Polytobacco Use and Nicotine Dependence Symptoms Among US Adults, 2012–2014

Abstract

IntroductionThe tobacco product landscape has changed substantially. Little is known about the recent pattern of polytobacco use (at least two tobacco products) among US adults and its relationship to nicotine dependence.MethodsUsing the 2012–2013 and 2013–2014 National Adult Tobacco Survey (NATS) data (N = 135 425 adults), we analyzed the prevalence and correlates of polytobacco use among each of the six categories of current tobacco user (cigarettes, cigars, pipes, hookah, e-cigarettes, and smokeless tobacco). Based on five nicotine dependence symptom measures from the NATS, difference in the prevalence of dependence symptoms between polytobacco and sole-product users for each category of tobacco user was assessed using multivariable regression analyses.ResultsDuring 2012–2014, 25.1% of adults were current users of any tobacco product. Among them, 32.5% were poly users with the largest poly use category being dual use of cigarettes and e-cigarettes (30.2%). Poly use prevalence was the lowest among current cigarette smokers (38.7%), followed by current users of smokeless tobacco (52.4%), hookah (59.2%), cigars (69.3%), e-cigarettes (80.9%), and pipes (86.2%). Among each category of current tobacco user, the prevalence of dependence symptom was consistently greater in polytobacco users than sole users for every symptom measure. After controlling for frequency of use and demographic covariates, the difference in nicotine dependence between poly users and sole users was statistically significant and consistent across all symptom measures for each category of tobacco user.ConclusionsBetween 52% and 86% of noncigarette tobacco users and nearly 40% of cigarette smokers engaged in polytobacco use. Poly users showed greater nicotine dependence than sole-product tobacco users.ImplicationsThis study examines recent patterns of polytobacco use separately for US adult current cigarette smokers, cigar smokers, pipe smokers, hookah users, e-cigarette users, and smokeless tobacco users. By including more tobacco products, particularly e-cigarettes and hookah, this study provides more comprehensive insight into polytobacco use. This study is also unique in comparing nicotine dependence between polytobacco and sole-product users among each category of tobacco users. Our results indicate that polytobacco use is very common and is associated with greater likelihood of reporting nicotine dependence symptoms. Tobacco cessation policies and programs should be tailored to address polytobacco use.

Prevalence and predictors of heated tobacco product use and its relationship with attempts to quit cigarette smoking among Korean adolescents

“…Specifically, users of multiple tobacco products may have higher levels of dependency and underestimate their harmful effects to a greater extent than their counterparts who use only a single tobacco product. It is noteworthy that the use of tobacco products and the cultural beliefs and values surrounding its use differ between Korea and the USA 28 29. Moreover, it is unclear whether the users of multiple tobacco products are likely to continue using multiple products or begin using a particular type of tobacco product.…”

Poly-tobacco product use among a representative sample of Chinese current smokers: a population survey

“…This is the rst large scale study to examine the prevalence of PTU, patterns and trends of concomitant use, and risk factors associated with PTU from a large representative sample of Chinese general population. We observed that the prevalence of current PTU (15.9%) was lower than the U.S. (38.7%), 23 but was higher than that in some large European countries, such as Russian (15.6%), Ukraine (12.0%) and…”

“…5 PTU affected more than 70 low, middle and high-income countries. 6 Tobacco industries targeted young population (aged [18][19][20][21][22][23][24] and have been advertising alternative tobacco products as viable smoking cessation and harm reduction tool for quitting conventional cigarette. 7 Youth were more likely to explore different tobacco products.…”

ERS and tobacco harm reduction

“…Argument 3: The tobacco harm reduction strategy is based on incorrect assumptions that smokers will replace conventional cigarettes with alternative nicotine delivery products. The majority of e-cigarette users (typically 60-80%) continue to smoke [12,13] and there seems to be no significant reduction in their consumption of conventional cigarettes [14]. Dual use is also very frequent in smokeless tobacco users [13].…”

“…The majority of e-cigarette users (typically 60-80%) continue to smoke [12,13] and there seems to be no significant reduction in their consumption of conventional cigarettes [14]. Dual use is also very frequent in smokeless tobacco users [13]. For dual users there is no health benefit.…”