Exclusive, Dual, and Polytobacco Use Among US Adults by Sociodemographic Factors: Results From 3 Nationally Representative Surveys

Purpose: To provide tobacco product use patterns for US adults by sociodemographic group. Design: A secondary analysis of Tobacco Use Supplement to the Current Population Survey (2014-15), National Health Interview Survey (2015), and Population Assessment of Tobacco and Health (2015-16). Setting: United States. Sample: Three nationally representative samples of adults (N = 28,070-155,067). Measures: All possible combinations of cigarette, Electronic Nicotine Delivery Systems (ENDS), other combustible product, and smokeless tobacco use, defined as current use every day or some days. Analysis: Weighted population prevalence and proportion among tobacco users of exclusive, dual, and polyuse patterns by sex, race/ethnicity, education, income, and age. Results: Exclusive cigarette use was the most prevalent pattern (10.9-12.8% of US population). Dual and polyuse were less prevalent at the population level (2.6-5.2% and 0.3-1.3%, respectively) but represented 16.7-25.5% of product use among tobacco users. Cigarette plus ENDS use was similar by sex, but men were more likely to be dual users of cigarettes plus other combustibles or smokeless tobacco. Among race/ethnic subgroups, non-Hispanic (NH) Whites were most likely to use cigarettes plus ENDS, while NH Blacks were most likely to use cigarettes plus other combustibles. Dual and polyuse were generally less common among adults with higher education, income, and age. Conclusion: Differences in product use patterns by sociodemographic group likely represent different risk profiles with important implications for resulting health disparities.

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A Comparison of Tobacco Product Prevalence by Different Frequency of Use Thresholds Across Three US Surveys

10.21203/rs.3.rs-333579/v1 ◽

2021 ◽

Author(s):

Luz María Sánchez-Romero ◽

Christopher J. Cadham ◽

Jana L. Hirschtick ◽

Delvon T. Mattingly ◽

Beomyoung Cho ◽

...

Keyword(s):

Tobacco Use ◽

Smokeless Tobacco ◽

Tobacco Product ◽

Adult Age ◽

Product Group ◽

Use Patterns ◽

Product Use ◽

Frequency Of Use ◽

Smokeless Tobacco Use ◽

Frequency Threshold

Abstract Background: With the increasing changes in tobacco use patterns, “current use” definition and the survey used may have important implications for monitoring population use trends. Methods: Using three US surveys (2014/15 TUS-CPS, NHIS and PATH), we compared the adult (age 18+) prevalence of four product groups (cigarettes, other combustibles, smokeless tobacco, and e-cigarettes) based on three past 30-day frequency of use thresholds: 1+, 10+, and 25+ days. We also examined mutually exclusive single, dual, and polytobacco users as a percentage of total users for each product group. Results: Regardless of threshold or product, the prevalence was higher in PATH followed by NHIS and TUS-CPS, in some cases by large percentages. The differences in cigarette and smokeless tobacco use prevalence in going from the 1+ to 10+ days and to the 25+ days threshold were minimal. Applying different frequency thresholds had the largest impact on other combustibles prevalence, with a 60% reduction with the 10+ days threshold and a 80% reduction with the 25+ days threshold, compared to the 1+ days threshold, followed by e-cigarettes with 40% and 60% reductions, respectively. The proportion of dual and polytobacco users decreased considerably when using the 10+ vs. the 1+ days threshold and polytobacco use was almost non-existent with the 25+ days threshold. Conclusion: The estimated prevalence of each tobacco product use depends largely on the survey and frequency of use threshold adopted. The choice of survey and frequency threshold merits serious consideration when monitoring patterns of tobacco use.

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A comparison of tobacco product prevalence by different frequency of use thresholds across three US surveys

BMC Public Health ◽

10.1186/s12889-021-11283-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Luz María Sánchez-Romero ◽

Christopher J. Cadham ◽

Jana L. Hirschtick ◽

Delvon T. Mattingly ◽

Beomyoung Cho ◽

...

