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. 2023 Aug 19;25(9):1565-1574.
doi: 10.1093/ntr/ntad072.

Indicators of Tobacco Dependence Among Youth: Findings From Wave 1 (2013-2014) of the Population Assessment of Tobacco and Health Study

David R Strong  1   2 , Allison M Glasser  3 , Eric C Leas  2 , John P Pierce  2 , David B Abrams  3 , Mary Hrywna  4 , Andrew Hyland  5 , K Michael Cummings  6 , Dorothy K Hatsukami  7 , Geoffrey T Fong  8   9 , Tara Elton-Marshall  10 , Eva Sharma  11 , Kathryn C Edwards  11 , Cassandra A Stanton  11 , Michael D Sawdey  12 , Carolina P Ramôa  12 , Marushka L Silveira  13   14 , Heather L Kimmel  15 , Raymond S Niaura  3
Affiliations

Indicators of Tobacco Dependence Among Youth: Findings From Wave 1 (2013-2014) of the Population Assessment of Tobacco and Health Study

David R Strong et al. Nicotine Tob Res. .

Erratum in

Abstract

Background: Prior work established a measure of tobacco dependence (TD) among adults that can be used to compare TD across different tobacco products. We extend this approach to develop a common, cross-product metric for TD among youth.

Methods: One thousand one hundred and forty-eight youth aged 12-17 who used a tobacco product in the past 30 days were identified from 13 651 youth respondents in Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study.

Findings: Analyses confirmed a single primary latent construct underlying responses to TD indicators for all mutually exclusive tobacco product user groups. Differential Item Functioning analyses supported the use of 8 of 10 TD indicators for comparisons across groups. With TD levels anchored at 0.0 (standard deviation [SD] = 1.0) among cigarette only (n = 265) use group, mean TD scores were more than a full SD lower for e-cigarette only (n = 150) use group (mean = -1.09; SD = 0.64). Other single product use group (cigar, hookah, pipe, or smokeless; n = 262) on average had lower TD (mean = -0.60; SD = 0.84), and the group with the use of multiple tobacco products (n = 471) experienced similar levels of TD (mean = 0.14; SD = 0.78) as the cigarette only use group. Concurrent validity was established with product use frequency among all user groups. A subset of five TD items comprised a common metric permitting comparisons between youth and adults.

Conclusion: The PATH Study Youth Wave 1 Interview provided psychometrically valid measures of TD that enable future regulatory investigations of TD across tobacco products and comparisons between youth and adult tobacco product use group.

Implications: A measure of tobacco dependence (TD) has been established previously among adults to compare TD across tobacco products. This study established the validity of a similar, cross-product measure of TD among youth. Findings suggest a single latent TD construct underlying this measure, concurrent validity of the scale with product use frequency across different types of tobacco users, and a subset of common items that can be used to compare TD between youth and adults who use tobacco.

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Conflict of interest statement

RN receives funding from the Food and Drug Administration Center for Tobacco Products via contractual mechanisms with Westat and the National Institutes of Health. Within the past three years, he has served as a paid consultant to the Government of Canada via a contract with Industrial Economics Inc, and has received an honorarium for a virtual meeting from Pfizer Inc. RN was an unpaid grant reviewer for the Foundation for a Smoke Free World. KMC provides expert testimony on the health effects of smoking and tobacco industry tactics in lawsuits filed against the tobacco industry. He has also received payment as a consultant to Pfizer, Inc, for services on an external advisory panel to assess ways to improve smoking cessation delivery in health care settings. GTF has a Senior Investigator Award from the Ontario Institute for Cancer Research (IA-004). Over the past two years, he has received grant funding from the U.S. National Cancer Institute (5P01CA200512), Canadian Institutes of Health Research (FDN-148477), Health Research Council of New Zealand, Health Canada, Korea Health Promotion Institute, National Cancer Center Japan, Santé Publique France, Bill and Melinda Gates Foundation, British Heart Foundation, Mayo Foundation for Medical Education and Research, Cancer Research UK, and the Dutch Lung Foundation. He has been an expert witness/consultant for the governments of Uruguay and Australia defending their country’s policies/regulations in litigation, and an expert consultant for the government of Singapore regarding policies and regulations on tobacco products. He has served as a member of the Expert Group on Articles 9/10 of the WHO Framework Convention on Tobacco Control, the WHO Expert Group on COVID-19 and Tobacco Use, and Health Canada’s Scientific Advisory Board on Vaping Products. Tara Elton-Marshall acknowledges funding from Canadian Institutes of Health Research (CIHR) for the Ontario CRISM Node Team (grant #SMN-139150) and the Team Grant: Partnerships for Cannabis Policy Evaluation.

Figures

Figure 1.
Figure 1.
Differential test functioning for youth product groups and youth and adult instruments. Plot a presents expected raw count of youth item responses to tobacco dependence (TD) for e-cigarette only (darker blue line) and cigarette only (lighter blue line) users. Plot b presents expected total TD for multiple product (darker blue line) and cigarette only (lighter blue line) users. Plot c presents expected raw count of youth and adult item responses for youth (purple line) and adult (green line) respondents.
Figure 2.
Figure 2.
Association between increasing frequency of tobacco use and mean level of Tobacco Dependence (TD) among youth. Plot a presents mean TD for groups with typical ranges of frequency for each product user group. Increasing quartiles of frequency of use were computed separately within cigarette only, e-cigarette only, other single product, and multiple product users. Plot b presents mean TD for each user group across a simple range of days youth used their respective tobacco products within the past 30 d. All means and 95% confidence intervals are weighted.
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