Multiple Tobacco Product Use Conceptual Framework: A 2021 Update on Evidence

Rubenstein, Dana; Pacek, Lauren R.; McClernon, F. Joseph

doi:10.1093/ntr/ntac032

Cited by 15 publications

(7 citation statements)

References 78 publications

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“…Since past-month EC use may serve as a proxy for “trying” ECs among adults who smoke, this is also consistent with research showing that endorsing family/friends’ approval of ECs is associated with an interest in trying ECs among adults over 45 years. 24 While the current study cannot discern reasons for EC use, and multiple tobacco product use (ie, substitution vs complementarity) 34 is a possibility, results may also indicate that adults may be differentially interested in switching from CC to EC depending on age and social norms.…”

Section: Discussionmentioning

confidence: 73%

Differences in Normative Beliefs and Tobacco Product Use by Age Among Adults Who Smoke: Cross-Sectional Analysis of a Nationally Representative Sample

Rubenstein,

Carroll,

Denlinger-Apte

et al. 2023

Substance Use & Addiction Journal

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Background: The prevalence of combusted cigarette (CC) smoking among older adults is stagnant, with 0 declines attributable to e-cigarette (EC) use. Given that normative beliefs are associated with quitting and switching to ECs, we assessed cross-sectional associations between age, CC, and EC descriptive and injunctive norms and potential interactions with tobacco use behavior. Methods: Data are from people with current, established (≥100 lifetime CCs) CC use (n = 8072) at Wave 5 (2018-2019) of the adult Population Assessment of Tobacco and Health Study. We used adjusted multivariable logistic regressions to model social norms as a function of age (18-24, 25-34, 35-44, 45-54, 55-64, ≥65 years). We also dichotomized age (≥55 vs 18-54) to investigate interactions between age and social norms on past 12-month CC quit attempts and past-month EC use. Results: Older age was positively associated with pro- and anti-CC norms and anti-EC norms. Significant interactive effects revealed that being advised to quit smoking by a healthcare provider was more strongly associated with CC quit attempts among adults ≥55 years (adjusted odds ratio [aOR] [95% CI]: 2.12 [1.66, 2.71]) than adults <55 years (aOR: 1.63 [1.34, 2.00]). Reporting people close to you use ECs was also more strongly associated with EC use among adults ≥55 years (aOR: 4.37 [3.35, 5.69]) than among adults <55 years (aOR: 3.43 [2.89, 4.08]). Conclusions: This study identified modifiable risk factors for tobacco use that may be particularly beneficial for older adults. Behavioral and communication interventions that target normative beliefs may maximize smoking cessation, or harm reduction when cessation is not possible.

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Section: Discussionmentioning

confidence: 73%

Differences in Normative Beliefs and Tobacco Product Use by Age Among Adults Who Smoke: Cross-Sectional Analysis of a Nationally Representative Sample

Rubenstein,

Carroll,

Denlinger-Apte

et al. 2023

Substance Use & Addiction Journal

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“…However, what has previously been classified as “discontinued” use may reflect a differential use pattern. Differential patterns of use can be explained by personal-level factors (i.e., nicotine dependence), person-product level factors (i.e., perceived harm), situational factors (i.e., product availability, social group norms), as well as the dynamic complementarity of the products themselves [ 19 ]. Our consumption taxonomy framework highlights the shifting consumption and dynamic complementarity of LCC-T, LCC-B, large cigar, and cigarette product use among young adults.…”

Section: Discussionmentioning

confidence: 99%

“…Data from Wave 4 of the PATH study indicate that 33% of tobacco-using adults, ages 18 and older, were past 30-day multiple tobacco product users. The dual use of cigarettes and cigarillos was the most commonly reported combustible multiple tobacco use pattern among those adults, with 32.3% dual use of these products [ 19 ]. Moreover, the financial status of some price-sensitive LCC smokers may also influence episodic use among dual- or multi-tobacco product users.…”

Section: Introductionmentioning

confidence: 99%

Tobacco Whack-A-Mole: A Consumption Taxonomy of Cigar & Other Combustible Tobacco Products among a Nationally Representative Sample of Young Adults

Sterling

Masyn

Moore

et al. 2022

IJERPH

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Introduction: Little filtered cigars and cigarillos (LCCs) are consumed infrequently, co-administered with marijuana, and concurrently used with other tobacco products. Reliance on the past 30-day use estimate, a marker of tobacco user status, may underestimate the dynamic nature of intermittent LCC and other tobacco product use. We developed a framework to capture the intermittent nature of exclusive LCC use and dual/poly use with cigarettes and large cigars using broader timing of last product use categories and product use modality (e.g., with marijuana). Methods: Data come from the baseline C’RILLOS study, a U.S. nationally representative sample of young adults aged 18–34 (n = 1063) collected in October 2019. We developed a consumption taxonomy framework that accounted for respondents’ modality of LCC use (i.e., use with tobacco, LCC-T, or use with marijuana as blunts, LCC-B), the exclusive use of LCCs and other tobacco products (i.e., cigarettes, and large cigars) or their co-use and the timing of last product use (i.e., ever and past 30 days, past 3 months, past 6 months, greater than 6 months). Results: Seventy-five percent of our sample reported ever use of any combustible tobacco product, including LCCs. The most common ever use pattern was poly use of LCC-T + LCC-B + cigarettes (16%). Our consumption taxonomy framework demonstrated the fluid nature of combustible tobacco product use among LCC users. For instance, among past 30-day cigarette users, 48% reported using LCC-T, 39% reported using LCC-B, and 32% reported using large cigars in the past 3 months or more. Discussion: The tobacco use field currently classifies ‘tobacco users’ based on the product they smoked in the past 30 days. Any tobacco product use beyond the past 30-day period is considered ‘discontinued use’ and not the focus of intervention or tobacco regulatory science decisions. We documented the substantial proportion of young adult LCC, cigarette, and large cigar users who either exclusively or dual/poly used these combustible products in recent (e.g., past 3 months) periods. To prevent underestimation of use, surveillance measures should assess the use modality, timing of last product use, and exclusive/multiple product use to more accurately identify the smoking status of young adult LCC users.