Keyword(s):

Tobacco Use ◽

Smokeless Tobacco ◽

Tobacco Product ◽

Adult Age ◽

Product Group ◽

Use Patterns ◽

Product Use ◽

Frequency Of Use ◽

Smokeless Tobacco Use ◽

Frequency Threshold

Abstract Background With the increasing changes in tobacco use patterns, “current use” definition and the survey used may have important implications for monitoring population use trends. Methods Using three US surveys (2014/15 TUS-CPS, NHIS and PATH), we compared the adult (age 18+) prevalence of four product groups (cigarettes, other combustibles, smokeless tobacco, and e-cigarettes) based on three past 30-day frequency of use thresholds: 1+, 10+, and 25+ days. We also examined mutually exclusive single, dual, and polytobacco users as a percentage of total users for each product group. Results Regardless of threshold or product, the prevalence was higher in PATH followed by NHIS and TUS-CPS, in some cases by large percentages. The differences in cigarette and smokeless tobacco use prevalence in going from the 1+ to 10+ days and to the 25+ days threshold were minimal. Applying different frequency thresholds had the largest impact on other combustibles prevalence, with a 60% reduction with the 10+ days threshold and a 80% reduction with the 25+ days threshold, compared to the 1+ days threshold, followed by e-cigarettes with 40 and 60% reductions, respectively. The proportion of dual and polytobacco users decreased considerably when using the 10+ vs. the 1+ days threshold and polytobacco use was almost non-existent with the 25+ days threshold. Conclusion The estimated prevalence of each tobacco product use depends largely on the survey and frequency of use threshold adopted. The choice of survey and frequency threshold merits serious consideration when monitoring patterns of tobacco use.

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Trends in Exclusive, Dual and Polytobacco Use among U.S. Adults, 2014–2019: Results from Two Nationally Representative Surveys

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182413092 ◽

2021 ◽

Vol 18 (24) ◽

pp. 13092

Author(s):

Delvon T. Mattingly ◽

Luis Zavala-Arciniega ◽

Jana L. Hirschtick ◽

Rafael Meza ◽

David T. Levy ◽

...

Keyword(s):

National Health Interview Survey ◽

Population Survey ◽

Tobacco Product ◽

Dual Use ◽

Use Patterns ◽

Product Use ◽

Interview Survey ◽

Race Ethnicity ◽

Nationally Representative ◽

Over Time

Although increases in the variety of tobacco products available to consumers have led to investigations of dual/polytobacco use patterns, few studies have documented trends in these patterns over time. We used data from the 2014/2015 and 2018/2019 Tobacco Use Supplement to the Current Population Survey (TUS-CPS) and the 2015–2019 National Health Interview Survey (NHIS) to estimate trends in the following use patterns: exclusive use of cigarettes, electronic nicotine delivery systems (ENDS), other combustibles (cigars/cigarillos/little filtered cigars and traditional pipes/hookah), and smokeless tobacco (four categories); dual use (two product groups) of each product group with cigarettes (three categories); polyuse with cigarettes (all four product groups; one category); and dual/polyuse without cigarettes (one category). We estimated trends in product use patterns overall and by age, sex, and race/ethnicity using two-sample tests for differences in linear proportions. From 2014/2015 to 2018/2019, exclusive ENDS use increased, whereas cigarettes and ENDS dual use decreased. Furthermore, polyuse with cigarettes decreased, whereas dual/polyuse without cigarettes increased, with trends varying by age, sex, and race/ethnicity. Our findings suggest that patterns of dual/polyuse with and without cigarettes have changed in recent years, indicating the need for further surveillance of concurrent tobacco product use patterns.

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E-cigarette, combustible, and smokeless tobacco product use combinations among youth in the United States, 2014-2019

10.1101/2020.06.11.20112581 ◽

2020 ◽

Author(s):

Jamie Tam

Keyword(s):

Tobacco Use ◽

Smokeless Tobacco ◽

The United States ◽

Tobacco Product ◽

School Type ◽

Annual Percent Change ◽

Product Use ◽

Prevalence Estimates ◽

Smokeless Tobacco Product ◽

History Of

ABSTRACTIntroductionYouth e-cigarette use has been rising, however U.S. prevalence data are generally reported without disaggregating by individuals’ use of other tobacco products. It is not clear how the proportion of youth e-cigarette users naïve to all combustible tobacco is changing.MethodsAnnual prevalence estimates of ever and current (defined as past 30-day use) tobacco use prevalence by school type are reported using the 2014-2019 National Youth Tobacco Surveys (NYTS) with mutually exclusive categories of e-cigarette, smokeless tobacco, and/or combustible tobacco product use. T-tests were used to compare annual estimates with the preceding year. The annual percent change (APC) for each category from 2014-2018 were analyzed using JoinPoint regression. Data for 2019 were reported separately due to the change in survey format from paper to electronic.ResultsCurrent use of only e-cigarettes among HS students who never used combustible tobacco increased significantly from 2014-2018 (APC = +42.4%, 95% CI: 0.7, 101.3); by 2019, prevalence peaked at 9.2% (95% CI: 8.2, 10.2) among never combustible users and 8.3% (95% CI: 7.3, 9.3) among former combustible users. This coincided with significant declines in use of only combustible tobacco (APC=-14.5%, 95% CI: −18.3, −10.5).ConclusionsUse of only e-cigarettes among US youth with no history of combustible tobacco use has increased substantially over time, even as combustible tobacco use continues to plummet. Of the 17.5% (95% CI: 15.7, 19.0) of HS students who currently used only e-cigarettes (but not other tobacco) in 2019, more than half have no history of combustible tobacco use.

