Research Article: Adolescents’ first tobacco products: Associations with current multiple tobacco product use

Date Published: May 23, 2019

Publisher: Public Library of Science

Author(s): Sarah D. Kowitt, Adam O. Goldstein, Erin L. Sutfin, Amira Osman, Clare Meernik, Courtney Heck, Leah M. Ranney, Michael Cummings.

http://doi.org/10.1371/journal.pone.0217244

Abstract

Understanding which tobacco products adolescents use first can lead to insights for tobacco prevention interventions and policies. We used cross-sectional data from high school students who reported ever using a tobacco product from the 2017 North Carolina Youth Tobacco Survey (n = 1,053). In multivariable regressions, we examined how demographic and psychosocial factors were associated with adolescents’ first product tried and how first product tried was associated with current tobacco use (i.e., no use, use of a single product, use of multiple products) and frequency of tobacco use. Cigarettes (34.8%) and e-cigarettes (33.7%) were the most frequently reported first products tried, followed by cigars (15.6%), smokeless tobacco (10.7%), waterpipe (4.0%), and other tobacco products (i.e., pipe tobacco or some other tobacco product) (1.2%). Demographic differences in adolescents’ first product tried existed, with Black adolescents having higher odds of initiating tobacco use via cigars (aOR: 6.17, 95% CI: 3.75, 10.14). Adolescents who initiated tobacco use via cigars (aOR: 2.33, 95% CI: 1.31, 4.13) or smokeless tobacco (aOR: 2.45, 95% CI: 1.18, 5.04) had higher odds of being a multiple current tobacco product user, whereas adolescents who initiated tobacco use via e-cigarettes (aOR: 0.57, 95% CI: 0.34, 0.93) had lower odds of being a multiple current tobacco product user. Additionally, adolescents who initiated tobacco use via smokeless tobacco had higher odds of currently using at least one tobacco product frequently (aOR: 1.90, 95% CI: 1.04, 3.48), while adolescents who initiated tobacco use via e-cigarettes had lower odds of currently using at least one tobacco product frequently (aOR: 0.40, 95% CI: 0.23, 0.70). These findings suggest that most adolescents reported initiating tobacco use via cigarettes or e-cigarettes and that trying certain products first (e.g., cigars, smokeless tobacco) was associated with higher odds of multiple current tobacco product use.

Partial Text

Over the last decade, the tobacco product landscape has changed markedly. Given these changes, data on how adolescents initiate tobacco use (i.e., which products they try first and demographic factors associated with first products tried) is needed. These data are important for several reasons. First, all tobacco products contain nicotine, which is highly addictive. Nicotine causes harm to adolescents’ developing brains and can lead to future tobacco use [1]. To prevent adolescents’ exposure to nicotine and tobacco products, we need to know how adolescents are initiating tobacco use (i.e., which products they are trying first). Second, in order to effectively prevent tobacco product use, we need to know how demographic factors are associated with which products adolescents try first. For instance, if Black adolescents are typically only trying cigars first, then interventions to prevent cigar use can be tailored to Black adolescents. Finally, if data indicate that trying certain products first (e.g., cigarettes) is associated with adolescents currently using multiple tobacco products, then tobacco prevention interventions and policies can be targeted toward those products.

In this study, we found that many adolescents reported initiating tobacco use with emerging tobacco products, such as e-cigarettes, alongside other more traditional tobacco products, such as cigarettes. We also found that trying certain products first, including cigars and SLT, was associated with higher odds of current multiple tobacco product use, that trying SLT was associated with higher odds of current frequent tobacco product use, and that trying e-cigarettes first was associated with lower odds of current multiple tobacco product use. Finally, we found several demographic and psychosocial characteristics, including race/ethnicity and adolescent SES to be associated with first product tried. These results have important implications for public health.

In this study, most adolescents reported initiating tobacco use via cigarettes or e-cigarettes and trying certain products first (e.g., smokeless tobacco) was associated with higher odds of multiple current tobacco product use and higher odds of currently using at least one tobacco product frequently. Examining how youth initiate and experiment with tobacco product use suggest that new efforts focused on emerging tobacco products, such as e-cigarettes, are needed, but that they should not replace existing efforts focused on preventing and reducing use of traditional tobacco products, such as cigarettes, cigars, waterpipe, and smokeless tobacco.

 

Source:

http://doi.org/10.1371/journal.pone.0217244

 

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