 0.001). Results demonstrate that an increase in the number of exposures to e-cigarette ads was associated with an increase in intent to use (b = 0.039, t = 7.4, p < 0.001). Models also demonstrated significant interactions between ad exposure and perceptions of use on future intention to use. For smokers, models explained 11.1% of the variance in intention to use (R2 = 0.111, F (15) = 3.1, p < 0.001). Ad exposure had a non-significant effect on intention to use e-cigarettes (b = −0.010, t = −0.2, p = 0.859). In smokers, ad exposure did not significantly affect the association between perceptions of use and intention to use. ConclusionsAds are most effective at attracting non-smoking youth as new users rather than promoting product switching in young cigarette smokers.

Impact of E-Cigarette Minimum Legal Sale Age Laws on Current Cigarette Smoking

PurposeThe purpose of this study was to use individual-level data to examine the relationship between e-cigarette minimum legal sale age (MLSA) laws and cigarette smoking among U.S. adolescents, adjusting for e-cigarette use. MethodsIn 2016 and 2017, we regressed (logistic) current (past 30-day) cigarette smoking (from 2009–2014 National Youth Tobacco Surveys [NYTS]) on lagged (laws enacted each year counted for the following year) and unlagged (laws enacted January–June counted for that year) state e-cigarette MLSA laws prohibiting sales to youth aged <18 or <19 years (depending on the state). Models were adjusted for year and individual- (e-cigarette and other tobacco use, sex, race/ethnicity, and age) and state-level (smoke-free laws, cigarette taxes, medical marijuana legalization, income, and unemployment) covariates. ResultsCigarette smoking was not significantly associated with lagged MLSA laws after adjusting for year (odds ratio [OR] = .87, 95% confidence interval [CI]: .73–1.03; p = .10) and covariates (OR = .85, .69–1.03; p = .10). Unlagged laws were significantly and negatively associated with cigarette smoking (OR = .84, .71–.98, p = .02), but not after adjusting for covariates (OR = .84, .70–1.01, p = .07). E-cigarette and other tobacco use, sex, race/ethnicity, age, and smoke-free laws were associated with cigarette smoking (p < .05). Results unadjusted for e-cigarette use and other tobacco use yielded a significant negative association between e-cigarette MLSA laws and cigarette smoking (lagged: OR = .78, .64–.93, p = .01; unlagged: OR = .80, .68–.95, p = .01). ConclusionsAfter adjusting for covariates, state e-cigarette MLSA laws did not affect youth cigarette smoking. Unadjusted for e-cigarette and other tobacco use, these laws were associated with lower cigarette smoking.

Cigarette Brand Preference and Pro-Tobacco Advertising Among Middle and High School Students - United States, 2012-2016.

Nearly all adult smokers first try cigarettes before age 18 years (1), and adolescents can show symptoms of nicotine dependence within days to weeks of the onset of occasional cigarette smoking (2). Having a usual cigarette brand among adolescent smokers could reflect exposure and receptivity to pro-tobacco advertising and tobacco product appeal (1). To identify usual cigarette brands smoked among U.S. middle and high school students who were current (past 30-day) cigarette smokers, CDC analyzed data from the 2012-2016 National Youth Tobacco Survey (NYTS). Marlboro, Newport, and Camel were the most commonly reported brands smoked during 2012-2016; in 2016, these three were the brands usually smoked for 73.1% and 78.7% of current cigarette smokers in middle and high school, respectively. These three brands also were the three most commonly identified as having a "favorite cigarette ad" in 2012. Efforts to reduce youth exposure to pro-tobacco advertising could help reduce youth smoking (1,3).

Smoke-Free Car Legislation and Student Exposure to Smoking.

Policies protecting children from exposure to secondhand smoke (SHS) may help prevent SHS-related negative health outcomes in children and discourage them from intending to smoke in the future. In this study, we assess the impact of California's 2007 smoke-free vehicle law on changes in middle and high school students' reported exposure to smoking in cars. Secondary aims included assessing the association of student-reported exposure to smoking in vehicles and lifetime asthma diagnosis and future intentions to smoke. Population-weighted data from the California Student Tobacco Survey and the National Youth Tobacco Survey were used to evaluate California and national trends, respectively. Weighted logistic regression models using California Student Tobacco Survey 2011 data assessed the association between the number of days of exposure to smoking in cars and student-reported lifetime asthma diagnosis as well as intention to smoke in the future. The proportion of California students reporting exposure to smoking in cars in the last 7 days declined <1% annually from 2001 through 2005, but declined 12% annually from 2007 to 2011. National trends did not show comparable declines after 2006. Students reporting exposure to smoking in vehicles were more likely to report having ever been diagnosed with asthma and intending to smoke in the future than students who were not exposed to SHS. These findings support the legislative intent that public policies that are designed to protect children from exposure to smoking in vehicles will yield better adolescent health outcomes and a lower risk of future adolescent cigarette smoking.

