Patterns Of Tobacco Product Use Research Articles

Sex and Racial/Ethnic Patterns of Tobacco Product Use Among Students at a U.S. University in 2021–2023

Background : Although the prevalence of conventional tobacco product use among U.S. college students has declined, an increasing number of students use various novel tobacco products. Objectives : This study aims to examine up-to-date sex and racial/ethnic patterns of tobacco use among students at a U.S. university in 2021–2023. Methods : Data of 2,732 students at an urban university in the Southeast of the U.S. were collected in 2021–2023 as part of the National College Health Assessment of the American College Health Association. Self-reported past 3-month use of five tobacco products (cigarette, electronic vapor products, water pipe/hookah, smokeless tobacco, and cigars) was dichotomized. We conducted multinomial logistic regression analysis to examine sex (male or female) and racial/ethnic (non-Hispanic White, non-Hispanic Black, Hispanic, or non-Hispanic Other) differences in single and dual/poly (con-current use of two or more tobacco products) tobacco use compared to nonuse, adjusting for age, student status, parent education level, obese status, psychological distress level, and survey year. Results : Male students had higher odds of being dual/poly tobacco user than female students, adjusting for covariates (adjusted odds ratio [AOR] = 2.00, 95% confidence interval [CI] = 1.42, 2.82). Non-Hispanic Black students had lower odds of being single (AOR = 0.43, 95% CI = 0.26, 0.69) and dual/poly (AOR = 0.09, 95% CI = 0.02, 0.37) tobacco user compared to non-Hispanic White students, adjusting for covariates. Conclusions : Considering higher health risk of con-current use of multiple tobacco products, dual/poly tobacco use prevention strategies targeting male and non-Hispanic White students may be considered.

Patterns of tobacco product use and substance misuse among adolescents in the United States

Among adolescents, sole use is the most common pattern of e-cigarette use. However, concurrent use of e-cigarettes with other tobacco products is not uncommon and may be associated with high-risk behaviors. We used data from 12,767 participants in the 2019 Youth Risk Behavior Survey to examine the patterns of tobacco product use among youth in the US. First, we examined the prevalence of e-cigarette-specific patterns of tobacco use (nonuse[no tobacco product use], sole use[sole e-cigarette use], dual-use[e-cigarette and one other tobacco product], and poly use[e-cigarette and two or more other tobacco products]). Then, using multivariable Poisson regression, we assessed how the tobacco use patterns were associated with the misuse of nine substances of abuse (alcohol, marijuana, cocaine, ecstasy, hallucinogens, heroin, inhalants, injectables, and methamphetamines).62.9% of youth reported nonuse of any tobacco product. The weighted prevalence of sole e-cigarette use, dual use, and poly use was 23.2%, 4.2%, and 3.3%, respectively. Across all the substances explored, the prevalence was highest among poly users, followed by dual users, sole users, and non-users. Compared to non-users, sole, dual, and poly users had 7.8(95 %CI:6.1–10.0), 14.3(95 %CI:10.8–18.8), and 19.7(95 %CI:15.0–25.9) times higher adjusted prevalence of reporting past-30-day binge drinking, after adjusting for age, sex, race/ethnicity, sexual orientation, and depressive symptoms. This pattern was seen across all the different substances explored. These findings highlight the high prevalence of substance misuse among youth who use tobacco products and the need to educate and counsel on substances of abuse among this population, particularly among poly-tobacco users.