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Youth Vaping and Tobacco Use in Context in the United States: Results From the 2018 National Youth Tobacco Survey

Nicotine & Tobacco Research ◽

10.1093/ntr/ntaa010 ◽

2020 ◽

Cited By ~ 8

Author(s):

Allison M Glasser ◽

Amanda L Johnson ◽

Raymond S Niaura ◽

David B Abrams ◽

Jennifer L Pearson

Keyword(s):

Public Health ◽

Tobacco Use ◽

The United States ◽

Tobacco Product ◽

Decision Makers ◽

Public Health Decision ◽

Use Patterns ◽

Product Use ◽

Health Decision ◽

Low Prevalence

Abstract Introduction According to the National Youth Tobacco Survey (NYTS), youth e-cigarette use (vaping) rose between 2017 and 2018. Frequency of vaping and concurrent past 30-day (p30d) use of e-cigarettes and tobacco products have not been reported. Methods We analyzed the 2018 NYTS (N = 20 189) for vaping among all students (middle and high school; 6–12th grades; 9–19 years old) by frequency of vaping, exclusive vaping, p30d poly-product use (vaping and use of one or more tobacco product), and any past tobacco product use. Results In 2018, 81.4% of students had not used any tobacco or vapor product in the p30d, and 86.2% had not vaped in the p30d. Among all students, of the 13.8% vaped in the p30d, just over half vaped on ≤5 days (7.0%), and roughly a quarter each vaped on 6–19 days (3.2%) and on 20+ days (3.6%). Almost three quarters of p30d vapers (9.9%) reported past or concurrent tobacco use and the remainder (3.9%) were tobacco naïve. 2.8% of students were tobacco naïve and vaped on ≤5 days; 0.7% were tobacco-naïve and vaped on 6–19 days, and 0.4% were tobacco-naïve and vaped on 20+ days. Conclusions Vaping increased among US youth in 2018 over 2017. The increases are characterized by patterns of low p30d vaping frequency and high poly-product use, and a low prevalence of vaping among more frequent but tobacco naïve vapers. Implications Results underscore the importance of including the full context of use patterns. The majority of vapers (60.0%–88.9% by use frequency) were concurrent p30d or ever tobacco users. About 4% of students were tobacco naïve and vaped in the p30d, but few (0.4%) vaped regularly on 20 or more days. Reporting youth vaping data with frequency and tobacco product co-use will give public health decision-makers the best possible information to protect public health.

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Mortality Risks Associated With Dual– and Poly–Tobacco-Product Use in the United States

American Journal of Epidemiology ◽

10.1093/aje/kwz143 ◽

2019 ◽

Cited By ~ 2

Author(s):

Kelvin Choi ◽

Maki Inoue-Choi ◽

Timothy S McNeel ◽

Neal D Freedman

Keyword(s):

United States ◽

The United States ◽

Tobacco Product ◽

Cigarette Smokers ◽

Tobacco Products ◽

Mortality Risks ◽

Use Patterns ◽

Product Use ◽

Nationally Representative ◽

The Impact

Abstract Increasing numbers of adults in the United States use more than 1 tobacco product. Most use cigarettes in combination with other tobacco products. However, little is known about the all-cause and cancer-specific mortality risks of dual– and poly–tobacco-product use. We examined these associations by pooling nationally representative data from the 1991, 1992, 1998, 2000, 2005, and 2010 National Health Interview Surveys (n = 118,144). Mortality information was obtained through linkage to the National Death Index. Cigarette smokers who additionally used other tobacco products smoked as many if not more cigarettes per day than exclusive cigarette smokers. Furthermore, cigarette smokers who additionally used other tobacco products had mortality risks that were as high as and sometimes higher than those of exclusive cigarette smokers. As tobacco use patterns continue to change and diversify, investigators in future studies need to carefully assess the impact of noncigarette tobacco products on cigarette use and determine associated disease risks.

