Correlates of Awareness and Use of Heated Tobacco Products in a Sample of US Young Adults in 2018–2019

Abstract Introduction Tobacco companies have devoted increased resources in recent years to developing and marketing heated tobacco products (HTPs) as alternatives to combustible products like cigarettes. However, little is known about correlates of awareness and use of these products in American young adults. Methods Two thousand four hundred ninety-seven young adults (mean age = 21.6) completed survey items on HTP awareness and lifetime use in 2018–2019. Logistic regression models compared young adults who were (1) unaware of HTPs (reference group) with those who were, (2) aware of HTPs, and (3) had ever used HTPs on demographic, tobacco, and other substance use characteristics. Among current smokers, these groups were compared on cigarette use, dependence, and readiness to quit. Results Approximately 12% of respondents (n = 293) were aware of HTPs, and 5% (n = 134) reported lifetime HTP use. Controlling for demographics, HTP awareness and use were both associated with greater use of all types of tobacco products, number of different tobacco products, and use of marijuana and other drugs. Among current smokers, HTP awareness and use correlated with heavier cigarette consumption, greater dependence, and past-month marijuana use, but not with recent quit attempts or thinking about quitting cigarettes. Conclusions Awareness and use of HTPs among young adults were associated with greater use of tobacco products and other substances and, among current smokers, with greater cigarette dependence (but not cessation-related factors). As these products become increasingly available in the United States, additional surveillance and monitoring activities are needed to better understand use patterns, consequences, and reasons for using HTPs. Implications Few studies have examined factors associated with awareness and use of heated tobacco products (HTPs) among US young adults. HTP awareness and lifetime use correlated with a range of factors, including male gender, white race/ethnicity, and tobacco and other substance use. Lifetime use of HTPs was low (5%); most lifetime HTP users reported history of other tobacco use, but a sizeable minority (14%) reported no other tobacco product use history. Among current cigarette smokers, cigarette dependence, poly-tobacco use, and marijuana use—but not cigarette cessation attempts or contemplation—were associated with greater likelihood of awareness and use of HTPs.

Download Full-text

Transitions in Tobacco Product Use by U.S. Adults between 2013–2014 and 2014–2015: Findings from the PATH Study Wave 1 and Wave 2

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph15112515 ◽

2018 ◽

Vol 15 (11) ◽

pp. 2515 ◽

Cited By ~ 8

Author(s):

Karin Kasza ◽

Nicolette Borek ◽

Kevin Conway ◽

Maciej Goniewicz ◽

Cassandra Stanton ◽

...

Keyword(s):

Older Adults ◽

Young Adults ◽

Tobacco Use ◽

The United States ◽

Tobacco Product ◽

Abuse Liability ◽

Tobacco Products ◽

Product Use ◽

Current Tobacco ◽

Pipe Tobacco

In 2013–2014, nearly 28% of adults in the United States (U.S.) were current tobacco users with cigarettes the most common product used and with nearly 40% of tobacco users using two or more tobacco products. We describe overall change in prevalence of tobacco product use and within-person transitions in tobacco product use in the U.S. between 2013–2014 and 2014–2015 for young adults (18–24 years) and older adults (25+ years). Data from Wave 1 (W1, 2013–2014) and Wave 2 (W2, 2014–2015) of the Population Assessment of Tobacco and Health (PATH) Study were analyzed (N = 34,235). Tobacco product types were categorized into: (1) combustible (cigarettes, cigars, pipe tobacco, hookah), (2) noncombustible (smokeless tobacco, snus pouches, dissolvable tobacco), and (3) electronic nicotine delivery systems (ENDS). Transitions for individual combustible-product types, and for single- and multiple-product use, were also considered. Overall prevalence of current tobacco use decreased from 27.6% to 26.3%. Among W1 non-tobacco users, 88.7% of young adults and 95.8% of older adults were non-tobacco users at W2. Among W1 tobacco users, 71.7% of young adults transitioned, with 20.7% discontinuing use completely, and 45.9% of older adults transitioned, with 12.5% discontinuing use completely. Continuing with/transitioning toward combustible product(s), particularly cigarettes, was more common than continuing with/transitioning toward ENDS. Tobacco use behaviors were less stable among young adults than older adults, likely reflecting greater product experimentation among young adults. Relative stability of cigarette use compared to other tobacco products (except older adult noncombustible use) demonstrates high abuse liability for cigarettes.

