Patterns of Tobacco Product Use and Correlates Among Adults in the Population Assessment of Tobacco and Health (PATH) Study: A Latent Class Analysis

Abstract

IntroductionAs the tobacco industry and market evolves, there is a growing need to understand the patterns of use of tobacco products and how they relate to demographics, dependency, withdrawal, and quit behavior.MethodsWe analyzed data from wave 1 of the PATH Study consisting of 14856 individuals. Current users were defined as consuming at least 1 of 10 tobacco products. We performed a latent class analysis (LCA) to identify patterns of tobacco use. We used multinomial regression analysis to explore the association between these patterns with covariates representing socioeconomic status dependence/addiction, past quit attempts, and withdrawal severity.ResultsWe identified four groups of current tobacco users with distinct profiles: (1) 61% of the sample were identified as cigarette-only users; (2) 9% were smokeless tobacco users; (3) 17% of the sample were characterized by being current users of all types of combustible tobacco including cigars, cigarillos, filtered cigars, and smoking a pipe (4) finally, 13% were e-cig and hookah users. All classes also shared a varying frequency of cigarette use. Exclusive cigarette users were more likely to be older and female, and experienced higher dependency and withdrawal. Users of e-cigs and hookah were the younger, most educated of all four subgroups, and presented the lowest dependency and withdrawal among the four groups.ConclusionsFDA policy makers may want to discourage the use of tobacco products associated with higher tobacco dependency, and products that may contribute to experiencing higher levels of withdrawal symptoms by the user when trying to quit.ImplicationsWe identified four patterns of tobacco product use that are significantly related to demographic characteristics, dependency, and withdrawal. Policies should target users more likely to use tobacco products that increase dependency and withdrawal, making quitting more difficult.

Patterns and Correlates of Multiple Tobacco Product Use in the United States

“… 25 In contrast, users of e-cigarettes and hookah were the youngest and most educated of all four use groups and showed the lowest dependency and least withdrawal symptoms. 25 Sung et al analyzed patterns of tobacco use and dependence items from 2012 to 2013 and 2013 to 2014 of the National Adult Tobacco Surveys and found that after controlling for frequency of use and demographic covariates, dependence ratings were higher among polytobacco users compared with exclusive tobacco users and this finding was consistent across all symptom measures for each category of tobacco user. 26 Focusing on the products themselves, Reilly et al examined two brands each of little cigars and filtered cigars, as well as two research cigarettes for carbonyl delivery and found that cigar smokers are exposed to higher levels of carbonyls per cigar than cigarette smokers per cigarette.…”

“…Analyzing Wave 1 PATH Study data, Kypriotakis et al performed Latent Class Analysis (LCA) to identify four patterns of tobacco use and examined the association between these patterns with a set of covariates representing socioeconomic status, dependence/addiction, past quit attempts, and withdrawal severity. 25 Results showed that exclusive cigarette users were more likely to be older and female, and experience higher dependence and greater withdrawal symptoms. 25 In contrast, users of e-cigarettes and hookah were the youngest and most educated of all four use groups and showed the lowest dependency and least withdrawal symptoms.…”

“… 25 Results showed that exclusive cigarette users were more likely to be older and female, and experience higher dependence and greater withdrawal symptoms. 25 In contrast, users of e-cigarettes and hookah were the youngest and most educated of all four use groups and showed the lowest dependency and least withdrawal symptoms. 25 Sung et al analyzed patterns of tobacco use and dependence items from 2012 to 2013 and 2013 to 2014 of the National Adult Tobacco Surveys and found that after controlling for frequency of use and demographic covariates, dependence ratings were higher among polytobacco users compared with exclusive tobacco users and this finding was consistent across all symptom measures for each category of tobacco user.…”

“… 18 , 20–23 , 26 Four other papers used different time-based ranges, one looking at past-week cigarillo and cigarette use, 16 one looking at past 6-month use of cigarettes, e-cigarettes, and hookah, 19 and the other two papers defined polytobacco use as currently using more than one product every day or some days. 24 , 25 The remaining two papers do not fit into these categories as one does not define use because they studied the products themselves 27 and the other used ecological momentary assessment methods to assess frequency (days smoked) and amount (products smoked per day). 17 As definitions and analytic approaches evolve, results across studies should reveal whether definitions such as concurrent past 30-day use are the most appropriate measures to fully understand the impact of polytobacco use on nicotine dependence, smoking cessation, individual-level health effects, and net population health impact.…”

What influences demand for cigars among African American adult cigar smokers? Results from a hypothetical purchase task.

“…Further, AA are more likely to be poly-tobacco users (Kong et al, 2019; Mead et al, 2018) and co-use of cigarillos and cannabis is more frequent than using tobacco alone (Montgomery, 2015). These co-use patterns may compound the negative consequences of cigar smoking among AA and contribute to disproportionate disease burden (Cohn et al, 2015; Kypriotakis et al, 2018).…”