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Data Visualization Tools of Tobacco Product Use Patterns, Transitions and Sex Differences in the PATH Youth Data

Nicotine & Tobacco Research ◽

10.1093/ntr/ntaa056 ◽

2020 ◽

Vol 22 (10) ◽

pp. 1901-1908 ◽

Cited By ~ 1

Author(s):

Ralitza Gueorguieva ◽

Eugenia Buta ◽

Patricia Simon ◽

Suchitra Krishnan-Sarin ◽

Stephanie S O’Malley

Keyword(s):

Sex Differences ◽

Data Visualization ◽

Tobacco Use ◽

Tobacco Product ◽

Heat Maps ◽

Use Patterns ◽

Product Use ◽

Patterns Of Use ◽

Set Intersection ◽

Visualization Tools

Abstract Introduction Evaluations of multiple tobacco product use and temporal changes in patterns of use are complicated by a large number of combinations and transitions. Visualization tools could easily identify most common patterns and transitions. Methods Set intersection bar plots describe ever use of five tobacco products among 12–17 years old youth in wave 1 of the Population Assessment of Tobacco and Health (PATH) study (N = 11 497). Heat maps visualize unweighted frequencies of transitions from ever use at wave 1 (2013–2014) to past 12-month use at wave 2 (2014–2015). Weighted calibrated heat maps assess differences in relative frequencies of transitions by pattern at wave 1 and identify differences in transitions by sex. Results The most common tobacco product ever use patterns in wave 1 were of cigarettes only, e-cigarettes only or hookah only, followed by ever use of both cigarettes and e-cigarettes. Initiation of use between waves was uncommon. The most frequent transition among those who reported use at wave 2 but not at wave 1 (N = 971) was to e-cigarette use (N = 301). However, among e-cigarette-only ever users at wave 1 (N = 260), about half did not report any product use at wave 2. Use of three or more products remained stable. Adolescent girls compared to boys appeared more likely to report hookah use at both waves. Conclusion Set intersection bar plots and heat maps are useful for visualizing tobacco product use patterns and transitions, especially for multiple products. Both techniques could identify common problematic tobacco use patterns across and within populations. Implications Given the growing complexity of the youth tobacco use landscape, approaches to efficiently communicate patterns of multiple tobacco product use should be used more often. This study introduces set intersection bar plots and modified versions of heat maps to the tobacco product literature and illustrates their use in the PATH youth sample. These techniques are useful for visualizing absolute and relative frequencies of multiple possible patterns and transitions. They also suggest targets for subsequent statistical inference such as sex differences in hookah use. The methods can be applied more generally for data visualization wherever large number of combinations occurs.

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Characterizing Tobacco and Marijuana Use Among Youth Experiencing Homelessness in a Midwestern City

10.21203/rs.3.rs-824818/v1 ◽

2021 ◽

Author(s):

Allison M. Glasser ◽

Alice Hinton ◽

Amy Wermert ◽

Joseph Macisco ◽

Julianna Nemeth

Keyword(s):

Tobacco Use ◽

Marijuana Use ◽

Tobacco Product ◽

Housing Situation ◽

Use Patterns ◽

The Past ◽

Product Use ◽

Youth And Young Adults ◽

Selection Of ◽

Midwestern City

Abstract BackgroundCigarette smoking is three times more prevalent among youth experiencing homelessness compared with the general population. Co-use of tobacco and marijuana is also common. The aim of this study is to characterize tobacco and marijuana use among homeless young people in a Midwestern city.MethodsThis study included 96 youth and young adults (52% male, 39% female, 5% transgender/non-binary) attending a homeless drop-in center who had used at least one combustible tobacco product in the past week. We assessed past-month use of tobacco products and marijuana and other product use characteristics (e.g., frequency, brand and flavor).ResultsMost youth experiencing homelessness with past-week combustible tobacco use had used cigarettes (88.5%), cigars (92.7%), and marijuana (85.4%) in the past month. One-third used electronic vapor products, 19.8% smoked hookah, and 11.5% used smokeless tobacco. Most marijuana users co-administered with tobacco (69.8%). Daily combustible tobacco smoking was associated with having a child and smoking out of boredom/habit. Daily marijuana use was associated with using substances to cope with one’s housing situation. Newport and Black & Mild were the most popular brands of cigarettes and cigars. Most non-combustible tobacco users reported not having a usual brand. Cigar smokers reported the most varied selection of flavors.ConclusionsYoung combustible tobacco users experiencing homelessness engage in high-risk use patterns, including poly-tobacco use, co-use of tobacco with marijuana, and frequent combustible product use. Interventions that consider the full context of tobacco and marijuana use are needed to support cessation in this population.

