Twice as many youth in the United States used alternative tobacco products — e-cigarettes, cigars and hookahs — than conventional cigarettes, with a significant number using two or more tobacco products concurrently, recent study data suggest.
“Although youth use of conventional cigarettes is on the decline, use of nonconventional products is rising, and there may be an escalating trend for dual (using cigarettes with another product) and polytobacco use (using any three or more products),” Youn Ok Lee, PhD, from the Public Health Research Division of RTI International, and colleagues wrote.
Researchers utilized data on 24,658 sixth- to 12th-grade participants in the 2012 National Youth Tobacco Survey, a dataset chronicling the tobacco-related beliefs, attitudes and behaviors of all US middle and high school students.
The researchers’ final sample included student responses from 228 schools. The questionnaire defined current use of tobacco products as being any usage on at least 1 of the past 30 days. Surveys accounted for use of cigarettes, roll-your-own cigarettes, cigars, smokeless tobacco, pipes, hookahs, e-cigarettes, bidis, kreteks, snus and dissolvables.
Users were classified as: current exclusive product users, current use of cigarettes and one other product; current use of two other combustible products; current use of two other noncombustible products or a combination of one other combustible and one additional noncombustible product; current use of three or more tobacco products; and no current tobacco use.
The investigators wrote that 14.7% of surveyed participants currently use one or more tobacco products. Of these, 2.8% were exclusively cigarette smokers, while 4% were exclusive users of one noncigarette product. The researchers observed that 2.7% of smokers used cigarettes in combination with another tobacco product; 4.3% used three or more tobacco products concurrently.
Factors associated with the use of three or more tobacco products included:
- flavored tobacco product use (adjusted relative risk ratio [RRR] = 6.09);
- male gender (aRRR = 3.71);
- receptiveness to tobacco marketing (aRRR = 2.52); and
- nicotine dependence (aRRR = 1.91).
“This concurrent use should be of concern to the health community because of the potential additive harms posed by increased use of these products and the potential for increased exposure to nicotine and nicotine addiction,” the researchers wrote. “Researchers should include a wide range of other tobacco products in their surveillance efforts, including e-cigarettes and hookah, to better reflect the changing marketplace and provide more accurate and comprehensive estimates of youth tobacco use.” – by Jen Byrne
Disclosure: The researchers report no relevant financial disclosures.