Adolescent Dual Use Classification and Its Association With Nicotine Dependence and Quit Intentions

Abstract

Electronic cigarettes (e-cigarette) use is rapidly increasing in the U.S., especially among adolescents. A significant number of adolescents use both cigarettes and e-cigarettes, often referred to as dual use. We used a new classification of dual use, taking into account the frequency of use of both products. In addition, we examined the association between dual use with time to first cigarette after waking (a nicotine dependence measure) and quit intention. Methods: Data were drawn from the 2015e2018 National Youth Tobacco Survey. We grouped participants by dual use frequency. Multivariable logistic regression was used to examine the association of dual use frequency with nicotine dependence and quit intention. Results: Different categories of dual users varied in demographic characteristics and beliefs on the harms of cigarette smoking and e-cigarette use. Compared with cigarette-only smokers, significantly higher odds of nicotine dependence were found for high-frequency e-cigarette dual users (within 5 minutes of awakening, odds ratio [OR]: 1.67, 95% confidence interval [CI], 1.07e2.62; within 30 minutes, OR: 1.61, 95% CI, 1.15e2.27), high-frequency cigarette dual users (5 minutes, OR: 2.85, 95% CI, 1.76e4.63; within 30 minutes, OR: 4.14, 95% CI, 2.96e5.80), and high-frequency dual users (5 minutes, OR: 4.46, 95% CI, 2.88e6.91; 30 minutes, OR: 3.94, 95% CI, 2.43e6.42). In addition, high-frequency e-cigarette dual users had significantly lower quit intention compared with both cigarette-only smokers and low-frequency dual users. Conclusions: Findings highlight the need for a standard, granulated classification of dual user, as important characteristics may vary between different categories. Future studies on dual use should consider categorizing dual use into the four classifications described in this study.

Associations Between Risk Perceptions and Cigarette, E-cigarette, and Dual-Product Use Among Canadian Adolescents

“…Participants with high perceived risk could be concerned about the possibility of increased nicotine dependence or other risks associated with dual-use. 22,23 In addition, compared to those with low-risk perception, those with high-risk perception had higher odds of e-cigarette-only use relative to cigarette-only users. Our findings indicate that, relative to e-cigarette users, those with a high-risk perception of both products had lower odds of dual-use than those with a low-risk perception of both products.…”

Association between Intention to Quit Cigarette Smoking and Use of Heated Tobacco Products: Application of Smoking Intensity Perspective on Heated Tobacco Product Users

“…Therefore, smoking intensity, a meaningful indication of one’s interest in quitting smoking, should be considered when examining use of novel tobacco products in association with facilitating smoking cessation. There have been numerous studies that evaluate the association between e-cigarette use and intention to quit cigarette smoking, some of which included an in-depth analysis in relation to cigarette-smoking frequency (e.g., daily versus non-daily smoking) [ 16 , 17 ] or daily cigarette consumption (e.g., number of cigarettes smoked per day) [ 18 , 19 ]. Meanwhile, other studies focused on the association between HTP use and intention to quit cigarette smoking [ 20 , 21 , 22 ].…”

Trends in Smoking Behaviors Among US Adolescent Cigarette Smokers

“…14,25 Evidence also shows that dual use of cigarettes and e-cigarettes is positively associated with illicit substance use, alcohol use, truancy, and poor academic performance and is negatively related to quit intention. 11,[18][19][20] The increase we observed in e-cigarette use among cigarette smokers is concerning and warrants further investigation. Over the 8 years analyzed, the mean age of first cigarette use increased significantly.…”

“…[15][16][17] Those who use combustible cigarettes and e-cigarettes concurrently could be at risk for increased substance abuse and other risky behavior. 11,[18][19][20] Analyzing youth smoking behavior over time provides additional insights to inform policy and prevention efforts. Jones et al 10 found that smoking intensity decreased among current cigarette-smoking youth, with heavy smokers decreasing from 18.0% to 7.8% and light smokers increasing from 67.2% in 1991 to 79.4% in 2009.…”