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“…Since 2014, electronic cigarettes (e-cigarettes) have been the most common tobacco product among youth in the US, with multiple tobacco product use becoming increasingly popular . E-cigarette use has been linked to numerous adverse outcomes, including increased blood pressure, heart rate, air resistance in lungs, and immunomodulatory cytokines production .…”

Section: Introductionmentioning

confidence: 99%

Ocular Symptoms in Adolescents and Young Adults With Electronic Cigarette, Cigarette, and Dual Use

Nguyen,

Gaiha,

Chung

et al. 2023

JAMA Ophthalmol

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ImportanceDespite increasing use of cigarettes and electronic cigarettes (e-cigarettes) and related health effects among youth, few studies have reported their effects on eyes.ObjectiveTo examine the frequency and severity of ocular symptoms (ocular discomfort, pain, burning, itching, redness, dryness, glare, blurriness, strain, and headaches) in young e-cigarette and cigarette users.Design, Setting, and ParticipantsIn an observational cross-sectional study, a survey conducted in May 6 to 14, 2020, asked participants about use (ever, past 30 days, and past 7 days) of e-cigarettes and cigarettes. The participants included US individuals aged 13 to 24 years.Main Outcomes and MeasuresAssociations between vision-related outcomes (general vision, severity/frequency of ocular symptoms) and tobacco use were analyzed using weighted multivariable logistic regressions, adjusting for sociodemographic factors, contact lens use, and other combustible use.ResultsThere were 2168 never users, 2183 ever users, 1092 past 30-day users, and 919 past 7-day users of e-cigarettes; 55.9% of e-cigarette ever users also used cigarettes (dual users). Of the 4351 respondents, 63.8% identified as female, and mean (SD) age was 19.1 (2.9) years. Between 1.1% and 3.9% of ever dual users reported severe to very severe ocular symptoms; between 0.9% and 4.3% reported daily symptoms, which was higher than the proportion of symptoms in e-cigarette- or cigarette-only users. Past 7-day dual users had more severe itching (adjusted odds ratio [AOR], 2.37; 95% CI, 1.36-4.13; P = .002), redness (AOR, 2.58; 95% CI, 1.50-4.46; P = .001), dryness (AOR, 2.89; 95% CI, 1.64-5.08; P &lt; .001), glare (AOR, 2.56; 95% CI, 1.50-4.35; P = .001), blurriness (AOR, 2.47; 95% CI, 1.36-4.50; P = .003), headaches (AOR, 2.31; 95% CI, 1.34-4.00; P = .003); and more frequent pain (AOR, 3.45; 95% CI, 2.09-5.68; P &lt; .001), burning (AOR, 3.08; 95% CI, 1.86-5.09; P &lt; .001), and redness (AOR, 2.72; 95% CI, 1.69-4.36; P &lt; .001) than all other participants. Past 30-day dual users had more severe dryness (AOR, 2.65; 95% CI, 1.61-4.36; P &lt; .001) and more frequent pain (AOR, 3.33; 95% CI, 2.12-5.21; P &lt; .001) than all other participants. Ever dual users experienced more severe dryness (AOR, 1.60; 95% CI, 1.05-2.43; P = .03) and blurriness (AOR, 1.79; 95% CI, 1.21-2.64; P = .003) and more frequent pain (AOR, 1.69; 95% CI, 1.13-2.53; P = .01) and blurriness (AOR, 1.63; 95% CI, 1.13-2.36; P = .009) than never users.Conclusions and RelevanceIn this cross-sectional US study, adolescents and young adult users of both e-cigarettes and cigarettes had a higher likelihood of experiencing severe and frequent ocular symptoms, with past 7-day users reporting more symptoms than past 30-day users or ever users. These findings provide additional reasons for users of e-cigarettes and cigarettes to reduce their tobacco use to possibly prevent or minimize ocular symptoms.

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Multiple Tobacco Product Use Conceptual Framework: A 2021 Update on Evidence

Cited by 15 publications

References 78 publications

Differences in Normative Beliefs and Tobacco Product Use by Age Among Adults Who Smoke: Cross-Sectional Analysis of a Nationally Representative Sample

Differences in Normative Beliefs and Tobacco Product Use by Age Among Adults Who Smoke: Cross-Sectional Analysis of a Nationally Representative Sample

Tobacco Whack-A-Mole: A Consumption Taxonomy of Cigar & Other Combustible Tobacco Products among a Nationally Representative Sample of Young Adults

Ocular Symptoms in Adolescents and Young Adults With Electronic Cigarette, Cigarette, and Dual Use

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