Download Full-text

Nativity Status and Poly Tobacco Use among Young Adults in the United States

10.20944/preprints202112.0470.v1 ◽

2021 ◽

Author(s):

Peace C. Okpala ◽

Carrie Rosario ◽

Melissa J. Dupont-Reyes ◽

Michelle Y. Martin Romero ◽

Md Towfiqul Alam ◽

...

Keyword(s):

United States ◽

Young Adults ◽

Tobacco Use ◽

Regression Models ◽

The United States ◽

Foreign Born ◽

Tobacco Products ◽

Targeted Interventions ◽

Nativity Status ◽

The Us

Introduction: Young adults are the second largest segment of the immigrant population in the United States (US). Given recent trends in later age of initiation of tobacco use, we examined variation in use of tobacco products by nativity status for this population group. Methods: Our study included young adults 18-30 years of age sampled in the National Health Interview Survey (2015-2019), a nationally representative sample of the US population. We calculated prevalence of use of any and 2 or more tobacco products (cigarettes, cigars, pipes, e-cigarettes, and smokeless tobacco) for foreign-born (n=3,096) and US-born (n=6,811) young adults. Logistic regression models adjusted for age, sex, race-ethnicity, education, and poverty, while accounting for the complex survey design. Results: Foreign-born young adults were significantly less likely to use any tobacco product (Cigarette = 7.3% vs 10.7%; Cigar= 1.8% vs 4.8%; E-cigarette= 2.3% vs 4.5%, respectively; p<0.01) or poly tobacco use (1.9% vs. 4.2%; p<0.01) than US-born young adults. Adjusted regression models showed lower odds of poly tobacco use among the foreign-born than their US-born counterparts (Odds Ratio = 0.41, (95% Confidence Interval: 0.26-0.63)). Conclusion: Findings highlight the importance of targeted interventions by nativity status and further tobacco prevention efforts needed for the US-born.

Download Full-text

Pilot Ecological Momentary Assessment Study of Subjective and Contextual Factors Surrounding E-Cigarette and Combustible Tobacco Product Use among Young Adults

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182111005 ◽

2021 ◽

Vol 18 (21) ◽

pp. 11005

Author(s):

Deepa R. Camenga ◽

Angela M. Haeny ◽

Suchitra Krishnan-Sarin ◽

Stephanie S. O’Malley ◽

Krysten W. Bold

Keyword(s):

Young Adults ◽

Ecological Momentary Assessment ◽

Contextual Factors ◽

Tobacco Product ◽

Cigarette Use ◽

Tobacco Products ◽

Product Use ◽

Cigarette Dependence ◽

Ecological Momentary ◽

Momentary Assessment

Background: Dual use of e-cigarettes and combustible tobacco products is common in young adults. We aimed to explore how ratings of subjective and contextual factors differed between discrete episodes of e-cigarette use vs. combustible tobacco product smoking among a sample of young adults. Methods: Young adults (N = 29, ages 18–30) who used e-cigarettes and ≥1 combustible tobacco product at least once weekly completed a 1-week smartphone-based ecological momentary assessment (EMA). Twice daily random prompts assessed past-15-min use of tobacco products, ratings of subjective factors (e.g., negative affect, craving), and contextual factors related to activity, location, and companionship. A multivariable GEE model assessed whether subjective or contextual factors were associated with e-cigarette vs. combustible tobacco product episodes. Results: 184 tobacco use episodes were reported (39.7% e-cigarette, 60.3% combustible tobacco product). High baseline cigarette dependence, as measured by the Fagerström Test for Cigarette Dependence, was associated with lower odds of e-cigarette vs. combustible tobacco product episodes (aOR 0.01, 95% CI (0.002–0.08); p < 0.001). Neither between- or within-subjects negative affect or craving scores were associated with e-cigarette use. Activities of eating/drinking (aOR 0.20, 95% CI (0.08–0.49); p = 0.001) and being in the companionship of a person who smoked cigarettes (aOR 0.13, 95% CI (0.04–0.43); p = 0.001) were associated with lower odds of e-cigarette vs. combustible tobacco product use episodes. However, traveling (aOR 12.02, 95% CI (3.77–38.26); p ≤ 0.001) and being in a public space (aOR 2.76, 95% CI (1.10–6.96); p = 0.03) were associated with higher odds of e-cigarette than combustible tobacco product use episodes. Conclusions: This pilot data suggests that unique contextual factors may be associated with e-cigarette use, compared to combustible tobacco smoking in a sample of young adults who use both e-cigarettes and combustible tobacco products. Future research with larger samples is needed to better characterize varying contexts and cues for tobacco use among young adults who are dual users.