A Longitudinal Analysis of Respiratory Illness and Tobacco Use Transitions

Among individuals with chronic respiratory conditions, transitions between patterns of tobacco product use are not well understood. This study examines how transitions, including quitting altogether, differ over time between those who do and do not have chronic respiratory conditions. Data from youth and adult participants of the longitudinal Population Assessment of Tobacco and Health Study (2013-2018) were analyzed. Youth aged 12-17 years were included if they had aged into the adult sample by Wave 4. Stratified polytomous regression models built under a first-order Markov assumption modeled the probability of transitioning between different states/patterns of tobacco product use (exclusive current E-cigarette use, exclusive current combustible tobacco product use, current dual use of combustible products and E-cigarettes, and no current tobacco product use) at each wave. Marginal transition probabilities were computed as a function of ever or past-year diagnosis of a respiratory condition (separately for asthma and a composite variable representing chronic bronchitis, emphysema, and/or chronic obstructive pulmonary disease). Analyses were conducted in 2020-2021. Most individuals, regardless of respiratory condition, maintained the same pattern of tobacco use between waves. Exclusive combustible tobacco product users, including those with or without a respiratory condition, were not likely to become exclusive E-cigarette users or to quit using tobacco entirely. Although combustible tobacco use negatively impacts the management and prognosis of respiratory illnesses, combustible tobacco users who were recently diagnosed with a chronic respiratory condition were not likely to quit using tobacco. Efforts to encourage and support cessation in this medically vulnerable population should be increased.

Sex and Sexual Identity Differences in Poly-tobacco Use and Psychological Distress in U.S. Adults: Results From the National Health Interview Survey.

Poly-tobacco use (PTU), or the concomitant use of two or more nicotine and tobacco products, are a growing public health concern. Adults reporting increased psychological distress (PD) experience profound nicotine and tobacco health-related disparities. Sexual minority (SM) adults report more PTU and higher levels of PD than heterosexuals, yet little is known about patterns of nicotine and tobacco use and its relationship to PD in SM populations. The purpose of this study was to investigate sexual identity differences in PD and PTU. Data were drawn from the 2016-2018 National Health Interview Survey (N = 83 017), an annual cross-sectional survey of a nationally representative sample of U.S. adults. PD was assessed using the Kessler Psychological Distress Scale (K6). We fit sex-stratified, weighted, adjusted logistic models to compare PTU and PD by sexual identity. PTU was more prevalent in adults with higher K6 scores. Female adults and SM adults had significantly higher K6 scores and were significantly more likely to experience serious PD when compared to their male and heterosexual counterparts. The current study provides a snapshot of trends in PTU in relation to PD, gender, and sexual identity. Findings suggest higher rates of both PD and PTU in SM adults. Further research examining the mechanisms underlying this disparity is critical to the development of effective intervention and prevention strategies. Little is known about sex and sexual identity differences in the relations between patterns of tobacco product use and PD. This study is the first to examine the effect of gender and sexual identity on both PD and PTU. SMs reported higher rates of PD and were more likely to be poly-tobacco users. As new ways of engaging nicotine/tobacco continue to proliferate, health risks will endure especially for marginalized populations. An increased understanding of the psychological and social correlates of PTU in SMs is warranted.

Subjective Changes in Tobacco Product Use among Korean Adults during the COVID-19 Pandemic.

This study explored subjective changes in tobacco product use during the COVID-19 pandemic. The online survey included 828 tobacco product users and was implemented from 20 August to 27 August 2021. Participants were classified based on currently used products (cigarettes, heated tobacco products (HTPs), and e-cigarettes) and categorized as single, dual, or triple users. Subjective changes in product use over the past year were designated as “no chang”, “increase”, or “decreased”. Single use was most common, as reported by 447 participants (male 249, female 198), while 283 (male 164, female 119) and 98 (male 59, female 39) participants reported dual and triple use, respectively. Age, income, and triple use were associated with increased cigarette use, whereas living with family was associated with decreased use. Gender, age, income, and triple use were associated with the changed use of HTPs. No factors were significantly associated with an increase in e-cigarette use, whereas age and income were associated with decreased use. Similar to many COVID-19-related changes in cultural, social, and economic aspects of life, users’ patterns of tobacco product use have also changed. Increasing tobacco product taxes, effective messaging, and customized cessation services might help prevent or limit tobacco product usage.