Identifying patterns of tobacco use among US middle and high school students: A latent class analysis

ObjectivesThis study sought to (a) understand patterns of tobacco use among US middle and high school students based on their lifetime or current use of tobacco products: cigarettes, cigars, chewing tobacco, pipes, e-cigarettes, and hookah tobacco, and (b) examine differences in the underlying patterns by sociodemographic and tobacco-related characteristics (e.g., exposure to tobacco products, tobacco advertising, parental disapproval of tobacco use and feedback from healthcare providers). MethodsWe analyzed self-report data from the 2013 National Youth Tobacco Survey (n=18,046). Latent Class Analysis was conducted to identify patterns of tobacco use and tested how sociodemographic and tobacco-related characteristics are associated with such patterns. ResultsFour subtypes of tobacco use were identified: “Very Low Risk (VLR),” “Lifetime Smoking (LS),” “Lifetime Multiple Tobacco Use (LMT),” and “Past Month Multiple Tobacco Use (PMT).” Latino and Asian American youth were more likely to be in PMT. Compared with students in LS, students in VLR were less likely to receive advice not to use tobacco from their healthcare providers, but more likely to have parental disapproval of smoking. Students in LMT (vs. LS) were more likely to use tobacco coupons and promotional materials, report greater access to tobacco, and receive advice from a healthcare professional. Students in PMT (vs. LS) were more likely to use coupons, take part in tobacco promotions, and be exposed to smoking in a vehicle. ConclusionsOur study suggests that it may be important to consider the underlying patterns and correlates of tobacco use in designing tobacco control programs for youth.

Perceptions of e-Cigarettes and Noncigarette Tobacco Products Among US Youth

SM Amrock, L Lee, M Weitzman. Pediatrics. 2016;138(5):e20154306 Electronic cigarettes are the most commonly used tobacco product among youth in the United States, and the authors of this study sought to determine the perception of youth regarding their harm and addictiveness versus other tobacco products. A cross-sectional survey of students in grades 6 to 12 was performed. Data from the 2012 and 2014 National Youth Tobacco Survey were analyzed to describe correlates of perceptions of harm and addictiveness …

The Effect of Prices on Youth Cigarette and E-Cigarette Use: Economic Substitutes or Complements?

In 2016, the Surgeon General used longitudinal cohort studies to conclude that youth e-cigarette use is strongly associated with cigarette use. We re-evaluate data from the period of time before the writing of the Surgeon General report, using quasi-experimental methods, and reach the opposite conclusion. We study contemporaneous and intertemporal effects of e-cigarette and cigarette price and tax changes. Our price variation comes from 35,000 retailers participating in the Nielsen Retail Scanner data system. We match price and tax variation to survey data on current use of e-cigarettes and cigarettes for over 94,000 students between grades 6 to 12 in the National Youth Tobacco Survey (NYTS) for years 2011 to 2015. We find evidence that e-cigarettes and cigarettes are same-period economic substitutes. Coefficient estimates (while imprecisely estimated) also suggest potentially large positive effects of past e-cigarette prices on current cigarette use, indicating inter-temporal economic substitution. Our findings raise doubts about the conclusion of government-sponsored reports that e-cigarettes and cigarettes are strongly positively associated. We recommend revisiting and possibly amending this conclusion.

Curiosity and susceptibility to cigarette smoking among cigarette-naïve, waterpipe smoking US youth: National Youth Tobacco Survey, 2014.

INTRODUCTIONWaterpipe smoking is harmful and addictive and can be a gateway to cigarette smoking. This study examined the association between curiosity and susceptibility to cigarette smoking among cigarette-naïve US youth who smoke waterpipe using cross-sectional data from the National Youth Tobacco Survey, 2014.METHODSSusceptibility to cigarettes was assessed using a composite index of three questions: ‘Do you think you will smoke a cigarette in the next year?’, ‘Do you think that you will try a cigarette soon?’, and ‘If one of your best friends were to offer you a cigarette, would you smoke it?’. Curiosity was assessed by one question: ‘Have you ever been curious about smoking a cigarette?’.RESULTSAmong current waterpipe smokers, 48.5% (95% CI: 43.1-53.9) were susceptible to cigarettes and 42.6% (95% CI: 36.5-48.9) were curious about cigarettes. Overall, 45.1% (95% CI: 38.9-51.4) and 46.5% (95% CI: 40.2-52.8) of those living with a waterpipe smoker were susceptible and curious about cigarettes, respectively. Current waterpipe smokers had significantly higher odds of susceptibility to cigarettes (aOR=1.5, 95% CI: 1.1-2.3, p<0.04), but not for curiosity about cigarettes (aOR=1.2, 95% CI: 0.83-1.70, p=0.3).CONCLUSIONSInitiation of cigarettes among adolescents who smoke waterpipe can be due to increasing susceptibility to cigarette smoking rather than increasing curiosity about cigarettes.

Dual- and Polytobacco/Nicotine Product Use Trends in a National Sample of High School Students.

The study purpose was to examine changes in patterns of ever and current dual- and polyproduct use over time and to examine demographic and modifiable risk factors including tobacco smoke exposure (TSE). A secondary analysis of the 2013 to 2015 National Youth Tobacco Survey data. Nationwide high schools were selected. A total of 31 022 high school students. Ever and current (past 30 days) tobacco/nicotine product use, home tobacco/nicotine product use, TSE and e-cigarette vapor exposure, and demographic characteristics were measured. Multivariable logistic regression and multinomial logistic regression models. Of the students, 9.4% were ever dual users and 18.6% were ever poly users. Rates of ever/current use of e-cigarettes and hookah increased from 2013 to 2015 (all Ps < .001). In 2015, participants were 4.8 times (95% confidence interval [CI], 4.5-5.2) and 4.0 times (95% CI, 3.5-4.4) more likely to report ever/current e-cigarette use and 1.61 times (95% CI, 1.5-1.7) and 1.48 times (95% CI, 1.3-1.7) more likely to report ever/current hookah use. Participants reporting TSE were 15.4 times (95% CI, 11.5-21.0) more likely to report current poly use, and those with e-cigarette exposure were 10.4 times (95% CI, 7.8-13.8) more likely to report current poly use. From 2013 to 2015, rates of ever and current use of e-cigarettes and hookah increased. Tobacco smoke and e-cigarette exposure were associated with higher rates of dual and poly use. Prevention efforts targeting these products are needed.

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.