Download Full-text

Factors Influencing Smoking Among Indigenous Adolescents Aged 10–24 Years Living in Australia, New Zealand, Canada, and the United States: A Systematic Review

Nicotine & Tobacco Research ◽

10.1093/ntr/ntz219 ◽

2019 ◽

Vol 22 (11) ◽

pp. 1946-1956 ◽

Cited By ~ 3

Author(s):

Christina L Heris ◽

Catherine Chamberlain ◽

Lina Gubhaju ◽

David P Thomas ◽

Sandra J Eades

Keyword(s):

Mental Health ◽

United States ◽

Risk Factors ◽

Substance Use ◽

Young Adults ◽

Tobacco Use ◽

The United States ◽

Cultural Factors ◽

Indigenous Adolescents ◽

Environmental Level

Abstract Introduction Smoking rates are higher among Indigenous populations in most high-income countries with initiation primarily occurring in adolescence for all population groups. This review aims to identify protective and risk factors for smoking behavior among Indigenous adolescents and young adults. Aims and Methods We searched Medline, Embase, and Psychinfo for all original research published between January 2006 and December 2016 that reported influences on smoking for Indigenous adolescents or young adults aged 10–24 living in Australia, New Zealand, Canada, and the United States (US). Extracted data were coded to individual, social, and environmental level categories using a modified Theory of Triadic Influence framework. Results A total of 55 studies were included, 41 were descriptive quantitative and 14 qualitative, and 26 included Indigenous participants only. The majority were from the US (32). Frequently reported influences were at the individual and social levels such as increasing age; attitudes and knowledge; substance use; peer and family relationships; smoking norms; mental health; physical activity. At the environmental level, smoke-free spaces; second-hand smoke exposure; high community level prevalence; and social marketing campaigns were also frequently reported. Some studies referenced price, access, and traditional tobacco use. Few reported historical and cultural factors. Conclusions Young Indigenous people experience similar influences to other populations such as smoking among family and friends. Greater youth smoking is related to broader community level prevalence, but few studies explore the distal or historical contributing factors such as traditional tobacco use, colonization, experiences of intergenerational trauma and discrimination, or the role of cultural connection. Implications This review identified a range of factors that influence Indigenous youth smoking and contributes to an understanding of what prevention measures may be effective. Youth tobacco use occurs alongside other substance use and may also serve as an indicator of mental health. Comprehensive community-based programs that work more broadly to address the risk factors related to tobacco, including improving youth mental health, will be important for other behaviors as well. This research highlights the importance of social influence and need for ongoing denormalization of smoking. Future Indigenous led and community owned research is needed to identify likely protective cultural factors.

Download Full-text

Tobacco Use Trajectories in Young Adults: Analyses of Predictors Across Systems Levels

Nicotine & Tobacco Research ◽

10.1093/ntr/ntaa048 ◽

2020 ◽

Vol 22 (11) ◽

pp. 2075-2084

Author(s):

Carla J Berg ◽

Regine Haardörfer ◽

Angela Lanier ◽

Donyale Childs ◽

Bruce Foster ◽

...

Keyword(s):

College Students ◽

Substance Use ◽

Young Adult ◽

Tobacco Use ◽

Urban Areas ◽

Marijuana Use ◽

Tobacco Product ◽

Multinomial Regression ◽

Adult College Students ◽

College Type

Abstract Introduction Research is needed to examine trajectories of tobacco use beyond cigarette smoking, particularly during emerging middle young adulthood, and to identify distinct multilevel influences of use trajectories. Aims and Methods We examined (1) tobacco use trajectories over a 2-year period among 2592 young adult college students in a longitudinal cohort study and (2) predictors of these trajectories using variables from a socioecological framework, including intrapersonal-level factors (eg, sociodemographics, psychosocial factors [eg, adverse childhood experiences, depressive symptoms, and attention-deficit hyperactivity disorder symptoms], early-onset substance use), interpersonal factors (eg, social support, parental substance use), and community-level factors (eg, college type, rural vs. urban). Results About 64.5% were female and 65.0% were white. From age 18 to 26, 27%–31% of participants reported past 30-day use of any tobacco product. We identified four trajectory classes: Abstainers/Dabblers who never or infrequently used (89.2%); Adult users who began using frequently around age 20 and continued thereafter (5.9%); College Smokers who began using before 19 but ceased use around 25 (2.5%); and Teenage users who used during their teenage years but ceased use by 22 (1.9%). Multinomial regression showed that, compared to Abstainers/Dabblers, significant predictors (p < .05) of being (1) Adult users included being male, earlier onset marijuana use, attending public universities or technical colleges (vs. private universities), and living in urban areas; (2) College users included being male, earlier onset marijuana use, and parental alcohol or marijuana use; and (3) Teenage users included only earlier onset marijuana use. Conclusion Distinct prevention and intervention efforts may be needed to address the trajectories identified. Implications Among young adult college students, the largest proportion of tobacco users demonstrate the risk of continued and/or progression of tobacco use beyond college. In addition, specific factors, particularly sex, earlier onset marijuana use, parental use of alcohol and marijuana, and contextual factors such as college setting (type of school, rural vs. urban) may influence tobacco use outcomes. As such, prevention and cessation intervention strategies are needed to address multilevel influences.