Dependence on nicotine in US high school students in the context of changing patterns of tobacco product use.

Background and AimThere have been substantial recent changes in youth tobacco product use in the United States—including, notably, a rapid increase in use of e‐cigarettes. It is not known whether, and if so how far, these changes are reflected in levels of nicotine dependence. This study used data from a large, nationally representative sample of US adolescents to (i) estimate the annual prevalence of nicotine dependence in relation to current use of tobacco products, (ii) describe trends in dependence over time and (iii) evaluate whether the increase in youth use of tobacco products has been paralleled by a similar increase in the population burden of nicotine dependence.DesignSecondary analysis of National Youth Tobacco Surveys conducted annually, 2012–19.SettingUnited States.ParticipantsA total of 86 902 high school students.MeasurementsPrevalence of (i) strong cravings to use tobacco in the past 30 days and (ii) wanting to use nicotine products within 30 minutes of waking, in relation to type of product used (cigarettes, other combustible tobacco, smokeless tobacco, e‐cigarettes).FindingsBetween 2012 and 2019 there was a marked decline in past 30‐day cigarette smoking and a surge in use of e‐cigarettes. Different products were associated with differing levels of nicotine dependence, with cigarettes characterized by highest dependence (strong craving 42.3%; wanting to use within 30 minutes 16.8% among exclusive users in 2019) and e‐cigarettes in otherwise tobacco‐naive students by low dependence (16.1 and 8.8% respectively in 2019). The overall 33.8% increase in population use of nicotine products between 2012 and 2019 (from 23.2 to 31.2%) was not accompanied by an equivalent increase in overall population burden of dependence {percentage reporting craving 10.9% [95% confidence interval (CI) = 9.8–12.2%] in 2012 and 9.5% (95% CI = 7.5–12.0%) in 2019; wanting to use within 30 minutes 4.7% (95% CI = 4.0–5.5%) in 2012, 5.4% (95% CI = 4.0–7.2%) in 2019}.ConclusionsAmong US high school students, increases in the prevalence of nicotine product use from 2012 to 2019 do not appear to have been accompanied by a similar increase in the population burden of nicotine dependence. This may be at least partly attributable to a shift in the most common product of choice from cigarettes (on which users are most dependent) to e‐cigarettes (on which users are least dependent).

Differences in Exposure to Nicotine, Tobacco-Specific Nitrosamines, and Volatile Organic Compounds among Electronic Cigarette Users, Tobacco Smokers, and Dual Users from Three Countries.

Country-level differences in nicotine vaping products used and biomarkers of exposure among long-term e-cigarette users and dual users remain understudied. This cross-sectional study was conducted in 2014 in the United States (n = 166), United Kingdom (n = 129), and Poland (n = 161). We compared patterns of tobacco product use and nicotine and toxicant exposure among cigarette-only smokers (n = 127); e-cigarette-only users (n = 124); dual users of tobacco cigarettes and e-cigarettes (n = 95); and non-users (control group, n = 110) across three countries using mixed-effects linear regression. Compared with cigarette smokers, e-cigarette-only users had lower levels of toxicant biomarkers, but higher levels of nicotine biomarkers. Dual users had higher levels of toxicant biomarkers than e-cigarette-only users but similar levels to cigarette-only smokers. E-cigarette users in Poland, who overwhelmingly used refillable tank devices, exhibited greater levels of nicotine, and toxicant biomarkers relative to e-cigarette users in US/UK. Despite smoking fewer cigarettes, dual users from Poland exhibited similar levels of nicotine biomarkers compared with UK dual users, but higher than US dual users. Country-level differences in e-cigarette devices used and smoking behaviors (e.g., intensity) may contribute to differences in biomarker levels among users of the same products residing in different countries.

