Age of initiation of cigarillos, filtered cigars and/or traditional cigars among youth: Findings from the Population Assessment of Tobacco and Health (PATH) study, 2013–2017

Abstract

Significance Early age of initiation of tobacco use is associated with sustained tobacco use and lower rates of smoking cessation. Although much is known about age of initiation of cigarette use, much less is known about the age of initiation of cigar product use among youth. Methods Survival analyses of the Population Assessment of Tobacco and Health youth annual datasets (ages 12–17) from 2013 to 2017 were conducted for any cigar product use, cigarillos or filtered cigars, and traditional cigars across four cigar use outcomes, age of initiation of: susceptibility to use, ever use, past 30-day use and “fairly regular” use. An interval censoring survival method was implemented to estimate the probability of each outcome for age of initiation of each cigar product overall. Differences in age of initiation by sex and race/ethnicity were assessed using weighted Cox proportional hazards models for interval-censored data. Results For each outcome across the three cigar products, striking increases in the probability of initiation begin before 17 years old. For cigarillo or filtered cigars, males had a higher risk of onset of susceptibility to use, initiating ever use, and initiating past 30-day use at earlier ages than females. Compared to Non-Hispanic Whites, Hispanic and Non-Hispanic Other had lower risk of initiating ever use and past 30-day use at earlier ages. Non-Hispanic Black youth had higher risk of initiating past 30-day use and “fairly regular” use than Non-Hispanic White youth at earlier ages. Similar findings are reported for any cigar use and traditional cigar use. Conclusion Developmentally and culturally appropriate cigar use interventions and communication campaigns should be provided to youth before 17 years of age to prevent the onset and progression of cigar products. Regulatory policies that reduce appeal of all cigar products should be implemented to curb cigar initiation among youth.

Age at Initiation of Cigarette Use in a Nationally Representative Sample of US Youth, 2013-2017

“…29 That study found that the proportion of ever cigarette initiation occurring in early adulthood more than doubled from 20.6% in 2002 to 42.6% in 2018. 29 Additionally, a recent study 30 years, which could be explained by the shifting of cigarette initiation to later ages. Although the age of cigarette initiation may be shifting toward early adulthood rather than adolescence, suggesting that cigarette interventions should be implemented among young adults, our study suggests that a high amount of cigarette initiation still occurs among youth.…”

“… 29 That study found that the proportion of ever cigarette initiation occurring in early adulthood more than doubled from 20.6% in 2002 to 42.6% in 2018. 29 Additionally, a recent study 30 of PATH youth aged 26 to 34 years (who would have been aged 12 to 17 years in the early 2000s) that examined the recalled age of cigarette initiation found that the cumulative proportion of cigarette initiation was 85.8% by age 18 years. This finding is subject to recall bias; however, our results for youth aged 12 to 17 years between 2013 and 2017 showed that only 24.4% of cigarette initiation occurred by age 18 years, which could be explained by the shifting of cigarette initiation to later ages.…”

Age of Initiation of Dual Tobacco Use and Binge Drinking among Youth (12–17 Years Old): Findings from the Population Assessment of Tobacco and Health (PATH) Study

“…Sex differences in tobacco use have been reported in previous studies, with males reporting younger ages of initiation of cigarette, e-cigarette, and cigarillo use [ 25 , 26 , 27 , 28 ]. In addition, males are more likely to be dual and poly TP users [ 29 ].…”

“…Our results found that Non-Hispanic Black youth are less likely to initiate past 30-day use of cigarettes, cigarillos, and binge drinking at earlier ages compared to Non-Hispanic White youth. In contrast, a recent study that found that Non-Hispanic White youth were less likely to initiate past 30-day use of cigarillos as a single TP at earlier ages than Non-Hispanic Black youth [ 25 ]. This inconsistency could arise from the confounding effects due to concurrent use of cigarettes and binge drinking, substances which studies have shown Non-Hispanic White youth initiate earlier [ 29 , 34 , 48 ].…”

“…Previous publications of PATH youth reported the age of initiation single TPs, including cigarettes [ 27 ], e-cigarettes [ 26 ], and cigar products [ 25 ], which found that males are more likely to initiate past 30-day use of cigarettes, e-cigarettes, or cigar products at earlier ages than females. This is contrary to our results where we did not observe differences in the age of initiating polysubstance use between males and females.…”