Patterns of Alternative Tobacco Product Use: Emergence of Hookah and E-cigarettes as Preferred Products Amongst Youth

Abstract

Purpose There is a growing public health concern related to the rapid increase in the use of multiple tobacco products among adolescents. This study examined patterns of adolescent use of cigarettes, e-cigarettes, cigars/cigarillo, hookah/waterpipe, and smokeless/dip/chewing tobacco in a population of southern California adolescents. Methods Data from 2,097 11th- and 12th-grade participants in the Southern California Children’s Health Study were collected via self-report in 2014. Study participants were asked about lifetime and current (past 30 days) use of cigarettes, cigars/cigarillos/little cigars, e-cigarettes, hookah/waterpipe, and smokeless/dip/chewing tobacco. Latent class analysis (LCA) was used to identify patterns of tobacco use. Results Hookah/waterpipe tobacco use had the highest current prevalence (10.7%) followed by e-cigarettes (9.6%). The prevalence of use of smokeless/dip/chewing tobacco was lowest, with 2.2% of adolescents reporting current use. The LCA suggested four distinct classes, comprising nonusers (72.3% of the sample), polytobacco experimenters (13.9%), e-cigarette/hookah users (8.2%), and polytobacco users (5.6%). Multinomial logistic regression based on these four classes found that males had double the odds to be polytobacco users relative to nonusers compared to females (odds ratio, 2.3; 95% confidence interval, 1.26–4.25). Conclusions By identifying naturally occurring configurations of tobacco product use in teens, these findings may be useful to practitioners and policymakers to identify the need for tobacco control interventions that address specific tobacco products and particular combinations of polytobacco use. LCA can be used to identify segments of the population overrepresented among certain tobacco use classes (e.g., boys) that may benefit most from targeted polyproduct intervention approaches.

Multiple tobacco use among young adult waterpipe smokers in Egypt

“…However, the estimates reported for multiple use among current tobacco users vary widely (0.5%-66.2%) depending on the type of tobacco (smoked or smokeless) studied (5,7,12,19). The term "multiple tobacco product use" has only recently been used in the literature and has appeared mainly in studies done in the USA (6,9,11,31).…”

“…A large national study in the United States of America (USA) found that 40% of both adult and youth tobacco users used multiple tobacco products, mostly combining cigarettes and e-cigarettes (10). However, cigarette smoking is not always included in multiple tobacco use combinations (12). Waterpipe tobacco smoking, smokeless tobacco and electronic nicotine delivery systems (ENDS) are increasingly used worldwide (5,7,8,12,13,18,19), and have been promoted as less harmful alternatives to cigarettes (20,21).…”

“…However, cigarette smoking is not always included in multiple tobacco use combinations (12). Waterpipe tobacco smoking, smokeless tobacco and electronic nicotine delivery systems (ENDS) are increasingly used worldwide (5,7,8,12,13,18,19), and have been promoted as less harmful alternatives to cigarettes (20,21). Young people who use multiple tobacco products are more prone to nicotine dependence and to continue using tobacco as adults (22).…”

E-Cigarettes and Future Cigarette Use

“…by guest on May 9, 2018 http://pediatrics.aappublications.org/ Downloaded from e-cigarette use, 20 yes versus no), or susceptibility to smoking at initial evaluation (yes vs no). Additional analyses evaluated the risk of initiation of any combustible tobacco product (cigarettes, cigars, hookah, or pipes) associated with e-cigarette use at initial evaluation.…”

Curiosity and susceptibility to cigarette smoking among cigarette-naïve, waterpipe smoking US youth: National Youth Tobacco Survey, 2014

“…A recent report from the CDC (2014) has shown that among a nationally representative sample of adolescents, 9.4% and 9.2% of high school students smoked waterpipe and cigarettes, respectively, in the past 30 days 5 . In addition, waterpipe is increasingly becoming the first tobacco product tried by youth 6 , and different studies have shown that cigarette-naïve youth who smoke waterpipe are at a higher risk of initiating cigarette smoking [7][8][9][10][11] . Susceptibility and curiosity are two commonly used measures to identify cigarette-naïve youth at risk of experimenting with cigarettes 11,12 .…”