Multiple tobacco product use among US adolescents and young adults

Abstract

Objective: To assess the extent to which multiple tobacco product use among adolescents and young adults falls outside current Food and Drug Administration (FDA) regulatory authority.

Methods: We conducted a web-based survey of 1596 16-26-year-olds to assess use of 11 types of tobacco products. We ascertained current (past 30 days) tobacco product use among 927 respondents who ever used tobacco. Combustible tobacco products included cigarettes, cigars (little filtered, cigarillos, premium) and hookah; non-combustible tobacco products included chew, dip, dissolvables, e-cigarettes, snuff and snus. We then fitted an ordinal logistic regression model to assess demographic and behavioural associations with higher levels of current tobacco product use (single, dual and multiple product use).

Results: Among 448 current tobacco users, 54% were single product users, 25% dual users and 21% multiple users. The largest single use category was cigarettes (49%), followed by hookah (23%), little filtered cigars (17%) and e-cigarettes (5%). Most dual and multiple product users smoked cigarettes, along with little filtered cigars, hookah and e-cigarettes. Forty-six per cent of current single, 84% of dual and 85% of multiple tobacco product users consumed a tobacco product outside FDA regulatory authority. In multivariable analysis, the adjusted risk of multiple tobacco use was higher for males, first use of a non-combustible tobacco product, high sensation seeking respondents and declined for each additional year of age that tobacco initiation was delayed.

Conclusions: Nearly half of current adolescent and young adult tobacco users in this study engaged in dual and multiple tobacco product use; the majority of them used products that fall outside current FDA regulatory authority. This study supports FDA deeming of these products and their incorporation into the national media campaign to address youth tobacco use.

Keywords: Electronic nicotine delivery devices; Health Services; Non-cigarette tobacco products; Public policy.

Figure 1

Number and type of tobacco products used among current tobacco users. Green shaded bars represent tobacco products regulated by the Food and Drug Administration (FDA). Red shaded bars represent tobacco products not under FDA regulation. ‘Other’ includes all combination of tobacco products <5% of the number of tobacco products category. The full distribution of types of products by the number of tobacco products currently used shown in web-only table 2. Filt., filtered; E-cig, electronic cigarette.

Figure 2

Predicted probabilities of single, dual and multiple tobacco use among current users by age at first tobacco use. Age group set at 18–20 years, sex at male, race/ethnicity at non-Hispanic white, sensation seeking quartile at 2, friend smoking status at yes, parental smoking status at current, first tobacco product type cigarette and first tobacco product combustible.