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Cross-sectional Survey to Assess Tobacco and Nicotine Product Use since the Introduction of Tobacco Heating Products in Japan: Wave 1

Tobacco Regulatory Science ◽

10.18001/trs.7.3.6 ◽

2021 ◽

Vol 7 (3) ◽

pp. 210-220

Author(s):

Joshua D. Jones ◽

Jason Adamson ◽

Claudia Kanitscheider ◽

Krishna Prasad ◽

Oscar M. Camacho ◽

...

Keyword(s):

Population Level ◽

Tobacco Product ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Use Patterns ◽

Product Use ◽

Key Population ◽

Level Data ◽

Japanese Residents ◽

And Behavior

Objective: In this study, we obtained key population-level data on use patterns and behavior relating to tobacco and nicotine products in Japan. Methods: We performed a nationwide cross-sectional survey of the general population in Japan in 2019 to assess use patterns after the introduction of tobacco heating products (THPs). Eligible participants were Japanese residents, aged 20 years or older who consented to complete the survey. Individuals living in institutions were excluded. A 3-stage probability sampling method was applied that was geographically stratified by street blocks proportionate to population density. Respondents self-reported patterns of product use and reasons for THP use. Results: Complete responses were available from 5306 individuals, of whom 933.5 (17.6%) were current users, 984.2 (18.5%) were former users, and 3388.4 (63.9%) were never users of tobacco products (weighted respondent totals). Cigarettes were used by 14.6% of current tobacco product users and THPs by 5.3%. Cigarettes and THPs were used exclusively by 64.5% and 12.2%, respectively, and both were used by 12.7%. The most common reasons reported for THP use were perceived reduction in harm to self and others compared to cigarettes. Conclusions: Whereas the prevalence of cigarette use in Japan is decreasing, THPs seem to be increasingly used as long-term alternatives to cigarette smoking.

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Six-Week Actual Use Study to Evaluate the Impact of Oral Tobacco-Derived Nicotine Pouches on Cigarette Smoking and Smokeless Tobacco Product Use Behaviors

10.21203/rs.3.rs-951433/v1 ◽

2021 ◽

Author(s):

Stacey McCaffrey ◽

Jennifer Lewis ◽

Elizabeth Becker ◽

Andrea Vansickel ◽

Elsa Larson ◽

...

Keyword(s):

Smokeless Tobacco ◽

Tobacco Product ◽

Daily Consumption ◽

Open Label ◽

Tobacco Products ◽

Use Patterns ◽

Product Use ◽

Actual Use ◽

Smokeless Tobacco Product ◽

The Impact

Abstract Background Oral tobacco-derived nicotine (OTDN) products are a rapidly emerging, innovative category of noncombustible tobacco products. These products are tobacco-leaf free and do not contain or generate many of the harmful and potentially harmful constituents (HPHCs) found in combustible cigarettes or smokeless tobacco (ST) products. OTDN products may therefore offer adult tobacco consumers a potentially reduced harm alternative. However, little is known about OTDN product use patterns or their ability to substitute for more harmful tobacco products.Methods We conducted an open-label, 2-phase, actual use study designed to characterize OTDN pouch product (on!® nicotine pouches - NP) use patterns, including impact on other tobacco use behaviors among adult tobacco consumers interested in using NP. Adult current cigarette smokers (AS) and/or adult ST users (ASTU) (n = 1,147 complete) who were not planning to quit were offered free choice of a portfolio of NP (seven flavors at five nicotine levels) to use at-home, ad-libitum, for 6-weeks following an initial 5-day trial. Participants responded to daily electronic surveys that captured the amount, frequency, and topography (e.g., time in mouth, placement in mouth) of NP and other tobacco product use. Results The majority (99 to 100%) of study participants used NP throughout the 6-week period. Participants used ~5-6 pouches/day of a variety of flavors and nicotine levels. At the end of 6 weeks, a modest proportion of AS (27%) and a substantial proportion of ASTU (71%) reported no use of cigarettes or ST respectively, while reporting continued use of NPs. Additionally, 39% of AS and 14% of ASTU reduced daily consumption of cigarettes or ST products, respectively by 50-99%. Conclusions Participants found NPs acceptable with a sizeable proportion completely switching away from or substantially reducing (50-99%) their cigarette or ST consumption by week 6. Availability of a variety of flavors and nicotine levels appeared to facilitate the conversion to NP. These data suggest that, under the conditions of the study, NP can be a potential substitute for cigarettes or ST products and may offer harm reduction potential for adult smokers and smokeless tobacco users not interested in quitting.Trial Registration Note: This study is an observational study with tobacco products currently available in the marketplace for adult tobacco consumers. Since there is no intervention per se and we did not collect any biosamples this is not a “clinical study” and there is no appropriate registry for such behavioral observational studies, we do not believe that this requirement is applicable.

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