Teens who use one or more forms of tobacco may not perceive themselves as tobacco users, with more than half of e-cigarette users denying their tobacco use status, according to research published in Pediatrics.
Additionally, despite the understanding that tobacco products are harmful, a significant number of adolescents who use one tobacco product do not perceive their preferred tobacco product as harmful.
“Early initiation and continued tobacco use can cause premature disease and death,” Israel Agaku, DMD, MPH, PhD, from the Office on Smoking and Health in the National Center for Chronic Disease Prevention at the CDC, and colleagues wrote. “However, the internalization of tobacco use as a health threat may depend not only on the perceived seriousness of tobacco-attributable health risks in general but also on individuals’ subjective risk assessment of their own susceptibility, beginning with whether they even consider themselves as tobacco users if they use tobacco products.”
To examine the perceived risk of tobacco use and tobacco use status of adolescents who use tobacco products, the researchers conducted an analysis that included participants between grades 6 and 12 within the United States. All students participated in the 2016 National Youth Tobacco Survey.
Agaku and colleagues defined those who did not self-identify as tobacco users as adolescents who reported past 30-day use of one specific product or two or more products but denied this status. Additionally, the researchers evaluated the perceived harm of several tobacco products and conducted descriptive and multivariable logistic regression analyses.
Of the 20,675 children who participated in the survey, 2,350 used tobacco products, including cigarettes and bidis, hookah, e-cigarettes, cigars, smokeless tobacco and loose tobacco products. Denying tobacco use was common, with single-use users of roll-your-own or pipe tobacco (82.2%), e-cigarettes (59.7%), cigars (56.6%), hookah (44.0%), smokeless tobacco (38.5%) and cigarettes (26.5%) reporting this status.
The researchers observed that those who did not have symptoms of nicotine dependence were more likely to deny tobacco use status when compared with those who did exhibit symptoms (adjusted OR = 2.16). Furthermore, adolescents who access tobacco in social situations are less likely to deny tobacco use status than those who purchased tobacco (aOR = 3.81).
When considering the dangers of tobacco use, those who perceived all tobacco products as harmful and used one product were likely to believe that their product of choice was not harmful (e-cigarettes: 74.6%; smokeless tobacco: 41.8%; cigarettes: 15.5%).
“Although noncombustible products, such as e-cigarettes, generally contain fewer toxicants than combustible tobacco products, no tobacco product is harmless,” Agaku and colleagues wrote. “While moderation is encouraged for certain ingested substances that are potentially harmful in excess doses — eg, fat, salt and sugar — youth use of tobacco products in any amount is unsafe. Multifaceted interventions that address protobacco social and contextual factors — such as youth-oriented tobacco advertising and marketing, product design and packaging, as well as social norms and access — can help reduce tobacco use.”
“The findings from this study can be useful to health professionals, especially within primary health care when screening adolescent patients for tobacco product use,” the researchers continued. “Asking about the diversity of tobacco products, including occasional use, might better capture youth who may not otherwise identify as users of tobacco products.” – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.