First tobacco product tried: Associations with smoking status and demographics among college students

Abstract

Introduction As the tobacco market expands, so too have the opportunities for youth to be introduced to nicotine. The goal of this study was to identify product choice for initial tobacco trial, correlates associated with product choice, and the relationship between first product and current cigarette smoking among college students. Methods A cross-sectional web survey of 3,146 first-year students at 11 universities in North Carolina and Virginia was conducted in fall 2010. Results Weighted prevalence of ever use of tobacco was 48.6%. Cigarettes were the most common first product (37.9%), followed by cigars (29.3%), hookahs (24.6%), smokeless tobacco (6.1%), and bidis/kreteks (2.2%). Two thirds (65%) of current smokers initiated with cigarettes, but 16.4% started with cigars, 11.1% with hookahs, 5.7% with smokeless, and 1.7% with bidis/kreteks. Females were more likely to report their first product was cigarettes and hookahs, while males were more likely to start with cigars and smokeless tobacco. Compared to those whose first product trial occurred after the age of 18, younger age of initiation (17 years or younger) was associated with cigarettes and smokeless as first products, while older age of initiation (18 or older) was associated with starting with hookahs and cigars. Dual or poly tobacco use was more common among those who initiated with hookahs and smokeless tobacco. Conclusions While over a third of students used cigarettes first, two thirds started with a non-cigarette product. Just about a third of current cigarette smokers initiated with a non-cigarette product, suggesting that those non-cigarette products may have facilitated escalation to cigarettes.

Initial use of tobacco or marijuana and later use profiles in young adults

“…Other research has indicated that first using cigarettes increased the likelihood of initiating marijuana by four times 17 . Additionally, those who initiated with smokeless tobacco were twice more likely to initiate cigarettes and more likely to be dual or poly tobacco users 15 . Other studies have documented that experimenting with various products is related to increased risk for other substance use.…”

“…Additionally, 2012 National Youth Tobacco Survey data indicated that 20.3% of middle school students and 7.2% of high school students reported using e-cigarettes as their first tobacco product 14 . A 2015 cross-sectional study of 3146 college students found that 38% chose cigarettes as their first product, 29% chose cigars, 6% smokeless tobacco, and 25% hookah (with no one reporting e-cigarettes as first product used) 15 . A 2013 study of New York undergraduate students reported that hookah was the first tobacco product used by 25.4% of ever tobacco users and 50% of never cigarette smokers 16 .…”

“…With regard to the second question, i.e. profiles of subsequent substance use, Suftin et al 15 found that those who initiated with cigarettes or cigar products were more likely to be current cigarette smokers compared to those who initiated with ATPs 15 . Other research has indicated that first using cigarettes increased the likelihood of initiating marijuana by four times 17 .…”

“…Cessation 2020;6(March):16 https://doi.org/10.18332/tpc/117070 indicated higher odds of using cigarettes first among those aged <17 years, females, Hispanics/Latinos, and those of lower socioeconomic status (SES), relative to their counterparts 15,23 . Cigars and LCCs as first products used have been associated with being male and younger at initiation 15,24 . Smokeless tobacco and e-cigarettes as first products used are also associated with being male and White 14 .…”

“…Smokeless tobacco and e-cigarettes as first products used are also associated with being male and White 14 . Choosing hookah as first product has been related to being female, Black, and higher SES 15,16,23 . Regarding marijuana, there is limited literature on prevalence and correlates of marijuana being first used; however, 2017 data indicate that 6.8% of adolescents had used marijuana before the age of 13 years 25 .…”