Sociodemographic Patterns of Exclusive and Dual Combustible Tobacco and E-Cigarette Use among US Adolescents—A Nationally Representative Study (2017–2020)

Abstract

This study assessed the sociodemographic predictors of exclusive and dual use of the most frequently used nicotine/tobacco products, e-cigarettes, and combustible tobacco among adolescents. Cross-sectional data was from the 2017–2020 Monitoring the Future nationally representative study of eighth, tenth, and twelfth-grade students. We coded past 30 day nicotine/tobacco use into four mutually exclusive categories: no use, e-cigarette use only, combustible use (cigarette or cigar) only, and dual use (e-cigarette and combustible). We pooled the 2017–2020 data to examine the relationship between sex, race/ethnicity, parental education, and each product-use category using multinomial logistic regression, stratified by grade level. Among eighth (N = 11,189), tenth (N = 12,882), and twelfth graders (N = 11,385), exclusive e-cigarette use was the most prevalent pattern (6.4%, 13.2%, 13.8%, respectively), followed by dual use (2.7%, 4.5%, 8.9%), and exclusive combustible use (1.5%, 2.5%, 5.3%). eighth and tenth-grade adolescents whose highest parental education was a 4-year college degree or more had lower odds of exclusive combustible and dual use when compared to adolescents whose highest parental education was less than a high school degree. Research should continue to monitor the differential use of combustible tobacco products and e-cigarettes among adolescents from low socioeconomic status backgrounds or racial/ethnic minority households to inform ongoing and future interventions or policies.

Intergenerational transmission of parental risky health behaviors in Chinese children: Are there socioeconomic status differences?

“…As children's first teachers and socializing agents, parents' negative health behaviors can act as a bad model for their children (25)(26)(27)(28). In addition, parental socioeconomic status (SES) variables, including educational attainment, income, and occupational status, together with parenting styles, constitute the home environment in which children's behaviors are embedded (25,(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39).…”

“…In other words, the intergenerational transmission of risky health behaviors is likely to be in reverse to the SES gradient. However, other research studies showed that with increasing SES, the intergenerational transmission of risky parental health behaviors becomes increasingly apparent (35,37,(53)(54)(55). Yu and Abler (54) proposed that higher education in rural China is often associated with more social activities, and with cigarettes and wine being more accessible.…”

Trends of Single, Dual, and Polytobacco Use Among School-Based Students in the United States: An Analysis of the National Youth Tobacco Survey

“…9,10 Some research has examined the overlap between e-cigarette use and dual/polytobacco use among youth in the United States, and the evidence points toward substantial co-use. 7,8,[11][12][13][14][15][16] For instance, in a state-representative study of middle and high school students in Florida, most students who used e-cigarettes reported concurrent use with other tobacco products, with 37.8% reporting dual use (e-cigarettes/other tobacco product), and 40.2% reporting polytobacco use (e-cigarettes/cigarettes/ other tobacco product). 12 Similarly, an analysis using data from the National Youth Tobacco Survey between 2011-2015 found that 52% of students who reported using an e-cigarette during the past month also reported using at least one other tobacco product.…”

“…8 Epidemiological studies have found differences in the patterns of dual and polytobacco use by sociodemographic group. 11,13,14,16,17 For instance, studies have documented that youth who use three or more tobacco products (i.e., polytobacco use) are more likely to be older 16,18 and male. 3,11,19 Moreover, differences in the patterns of tobacco product use among youth have been observed by race/ethnicity.…”

“…3,11,19 Moreover, differences in the patterns of tobacco product use among youth have been observed by race/ethnicity. Non-Hispanic (NH) White youth report the highest prevalence of exclusive e-cigarette use 4,11,16,20 and dual/polytobacco use, 10,11,19 while Non-Hispanic (NH) Black youth report the highest prevalence of exclusive other combustible tobacco product use (e.g., cigars, filtered cigars, cigarillos). 11,21 Despite evidence of sociodemographic differences in dual and polytobacco use, research has yet to examine the changing sociodemographic profile of dual and polytobacco users in a context where the trends of youth tobacco product use are evolving rapidly.…”