Patterns of tobacco use and nicotine dependence among youth, United States, 2017–2018

This study examined patterns of tobacco product use and their association with nicotine dependence among U.S. youth. Combined data from the 2017–2018 National Youth Tobacco Surveys were analyzed for students that reported current (past-30-day) use of e-cigarettes, cigarettes, cigars, smokeless tobacco, or hookah (n = 6106). Analyses assessed multiple product use (≥2 tobacco products) overall and by sex, school level, race/ethnicity, current use, and frequent use (use of a product for ≥20 of the preceding 30 days). Multivariable logistic regression was used to identify correlates of nicotine dependence. During 2017–2018, 40.8% of tobacco product users reported use of multiple products. Multiple product use ranged from 47.0% among e-cigarette users to 80.7% among cigarette smokers. Among frequent users of each respective product, 80.0% of cigarette smokers, 74.9% of cigar smokers, 73.6% of smokeless tobacco users, 70.7% of hookah smokers, and 40.3% of e-cigarette users reported use of multiple products. Most youth who reported nicotine dependence (64.0%) were multiple product users. E-cigarettes were the most common single product used (36.3%) and the product most commonly used in combination with other products; e-cigarettes plus cigarettes (6.7%) was the most common product combination. Combustible product use, smokeless tobacco use, multiple product use and frequent use were associated with greater odds of nicotine dependence. Nicotine dependence among youth is especially influenced by cigarette use, smokeless tobacco use, frequent use of any tobacco product, and multiple product use. Proven tobacco control interventions in coordination with regulatory efforts can reduce youth tobacco product use.

Unpacking the Non-Hispanic Other Category: Differences in Patterns of Tobacco Product Use Among Youth and Adults in the United States, 2009-2018.

Studies investigating patterns of tobacco use by race often aggregate non-Black and non-Hispanic racial minorities into the "Other" category, masking important differences. Pooling 10years (2009-2018) of National Survey on Drug Use and Health data (n = 52,424), we estimated the prevalence and proportion of individual tobacco product use and patterns of single, dual, and polytobacco use overall and by sex for youth (12-17) and adult (18 +) non-Hispanic Asian, American Indian/Alaska Native (AI/AN), Native Hawaiian/other Pacific Islander (NH/PI), and multiracial respondents. Cigarette prevalence was highest among AI/AN youth (8.6%) and adults (37.3%). For youth and adults, the AI/AN subgroup had the highest prevalence of single (9.2% youth, 35.8% adults) and dual (2.8% youth, 6.6% adults) use, followed by multiracial respondents. Furthermore, among tobacco users, AI/AN and multiracial youth and adults had the highest proportions of dual and poly use compared to other races. Appropriate tobacco prevention and cessation interventions should consider variation in tobacco use among non-Hispanic "Other" subgroups.

Not Quite the Rule, But No Longer the Exception: Multiple Tobacco Product Use and Implications for Treatment, Research, and Regulation.

The patterns of tobacco product use in the United States have changed during the past several decades. Currently, a large proportion of tobacco users report using multiple tobacco products (MTPs). The prevalence of MTP use varies significantly by cigarette smoking frequency, as well: nearly half (46.9%) of all non-daily smokers report using other tobacco products within the past 30 days. Despite this, much of extant tobacco dependence treatment efforts, tobacco regulatory science research, and tobacco product research, in general, has focused largely on single product use (ie, cigarette smoking). To effectively design interventions and model the potential impact of regulations on tobacco products aimed at reducing tobacco use, as well as effectively study tobacco users, it is essential to consider actual use patterns in the population of tobacco users. Implications: MTP use is increasingly common in the United States. This commentary highlights the impact that MTP use has for efforts to treat tobacco dependence, tobacco regulatory science efforts, as well as on tobacco research, in general.

