A Risk-Continuum Categorization of Product Use Among US Youth Tobacco Users

Nicotine Tob Res. 2016 Jul;18(7):1596-605. doi: 10.1093/ntr/ntw008. Epub 2016 Jan 13.


Introduction: To examine prevalence and correlates of five mutually exclusive tobacco-use patterns among US youth tobacco users.

Methods: A nationally representative sample of tobacco users (N = 3202, 9-17 years) was classified into five product-use patterns. Weighted multinominal and multivariate logistic regression models were used to examine prevalence of product-use patterns by gender, race and ethnicity, and grade level; and associations between product-use patterns and perceived accessibility of tobacco products, exposure and receptivity to pro-tobacco marketing, social benefits of smoking, and tobacco-associated risks.

Results: Dual use (ie, use of two product categories) was the most prevalent pattern (30.5%), followed by non-cigarette combustible only (26.7%), polytobacco (ie, use of three product categories; 17.5%), cigarette only (14.9%), and noncombustible only (10.4%) use. Product-use patterns differed by gender, race, and ethnicity. Compared to cigarette only users, dual and polytobacco users were more likely to be exposed to and be receptive to pro-tobacco marketing, and were less likely to acknowledge tobacco-use related risks (Ps < .05).

Conclusions: Curbing tobacco use warrants research on users of more than one tobacco-product categories according to the risk-continuum categorization.

Implications: We present a risk-continuum categorization of product-use patterns among tobacco users not older than 17 years. We classify tobacco users into five mutually exclusive product-use patterns: cigarette only users, non-cigarette combustible only users, noncombustible only users, dual use, and polytobacco use. This categorization overcomes limitations in current literature on tobacco-use patterns, which include exclusion of certain products (eg, e-cigarettes) and product-use patterns (eg, exclusive users of non-cigarette products), and inconsistent classification of tobacco users. It is parsimonious yet complex enough to retain differential characteristics of sub-tobacco users based on number (single, dual, polytobacco) and categories (cigarettes, non-cigarette combustibles, noncombustibles) of tobacco products consumed.

MeSH terms

  • Adolescent
  • Adolescent Behavior*
  • Child
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Logistic Models
  • Male
  • Prevalence
  • Risk Factors
  • Smoking / epidemiology*
  • Smoking Prevention
  • Surveys and Questionnaires
  • Tobacco Products / supply & distribution*
  • United States / epidemiology