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. 2018 Nov 9;15(11):2515.
doi: 10.3390/ijerph15112515.

Transitions in Tobacco Product Use by U.S. Adults Between 2013⁻2014 and 2014⁻2015: Findings From the PATH Study Wave 1 and Wave 2

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Transitions in Tobacco Product Use by U.S. Adults Between 2013⁻2014 and 2014⁻2015: Findings From the PATH Study Wave 1 and Wave 2

Karin A Kasza et al. Int J Environ Res Public Health. .
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Abstract

In 2013⁻2014, nearly 28% of adults in the United States (U.S.) were current tobacco users with cigarettes the most common product used and with nearly 40% of tobacco users using two or more tobacco products. We describe overall change in prevalence of tobacco product use and within-person transitions in tobacco product use in the U.S. between 2013⁻2014 and 2014⁻2015 for young adults (18⁻24 years) and older adults (25+ years). Data from Wave 1 (W1, 2013⁻2014) and Wave 2 (W2, 2014⁻2015) of the Population Assessment of Tobacco and Health (PATH) Study were analyzed (N = 34,235). Tobacco product types were categorized into: (1) combustible (cigarettes, cigars, pipe tobacco, hookah), (2) noncombustible (smokeless tobacco, snus pouches, dissolvable tobacco), and (3) electronic nicotine delivery systems (ENDS). Transitions for individual combustible-product types, and for single- and multiple-product use, were also considered. Overall prevalence of current tobacco use decreased from 27.6% to 26.3%. Among W1 non-tobacco users, 88.7% of young adults and 95.8% of older adults were non-tobacco users at W2. Among W1 tobacco users, 71.7% of young adults transitioned, with 20.7% discontinuing use completely, and 45.9% of older adults transitioned, with 12.5% discontinuing use completely. Continuing with/transitioning toward combustible product(s), particularly cigarettes, was more common than continuing with/transitioning toward ENDS. Tobacco use behaviors were less stable among young adults than older adults, likely reflecting greater product experimentation among young adults. Relative stability of cigarette use compared to other tobacco products (except older adult noncombustible use) demonstrates high abuse liability for cigarettes.

Keywords: cigarettes; cigars; electronic nicotine delivery systems (ENDS); epidemiology; hookah; longitudinal; population; smokeless tobacco; tobacco; transition.

Conflict of interest statement

Compton reports long-term stock holdings in General Electric, the 3M Companies, and Pfizer Incorporated, unrelated to this manuscript; Cummings has received grant funding from Pfizer, Inc., to study the impact of a hospital-based tobacco cessation intervention. Cummings also receives funding as an expert witness in litigation filed against the tobacco industry; Goniewicz receives fees for serving on an advisory board from Johnson & Johnson and grant support from Pfizer outside of the submitted work; Niaura reports having been a witness for plaintiffs vs. tobacco companies, receiving speaker fees, receiving honoraria, sitting on advisory boards, being a site PI, and consulting for pharmaceutical company testing and marketing smoking cessation aids, but not in the last six years. Fong has a Senior Investigator Award from the Ontario Institute for Cancer Research and Prevention Scientist Award from the Canadian Cancer Society Research Institute. Conway reports preparing this article while employed at the NIH/National Institute on Drug Abuse. No other potential conflict of interest relevant to this manuscript was reported.

Figures

Figure 1
Figure 1
Transitions in current tobacco product use among young adults (aged 18-24 years) and older adults (aged 25+ years) in the United States: 2013–2014 to 2014–2015. Notes. Each bar in the figure represents a mutually exclusive tobacco product user group at Wave 1 (W1). N underneath each bar indicates the weighted population size for each tobacco product user group at W1 (i.e., the scale of the y-axis differs across bars). For each tobacco product user group at W1, transitions between W1 and Wave 2 (W2) are indicated by the colored distribution of each bar; for example, among the 18,887,580 young adult No tobacco users at W1, 89% continued No tobacco use at W2 and 6% transitioned to Combustible only use at W2. Current tobacco use defined as: for cigarettes, currently using everyday/somedays and smoked at least 100 cigarettes in lifetime; for hookah, currently using everyday/somedays/usually weekly/usually monthly; for all other products, currently using everyday/somedays. ‘Combustible’ includes cigarettes, traditional cigars, cigarillos, filtered cigars, hookah, pipe tobacco; ‘noncombustible’ includes smokeless tobacco, snus pouches, dissolvable tobacco; ‘ENDS’ includes e-cigarettes at each wave and e-products at W2. ‘No tobacco’ defined as no current use of any tobacco product. Estimates are suppressed when unweighted denominator <50 or RSE>30%; all estimates for ‘Noncombustible + ENDS’ are suppressed. Non-suppressed estimates <3 are not shown in the figure (for readability) but are shown in the appendix.
Figure 2
Figure 2
Transitions in current cigarette use among young adults (aged 18–24 years) and older adults (aged 25+ years) in the United States: 2013–2014 to 2014–2015. Notes. Each bar in the figure represents a cigarette user group at Wave 1 (W1). N underneath each bar indicates the weighted population size for each cigarette user group at W1 (i.e., the scale of the y-axis differs across bars). Transitions between W1 and Wave 2 (W2) are indicated by the colored distribution of each bar; for example, among the 2,045,798 young adult Cigarette only users at W1, 11% transitioned to No tobacco use at W2, 60% continued Cigarettes only use at W2, and 26% transitioned to Cigarettes plus use at W2. Current tobacco use defined as: for cigarettes, currently using everyday/somedays and smoked at least 100 cigarettes in lifetime; for hookah, currently using everyday/somedays/usually weekly/usually monthly; for all other products, currently using everyday/somedays. Single/multiple-product use defined with respect to the following six product types: cigarettes, cigars, hookah, pipe, noncombustible (i.e., smokeless tobacco, snus pouches, dissolvable tobacco), ENDS (which includes e-cigarettes at each wave and e-products at W2). ‘Cigarettes only’ defined as current use of cigarettes and no current use of any other product, ‘Cigarettes plus’ defined as current use of cigarettes plus current use of at least one other product, ‘Cigars only’ defined as current use of cigars and no current use of any other product, ‘Hookah only’ defined as current use of hookah and no current use of any other product, ‘Noncombustible only’ defined as current use of noncombustible and no current use of any other product, ‘ENDS only’ defined as current use of ENDS and no current use of any other product, ‘Non-cigarette multiple-product’ defined as current use of at least two product types excluding cigarettes, ‘No tobacco’ defined as no current use of any tobacco product. Estimates are suppressed when unweighted denominator <50 or RSE>30%. Non-suppressed estimates <3 are not shown in the figure (for readability) but are shown in the appendix.

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