Introduction:
The recent decline in use of cigarette products has been offset by an increase in non-cigarette tobacco products (NCP) among young individuals. In this study, we assess the prevalence and association of NCP use across the range of social determinants of health (SDOH) among a nationally representative population of young U.S. adults.
Hypothesis:
Lower SDOH is associated with higher likelihood of NCP use.
Methods:
We utilized cross-sectional data from the 2014-2017 National Health Interview Survey (NHIS). Current use of e-cigarettes, smokeless tobacco, and other NCP was self-reported. Relevant SDOH features were identified based on published literature and included 39 key items from 6 major domains. Each of these items was scored 1 if unfavorable and 0 if favorable and summed to derive a total SDOH risk score. Weighted multivariable logistic regression was used to assess the association between computed SDOH risk quartiles and NCP use.
Results:
The study population consisted of 53,023 participants (mean age 30 [SD 7] years, 50% men, 58% white), which translates to 113M US adults. Of them, 4.2%, 3.0% and 6.1% reported current use of e-cigarettes, smokeless tobacco and other NCP products, respectively with overall (any) NCP use at 11.6%. The respective prevalence in non-cigarette users was 2.3%, 2.4% and 4.4%. A graded increase in age-adjusted prevalence of specific and overall NCP was noted across increasing SDOH risk score quartiles (
Figure).
Accounting for demographics and comorbidities, those in the highest SDOH risk score quartile vs lowest had 1.86-fold higher odds of use of e-cigarettes (1.49-2.34), smokeless tobacco (1.33 [1.05-1.68]) and overall NCP (1.44 [1.26-1.65]).
Conclusions:
In a nationally representative sample, 1 in 14 young adults with the most unfavorable SDOH profile reported NCP use. Evaluation of SDOH may provide opportunities for targeted public health approaches to prevent NCP use and its ensuing complications.