Download Full-text

Exposure to a Tobacco-Specific Carcinogen Among Adolescent Smokeless Tobacco Users in Rural California, United States

Nicotine & Tobacco Research ◽

10.1093/ntr/ntz147 ◽

2019 ◽

Vol 22 (10) ◽

pp. 1764-1771

Author(s):

Benjamin W Chaffee ◽

Peyton Jacob ◽

Elizabeth T Couch ◽

Neal L Benowitz

Keyword(s):

United States ◽

High School ◽

Tobacco Use ◽

Smokeless Tobacco ◽

The United States ◽

Tobacco Product ◽

Geometric Means ◽

Tobacco Products ◽

Smokeless Tobacco Products ◽

Smokeless Tobacco Use

Abstract Introduction Approximately the same percentage of male high school students in the United States currently uses conventional smokeless tobacco as smokes cigarettes, resulting in toxin exposure. Methods This study assessed tobacco product use (smokeless, combustible, and electronic cigarettes) and nicotine and carcinogen exposures in a sample of 594 male rural high school baseball players—a population traditionally at risk for smokeless tobacco use. Salivary specimens were assayed for cotinine (a biomarker of nicotine exposure) and urine specimens for 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL, a biomarker of the carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) using liquid chromatography–tandem mass spectrometry. Results The prevalence of past 30-day use of any tobacco product was 29%. Past 7-day smokeless tobacco use (prevalence: 13%) was associated with the highest levels of cotinine and NNAL observed in the sample, whether smokeless tobacco was used exclusively (geometric means: cotinine 11.1 ng/mL; NNAL 31.9 pg/mg-creatinine) or in combination with combustible products (geometric means: cotinine 31.6 ng/mL; NNAL 50.0 pg/mg creatinine). Cotinine and NNAL levels were incrementally higher in each increasing category of smokeless tobacco use frequency. However, observed levels were lower than previously reported for adults, likely reflecting less smokeless use per day among adolescents. Conclusions Based on these biomarker observations, adolescents who use conventional smokeless tobacco products are exposed to substantial levels of nicotine and NNK. Although exposed to lower levels than adult smokeless users, the findings are concerning given the young age of the sample and tendency for smokeless tobacco users to increase use intensity over time. Implications This study demonstrates that adolescents using smokeless tobacco are exposed to levels of nicotine and NNK that increase with use frequency and that exceed exposures among peers using other tobacco products. Youth smokeless tobacco use in the United States has not declined along with youth smoking prevalence, giving greater importance to this health concern. To reduce youth (and adult) exposures, needed actions include effective smokeless tobacco use prevention, potentially in combination with reducing the levels of harmful and potentially harmful chemicals in smokeless tobacco products currently popular among adolescents.

Download Full-text

Use of Emerging Tobacco Products in the United States

Journal of Environmental and Public Health ◽

10.1155/2012/989474 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 99

Author(s):

Robert McMillen ◽

Jeomi Maduka ◽

Jonathan Winickoff

Keyword(s):