Patterns of alternative tobacco product use among youth experiencing homelessness

IntroductionIdentifying distinct patterns of tobacco product use can inform efforts to reduce poly-tobacco use among young people, but little is known regarding patterns of use among youth experiencing homelessness. This study identified patterns of using tobacco/nicotine products among youth experiencing homelessness, and assessed whether certain subgroups of youth were more likely than others to engage in specific patterns of use. MethodsData were collected from a probability sample of 469 homeless youth who used tobacco in the past month, recruited from 25 service and street sites in Los Angeles County. Participants reported on lifetime and past month use of natural cigarettes, cigars, little cigars/cigarillos, electronic nicotine delivery systems, hookah, and chewing tobacco. Latent class analysis was used to identify patterns of tobacco product use. ResultsWe identified four main classes of use: traditional cigarettes smokers (34.7% of the sample), poly-tobacco experimenters (24.9%), current users of combustible products (natural cigarettes, cigars, little cigars/cigarillos; 27.1%), and current poly-tobacco users (13.1%). Youth who were male, slept outdoors, and screened positive for substance abuse disorder were more than twice as likely as their counterparts to be current poly-tobacco users relative to traditional cigarettes smokers. ConclusionsRates of poly-tobacco experimentation and current use among youth experiencing homelessness are high. This suggests that efforts to reduce the use of tobacco products in this population should focus on the combined use of these products, and further, that users with the greatest poly-use may have competing unmet needs such as substance use disorders and more severe homelessness.

Youth perception of harm and addictiveness of tobacco products: Findings from the Population Assessment of Tobacco and Health Study (Wave 1)

PurposeWe provide a US national assessment of youth perceptions of the harm and addictiveness of six separate tobacco products, identifying a continuum of perceived harm associated with a range of products in relation to patterns of current use, former use, and susceptibility to use tobacco products. MethodsWe evaluated youth respondents (N = 13,651) ages 12–17 from Wave 1 (2013–2014) of the Population Assessment of Tobacco and Health (PATH) Study. Analyses (2015–2016) focused on refining measures of perceived harm for each product and delineating youth characteristics (demographic, tobacco use status) associated with beliefs about the harmfulness and addictiveness of tobacco products. ResultsCigars, hookah and e-cigarettes were each perceived as having significantly lower harm (p's < 0.05) than smokeless products, with the lowest ratings of harmfulness and addictiveness observed for hookah and e-cigarettes (p's < 0.001). Incrementally lower levels of harm and addictiveness perceptions were observed among youth at increasing risk for tobacco use (p's < 0.05). ConclusionsAmong U.S. youth, lower perceptions of harm and addictiveness of tobacco products were associated with susceptibility to use tobacco and patterns of tobacco product use. Future longitudinal assessments from the PATH Study can provide key information on youth development of perceptions of harm and addictiveness and influences on patterns of tobacco use.

Patterns of Tobacco Product Use and Correlates Among Adults in the Population Assessment of Tobacco and Health (PATH) Study: A Latent Class Analysis.

IntroductionAs the tobacco industry and market evolves, there is a growing need to understand the patterns of use of tobacco products and how they relate to demographics, dependency, withdrawal, and quit behavior.MethodsWe analyzed data from wave 1 of the PATH Study consisting of 14856 individuals. Current users were defined as consuming at least 1 of 10 tobacco products. We performed a latent class analysis (LCA) to identify patterns of tobacco use. We used multinomial regression analysis to explore the association between these patterns with covariates representing socioeconomic status dependence/addiction, past quit attempts, and withdrawal severity.ResultsWe identified four groups of current tobacco users with distinct profiles: (1) 61% of the sample were identified as cigarette-only users; (2) 9% were smokeless tobacco users; (3) 17% of the sample were characterized by being current users of all types of combustible tobacco including cigars, cigarillos, filtered cigars, and smoking a pipe (4) finally, 13% were e-cig and hookah users. All classes also shared a varying frequency of cigarette use. Exclusive cigarette users were more likely to be older and female, and experienced higher dependency and withdrawal. Users of e-cigs and hookah were the younger, most educated of all four subgroups, and presented the lowest dependency and withdrawal among the four groups.ConclusionsFDA policy makers may want to discourage the use of tobacco products associated with higher tobacco dependency, and products that may contribute to experiencing higher levels of withdrawal symptoms by the user when trying to quit.ImplicationsWe identified four patterns of tobacco product use that are significantly related to demographic characteristics, dependency, and withdrawal. Policies should target users more likely to use tobacco products that increase dependency and withdrawal, making quitting more difficult.

