Patterns of youth tobacco and polytobacco usage: The shift to alternative tobacco products

Am J Drug Alcohol Abuse. 2017 Nov;43(6):694-702. doi: 10.1080/00952990.2016.1225072. Epub 2016 Sep 26.


Background: Despite significant declines in youth cigarette smoking, overall tobacco usage remains over 20% as non-cigarette tobacco product usage is increasingly common and polytobacco use (using 1+ tobacco product) remains steady.

Objectives: The present study was designed to identify patterns of youth tobacco use and examine associations with sociodemographic characteristics and tobacco dependence.

Methods: The current analysis uses Latent Class Analysis (LCA) to examine the 6,958 tobacco users (n = 2,738 female) in the National Youth Tobacco Survey (2012 and 2013). We used as indicators past month use of tobacco products (cigarettes, cigars, smokeless tobacco, e-cigarettes, hookah, snus, pipes, bidis, and kreteks) and regressed resulting classes on sociodemographic characteristics and tobacco dependence.

Results: Nine classes emerged: cigarette smokers (33.4% of sample, also included small probabilities for use of cigars and e-cigarettes), cigar smokers (16.8%, nearly exclusive), smokeless tobacco users (12.3%, also included small probabilities for cigarettes, cigars, snus), hookah smokers (11.8%), tobacco smokers/chewers (10.7%, variety of primarily traditional tobacco products), tobacco/hookah smokers (7.2%), tobacco/snus/e-cig users (3.3%), e-cigarette users (2.9%,), and polytobacco users (1.7%, high probabilities for all products). Compared to cigarette smokers, tobacco/hookah smokers and hookah smokers were more likely to report Hispanic ethnicity. Polytobacco users were more likely to report dependence (AOR:2.77, 95% CI:[1.49-5.18]), whereas e-cigarette users were less likely (AOR:0.49, 95% CI:[0.24-0.97]).

Conclusion: Findings are consistent with other research demonstrating shifts in adolescent tobacco product usage towards non-cigarette tobacco products. Continuous monitoring of these patterns is needed to help predict if this shift will ultimately result in improved public health.

Keywords: Non-cigarette tobacco products; addiction; co-substance use; electronic nicotine delivery systems; priority/special populations.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adolescent Behavior / psychology*
  • Child
  • Female
  • Humans
  • Male
  • Risk Factors
  • Surveys and Questionnaires
  • Tobacco Products / statistics & numerical data*
  • Tobacco Use / epidemiology*
  • Tobacco Use / psychology*
  • Tobacco Use Disorder / epidemiology
  • United States / epidemiology
  • Young Adult