Young Adults ◽

Smoking Status ◽

Multivariable Analysis ◽

The United States ◽

Tobacco Product ◽

Tobacco Products ◽

User Groups ◽

Nationally Representative ◽

Higher Educational Attainment ◽

Never Smokers

This paper provides the first nationally representative estimates for use of four emerging products. Addressing the issue of land-line substitution with cell phones, we used a mixed-mode survey to obtain two representative samples of US adults. Of 3,240 eligible respondents contacted, 74% completed surveys. In the weighted analysis, 13.6% have tried at least one emerging tobacco product; 5.1% snus; 8.8% waterpipe; 0.6% dissolvable tobacco products; 1.8% electronic nicotine delivery systems (ENDS) products. Daily smokers (25.1%) and nondaily smokers (34.9%) were the most likely to have tried at least one of these products, compared to former smokers (17.2%) and never smokers (7.7%),P<.001. 18.2% of young adults 18–24 and 12.8% of those >24 have tried one of these products,P<.01. In multivariable analysis, current daily (5.5, 4.3–7.6), nondaily (6.1, 4.0–9.3), and former smoking status (2.7, 2.1–3.6) remained significant, as did young adults (2.2, 1.6–3.0); males (3.5, 2.8–4.5); higher educational attainment; some college (2.7, 1.7–4.2); college degree (2.0, 1.3–3.3). Use of these products raises concerns about nonsmokers being at risk for nicotine dependence and current smokers maintaining their dependence. Greater awareness of emerging tobacco product prevalence and the high risk demographic user groups might inform efforts to determine appropriate public health policy and regulatory action.

Download Full-text

Polytobacco product use among current cigarette smokers in Hong Kong, China: results from population surveys (2015–17)

BMC Public Health ◽

10.1186/s12889-021-10341-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

S. L. Chau ◽

M. P. Wang ◽

Y. Wu ◽

D. Y. T. Cheung ◽

A. Kong ◽

...

Keyword(s):

Control Policy ◽

Tobacco Product ◽

Cigarette Use ◽

Related Factors ◽

Cigarette Smokers ◽

Tobacco Products ◽

Product Use ◽

Younger Age ◽

Current Cigarette ◽

Age And Sex

Abstract Background Polytobacco product use is increasingly popular, but little is known about the prevalence, trend, and factors of such use particularly in non-western countries. Method A representative sample of 1139 current cigarette smokers aged 15+ (84.1% male) were telephone interviewed in Tobacco Control Policy-related Surveys in 2015–2017. Information collected included poly-tobacco use (PTU), smoking and socio-demographic characteristics. Associations of current PTU with related factors were analyzed using logistic regression with adjustment for confounders. Prevalence was weighted by age and sex of current cigarette users in the general population. Results Eighty-four point one percent (95% CI 81.4–86.6%) were exclusive cigarette smokers. Fifteen point nine percent (13.4–18.6%) were current polytobacco product users, 12.3% (10.2–14.8%) used one tobacco product and 2.52% (1.59–3.97%) used two tobacco products in addition to cigarette. Cigarette use with cigar was more common (6.28%, 4.75–8.27%), and the least used product with cigarette was e-cigarette (1.05%, 0.44–2.50%). The changes in overall prevalence of PTU by number of products use varied in 3 years. Current PTU was associated with being male (AOR 2.01, 95% CI 1.12–3.61), younger age (AORs range from 1.34–4.65, P for trend < .001) and less ready to quit (2.08, 1.09–3.97). Conclusions Prevalence of PTU increased slowly by year, one tobacco product use with cigarette was more common. The most used tobacco product with cigarette was cigar. Being male, younger and less ready to quit were associated with current PTU.

Download Full-text

Exploring Stakeholder and Parent Perspectives of a County Response to Adolescent Vaping and E-Cigarette Use

Journal of Drug Issues ◽

10.1177/0022042621993495 ◽

2021 ◽

pp. 002204262199349

Author(s):

Natasha Kurji ◽

Thomas Koza ◽

Amanda Sharp ◽

Kathleen Moore

Keyword(s):

United States ◽

Substance Use ◽

The United States ◽

Classroom Observations ◽

School Age ◽

Parent Perspectives ◽

Cigarette Use ◽

Perceived Effectiveness ◽

Tobacco Products ◽

Hillsborough County

In the United States, regular cigarette use has steadily declined over the years; however, it has been met with an increase in vaping and e-cigarette use. In Tampa, Florida, this trend has been found especially prevalent among school-aged youth. To combat issues of substance use among youth and prevent criminalization for nonviolent crimes, school-age youth cited for use and possession of tobacco products in Hillsborough County were mandated to attend the Youth Tobacco Awareness Course (YTAC). The aim of this study was to investigate YTAC for its perceived effectiveness and usefulness in mitigating adolescent e-cigarette use. Classroom observations, parent focus groups, and program stakeholder interviews were conducted to comprehensively evaluate this program. Findings from this evaluation led to a deeper understanding of the barriers and facilitators to an effective course, the needs and perceptions of program stakeholders, as well as recommendations for improved future interventions.

Download Full-text