Characterizing Polytobacco Use Trajectories and Their Associations With Substance Use and Mental Health Across Mid-Adolescence.

BackgroundPolytobacco product use is suspected to be common, dynamic across time, and increase risk for adverse behavioral outcomes. We statistically modeled characteristic types of polytobacco use trajectories during mid-adolescence and tested their prospective association with substance use and mental health problems.MethodsAdolescents (N = 3393) in Los Angeles, CA, were surveyed semiannually from 9th to 11th grade. Past 6-month combustible cigarette, e-cigarette, or hookah use (yes/no) over four assessments were analyzed using parallel growth mixture modeling to identify a parsimonious set of polytobacco use trajectories. A tobacco product use trajectory group was used to predict substance use and mental health at the fifth assessment.ResultsThree profiles were identified: (1) tobacco nonusers (N = 2291, 67.5%) with the lowest use prevalence (<3%) of all products across all timepoints; (2) polyproduct users (N = 920, 27.1%) with moderate use prevalence of each product (8–35%) that escalated for combustible cigarettes but decreased for e-cigarettes and hookah across time; and (3) chronic polyproduct users (N = 182, 5.4%) with high prevalence of each product use (38–86%) that escalated for combustible cigarettes and e-cigarettes. Nonusers, polyproduct users, and chronic polyproduct users reported successively higher alcohol, marijuana, and illicit drug use and ADHD at the final follow-up, respectively. Both tobacco using groups (vs. nonusers) reported greater odds of depression and anxiety at the final follow-up but did not differ from each other.ConclusionsAdolescent polytobacco use may involve a common moderate risk trajectory and a less common high-risk chronic trajectory. Both trajectories predict substance use and mental health symptomology.ImplicationsVariation in use and co-use of combustible cigarette, e-cigarette, and hookah use in mid-adolescence can be parsimoniously characterized by a small set common trajectory profiles in which polyproduct use are predominant patterns of tobacco product use, which predict adverse behavioral outcomes. Prevention and policy addressing polytobacco use (relative to single product use) may be optimal tobacco control strategies for youth, which may in turn prevent other forms of substance use and mental health problems.

Biomarkers of exposure to new and emerging tobacco delivery products.

Accurate and reliable measurements of exposure to tobacco products are essential for identifying and confirming patterns of tobacco product use and for assessing their potential biological effects in both human populations and experimental systems. Due to the introduction of new tobacco-derived products and the development of novel ways to modify and use conventional tobacco products, precise and specific assessments of exposure to tobacco are now more important than ever. Biomarkers that were developed and validated to measure exposure to cigarettes are being evaluated to assess their use for measuring exposure to these new products. Here, we review current methods for measuring exposure to new and emerging tobacco products, such as electronic cigarettes, little cigars, water pipes, and cigarillos. Rigorously validated biomarkers specific to these new products have not yet been identified. Here, we discuss the strengths and limitations of current approaches, including whether they provide reliable exposure estimates for new and emerging products. We provide specific guidance for choosing practical and economical biomarkers for different study designs and experimental conditions. Our goal is to help both new and experienced investigators measure exposure to tobacco products accurately and avoid common experimental errors. With the identification of the capacity gaps in biomarker research on new and emerging tobacco products, we hope to provide researchers, policymakers, and funding agencies with a clear action plan for conducting and promoting research on the patterns of use and health effects of these products.

Progression of Poly-tobacco Product Use Patterns in Adolescents.

