Socioeconomic Disadvantage and Other Risk Factors for Using Higher-Nicotine/Tar-Yield (Regular Full-Flavor) Cigarettes

Abstract

Introduction: Use of machine-estimated higher nicotine/tar yield (regular full-flavor) cigarettes is associated with increased risk of nicotine dependence. The present study examined risk factors for using full-flavor versus other cigarette types, including socioeconomic disadvantage and other risk factors for tobacco use or tobacco-related adverse health impacts. Associations between use of full-flavor cigarettes and risk of nicotine dependence were also examined.

Methods: Data were obtained from nationally representative samples of adult cigarette smokers from the US National Survey on Drug Use and Health. Logistic regression and classification and regression tree modeling were used to examine associations between use of full-flavor cigarettes and educational attainment, poverty, race/ethnicity, age, sex, mental illness, alcohol abuse/dependence, and illicit drug abuse/dependence. Logistic regression was used to examine risk for nicotine dependence.

Results: Each of these risk factors except alcohol abuse/dependence independently predicted increased odds of using full-flavor cigarettes (p < .001), with lower educational attainment the strongest predictor, followed by poverty, male sex, younger age, minority race/ethnicity, mental illness, and drug abuse/dependence, respectively. Use of full-flavor cigarettes was associated with increased odds of nicotine dependence within each of these risk factor groupings (p < .01). Cart modeling identified how prevalence of full-flavor cigarette use can vary from a low of 25% to a high of 66% corresponding to differing combinations of these independent risk factors.

Conclusions: Use of full-flavor cigarettes is overrepresented in socioeconomically disadvantaged and other vulnerable populations, and associated with increased risk of nicotine dependence. Greater regulation of this cigarette type may be warranted.

Implications: Greater regulation of commercially available Regular Full-Flavor Cigarettes may be warranted. Use of this type of cigarette is overrepresented in socioeconomically disadvantaged and other vulnerable populations and associated with increased risk for nicotine dependence.

Figure 1.

A pruned, weighted classification and regression tree (CART) model in US adult (>18 years of age) smokers of associations between use of full-flavor (FF) versus lower (L) machine-estimated nicotine/tar yield cigarettes and the following seven risk factors: educational attainment, annual income below federal poverty level, race/ethnicity, sex, age, past year mental illness, and past year drug abuse/dependence. Results from a saturated model were pruned using CART analytic software to reduce complexity (R Core Team). Rectangles (nodes) represent prevalence of using FF or L yield brand cigarettes for the entire population (top-most node) or population subgroups (all others nodes). Nodes also list the proportion of the adult smoker population represented. Nodes wherein the majority uses FF cigarettes are bolded. Using the root node as an example, 49% and 51% of the US population of adult smokers use FF and L brand cigarettes, respectively; because prevalence of use of FF is below 50% the node is not bolded; the root node represents 100% of the US adult smoker population. Lines below nodes represent the binary yes―no branching around particular risk factors and risk factor levels, with subgroups in whom the risk factor/level is present moving leftward and downward and those in whom it is absent moving rightward and downward for further potential partitioning based on additional risk factors/levels. The bottom row comprises terminal nodes (ie, final partitioning for a particular subgroup). Note that minimal terminal node size was set to more than 1000 individuals. Terminal nodes contain the same information as the other nodes.