Background Susceptibility to tobacco use predicts tobacco use onset among youth. The current study aimed to estimate the extent of overlap in susceptibilities across various tobacco products, investigate sociopsychological correlates with susceptibilities, and examine whether the relationship linking susceptibility with the onset of use is product-specific or is accounted for by a general susceptibility-onset relationship. Methods The study population consisted of US youth 12–17 years old who had never used a tobacco product, sampled in the longitudinal Population Assessment of Tobacco and Health study wave 4 (Dec. 2016-Jan. 2018; n = 10,977). Tobacco product-specific susceptibility at wave 4 was assessed via questions about curiosity, likelihood to try, and likelihood of use if a best friend offered. The onset of use of various tobacco products was defined as first use occurring between the wave 4 and wave 4.5 (Dec. 2017-Dec. 2018) assessments (n = 8841). Generalized linear regression and structural equation models were used for data analysis. Results There is a large degree of overlap in susceptibilities across tobacco products (65% of tobacco-susceptible youth were susceptible to more than one tobacco product). Tobacco-susceptible youths were more likely to have recently used cannabis, consumed alcohol, or to have been associated with tobacco-using peers. Structural equation models suggest that the susceptibility-onset relationship largely operates in a non-product-specific manner after accounting for the general susceptibility-to-tobacco-onset relationship. Conclusions Youth susceptibility to tobacco use overlaps widely across different tobacco products and other risky behaviors. Findings from this study support a holistic approach towards the prevention of risk behaviors, supplemented by product-specific strategies when needed.

Importance: Susceptibility to tobacco use can help identify youth that are at risk for tobacco use. Objective: To estimate the extent of overlap in susceptibilities across various tobacco products, investigate correlates with susceptibilities, and examine whether the relationship linking susceptibility with the onset of use is product specific or is accounted for by a general susceptibility-onset relationship. Design: Prospective cohort study. Setting: Analysis of data from the longitudinal Population Assessment of Tobacco and Health study wave 4 (December 2016 to January 2018) and wave 4.5 youth surveys (December 2017 to November 2018). Participants: A nationally representative sample of non-institutionalized youth 12-17 years old who had never used a tobacco product at baseline assessment. Main variable of interest: Susceptibility to the use of each type of tobacco product assessed at wave 4. Main outcomes: Onset of use of various tobacco products defined as the first use occurring between waves 4 and 4.5 assessments. Results: Cigarettes and e-cigarettes were the most common (~25%), while snus was the least common (<5%), tobacco product to which youth were susceptible. There was a high degree of overlap in susceptibilities across tobacco products (65% of tobacco-susceptible youth were susceptible to more than one tobacco product). Tobacco-susceptible youth were more likely to have used cannabis or consumed alcohol in the past 30 days or to have tobacco-using peers. Susceptibility to use predicted the onset of use (incidence ratio = 3.2 to 12.9). Estimates for the product-specific path were null, except for e-cigarettes (β=0.08, 95% CI=0.04 to 0.13) and filtered cigars (β= -0.09, 95% CI= -0.13 to -0.05), after accounting for the general susceptibility-to-tobacco-onset relationship (β=0.50, 95% CI=0.42 to 0.58). Conclusions and Relevance: Youth susceptibility to tobacco use overlaps widely across different tobacco products and other risky behaviors. Public health efforts may benefit from a holistic approach to risk behavior prevention planning.