Diverse patterns of adolescent use and poly-use of tobacco products other than conventional cigarettes are emerging. Data characterizing common patterns of youth tobacco product use and typical transitions among patterns may inform tobacco control policy and prevention. This study identified common patterns of use and poly-use of five popular tobacco products (i.e., conventional cigarettes, electronic [e-]cigarettes, hookah, blunts, and cigars) and progression among patterns across time among ninth-graders using latent transition analysis (analyses conducted in 2015). Data were from a longitudinal cohort study of ninth-grade students enrolled in ten public high schools in California (N=3,304; 46.6% male; 48.3% Hispanic; mean age, 14.58 [SD=0.40] years), involving a baseline (2013) and 6-month follow-up (2014). Past 6-month any use of the five tobacco products was assessed. Poly-use (two or more products) constituted 42% and 50% of tobacco-using teens at baseline and follow-up, respectively. Three common patterns were identified, which reflected successfully greater degrees of low, intermediate, and high diversity of tobacco product use: non-users (baseline prevalence, 0.75; follow-up prevalence, 0.64); e-cigarette/hookah users only (prevalence, 0.21, 0.27); and poly-tobacco product users of all five products (prevalence, 0.04, 0.09). Most typical transitions involved progressing to the next more diverse pattern (non-user→e-cigarette/hookah user [probability=0.13] and e-cigarette/hookah user→poly-tobacco product user [probability=0.19]). Transition from one of the user patterns to non-user status was rare (probability≤0.08). Adolescent poly-tobacco use is common. E-cigarette and hookah use may reflect an intermediate pattern of tobacco product use progression along a continuum of poly-product use diversity.

The next generation of users: prevalence and longitudinal patterns of tobacco use among US young adults.

We monitored the prevalence and patterns of use of the array of tobacco products available to young adults, who are at risk for initiation and progression to established tobacco use. We used data from waves 1 to 3 of GfK's KnowledgePanel (2011-2012), a nationally representative cohort of young adults aged 18 to 34 years (n = 2144). We examined prevalence and patterns of tobacco product use over time, associated demographics, and state-level tobacco policy. We used multivariable logistic regression to determine predictors of initiation of cigarettes as well as noncombustible and other combustible products. The prevalence of ever tobacco use rose from 57.28% at wave 1 to 67.43% at wave 3. Use of multiple products was the most common pattern (66.39% of tobacco users by wave 3). Predictors of initiation differed by product type and included age, race/ethnicity, policy, and use of other tobacco products. Tobacco use is high among young adults and many are using multiple products. Efforts to implement policy and educate young adults about the risks associated with new and emerging products are critical to prevent increased initiation of tobacco use.

Patterns and correlates of polytobacco use in the United States over a decade: NSDUH 2002–2011

BackgroundFew studies have examined the patterns and correlates of polytobacco use among a large, nationally representative population over an extended period of time. MethodsThis study examined 10years of data from the National Survey on Drug Use and Health (NSDUH) to establish time trends and correlates for exclusive and mixed use of cigarettes, smokeless tobacco (SLT), cigars, and pipes. ResultsResults show that rates of polytobacco use were essentially unchanged from 2002 to 2011 (8.7% to 7.4%), though some product combinations, including cigarettes and SLT, cigars and SLT, and use of more than two products have increased. In tobacco users under age 26, the proportion of polytobacco use increased, even as overall tobacco use declined. The factors associated with polytobacco use among tobacco users included sex, income, education, risk taking/seeking behaviors, and outward indicators of ‘risk-liability’. ConclusionsFindings provide a snapshot of trends of single and polytobacco product use as well as trends in combinations of product use. Longitudinal studies are needed to examine the sequence of individual patterns of tobacco product use and to identify whether polytobacco use results in greater nicotine dependence, increased exposure to harmful and potentially harmful constituents and/or greater risk of tobacco related disease.