Sociodemographic Patterns of Exclusive, Dual, and Polytobacco Use Among U.S. High School Students: A Comparison of Three Nationally Representative Surveys

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The use of electronic nicotine delivery systems (ENDS) among youth in the United States has increased rapidly in the past decade. Simultaneously, while youth cigarette smoking has declined considerably, youth are still more likely to use menthol cigarettes than any other age group. We used nationally representative data on 15–17-year-olds from the Population Assessment of Tobacco and Health (PATH) Study and the National Youth Tobacco Survey (NYTS) (2013–2017) to better understand current cigarette (by menthol flavoring) and ENDS use in the US. We calculated weighted population prevalence estimates across years for multiple patterns of current cigarette and ENDS use (i.e., exclusive menthol cigarette, exclusive non-menthol cigarette, exclusive ENDS, dual ENDS and menthol cigarette, and dual ENDS and non-menthol cigarette) by sex, race/ethnicity, parental education level, household income, and homeownership. Overall, both exclusive menthol and non-menthol cigarette use declined from 2013–2017. Exclusive ENDS use increased, particularly among youth who were non-Hispanic White or had a higher socioeconomic status (measured by parental education, household income, and homeownership). Dual use of ENDS with either menthol or non-menthol cigarettes did not change significantly. Monitoring changes in these sociodemographic patterns will help inform future youth tobacco prevention strategies.

Section: Discussionsupporting

confidence: 92%

Sociodemographic Patterns of Exclusive and Dual Use of ENDS and Menthol/Non-Menthol Cigarettes among US Youth (Ages 15–17) Using Two Nationally Representative Surveys (2013–2017)

Patel

Hirschtick

Cook

et al. 2021

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“…This is consistent with the current literature finding that White high school students often report earlier initiation of alcohol use [ 32 , 46 ]. Similarly, data from nationally representative surveys found that Non-Hispanic White youth were more likely to initiate e-cigarette use, and had higher prevalence of exclusive, dual and poly tobacco use than youth of other racial/ethnic groups [ 47 , 48 ], which is in line with our findings. However, studies have not successfully documented possible reasons as to why this racial/ethnic difference occurs in e-cigarette use [ 49 , 50 ].…”

Section: Discussionsupporting

confidence: 91%

Age of Initiation of Dual Tobacco Use and Binge Drinking among Youth (12–17 Years Old): Findings from the Population Assessment of Tobacco and Health (PATH) Study

Pérez

Kuk

Bluestein

et al. 2021

Earlier exposure to binge drinking and tobacco use is associated with higher odds of substance use disorders. Using national youth data from the PATH study, we prospectively estimate the age of initiating past 30-day use of (1) cigarettes, e-cigarettes, and binge drinking, and (2) cigarettes, cigarillos, and binge drinking. Cox proportional hazard models were used to estimate differences in the age of initiation by sex, race/ethnicity, and previous use of other tobacco products. By age 21, 4.4% (95% CI: 3.7–5.2) and 2.0% (95% CI: 1.2–2.8) of youth reported initiation of past 30-day use outcomes (1) and (2), respectively. After controlling for sex and previous use of other tobacco products, statistically significant differences in the age of initiation by race/ethnicity were found for each outcome: Hispanic and non-Hispanic Black youth were less likely than non-Hispanic White youth to initiate past 30-day use of both outcomes (1) and (2) at earlier ages. Although the initiation of both outcomes remained relatively low by age 21, these incidences represent 1.56 million and 700,000 youth, respectively. This study provides the public with evidence to identify the particular ages at which education campaigns may be most effective to prevent youth from initiating these three substances. Further research is needed to estimate the age of initiation of other dual tobacco use patterns with binge drinking.

“…Studies have shown slight sociodemographic differences among adolescents who exclusively use e-cigarettes versus combustible tobacco products. While male adolescents are more likely than females to use e-cigarettes exclusively [ 12 , 13 ], studies have shown comparable rates of exclusive combustible tobacco product use among males and females [ 4 , 12 ]. Unlike exclusive e-cigarette use, which is more common among non-Hispanic White adolescents compared to racial/ethnic minority adolescents, non-Hispanic Black adolescents are more likely to use combustible tobacco [ 2 , 4 ] when compared to non-Hispanic White adolescents.…”

Section: Introductionmentioning

confidence: 99%

“…Adolescents who use e-cigarettes exclusively are also more likely to have a higher socioeconomic status (SES), while adolescents who exclusively use combustible tobacco products are more likely to have a lower SES. On the other hand, there are sociodemographic similarities among adolescents who use e-cigarettes exclusively and those who use e-cigarettes and combustible tobacco products (dual use) [ 12 , 13 ]. These adolescents are more likely to be male than female, non-Hispanic White than a racial/ethnic minority, and have more highly-educated parents than less-educated parents [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Sociodemographic Patterns of Exclusive and Dual Combustible Tobacco and E-Cigarette Use among US Adolescents—A Nationally Representative Study (2017–2020)

Usidame

Hirschtick

Mattingly

et al. 2022

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This study assessed the sociodemographic predictors of exclusive and dual use of the most frequently used nicotine/tobacco products, e-cigarettes, and combustible tobacco among adolescents. Cross-sectional data was from the 2017–2020 Monitoring the Future nationally representative study of eighth, tenth, and twelfth-grade students. We coded past 30 day nicotine/tobacco use into four mutually exclusive categories: no use, e-cigarette use only, combustible use (cigarette or cigar) only, and dual use (e-cigarette and combustible). We pooled the 2017–2020 data to examine the relationship between sex, race/ethnicity, parental education, and each product-use category using multinomial logistic regression, stratified by grade level. Among eighth (N = 11,189), tenth (N = 12,882), and twelfth graders (N = 11,385), exclusive e-cigarette use was the most prevalent pattern (6.4%, 13.2%, 13.8%, respectively), followed by dual use (2.7%, 4.5%, 8.9%), and exclusive combustible use (1.5%, 2.5%, 5.3%). eighth and tenth-grade adolescents whose highest parental education was a 4-year college degree or more had lower odds of exclusive combustible and dual use when compared to adolescents whose highest parental education was less than a high school degree. Research should continue to monitor the differential use of combustible tobacco products and e-cigarettes among adolescents from low socioeconomic status backgrounds or racial/ethnic minority households to inform ongoing and future interventions or policies.