title: Multiple tobacco product use among US adolescents and young adults.
abstract: OBJECTIVE
  To assess the extent to which multiple tobacco product use among adolescents and young adults falls outside current Food and Drug Administration (FDA) regulatory authority.
  
  
  METHODS
  We conducted a web-based survey of 1596 16-26-year-olds to assess use of 11 types of tobacco products. We ascertained current (past 30 days) tobacco product use among 927 respondents who ever used tobacco. Combustible tobacco products included cigarettes, cigars (little filtered, cigarillos, premium) and hookah; non-combustible tobacco products included chew, dip, dissolvables, e-cigarettes, snuff and snus. We then fitted an ordinal logistic regression model to assess demographic and behavioural associations with higher levels of current tobacco product use (single, dual and multiple product use).
  
  
  RESULTS
  Among 448 current tobacco users, 54% were single product users, 25% dual users and 21% multiple users. The largest single use category was cigarettes (49%), followed by hookah (23%), little filtered cigars (17%) and e-cigarettes (5%). Most dual and multiple product users smoked cigarettes, along with little filtered cigars, hookah and e-cigarettes. Forty-six per cent of current single, 84% of dual and 85% of multiple tobacco product users consumed a tobacco product outside FDA regulatory authority. In multivariable analysis, the adjusted risk of multiple tobacco use was higher for males, first use of a non-combustible tobacco product, high sensation seeking respondents and declined for each additional year of age that tobacco initiation was delayed.
  
  
  CONCLUSIONS
  Nearly half of current adolescent and young adult tobacco users in this study engaged in dual and multiple tobacco product use; the majority of them used products that fall outside current FDA regulatory authority. This study supports FDA deeming of these products and their incorporation into the national media campaign to address youth tobacco use.
authors.affiliation: Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA.
authors.forename: Samir
authors.initials: S
authors.lastname: Soneji
authors.affiliation: Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA.
authors.forename: James
authors.initials: J
authors.lastname: Sargent
authors.affiliation: Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA.
authors.forename: Susanne
authors.initials: S
authors.lastname: Tanski
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000328:Adult; D000367:Age Factors; D066300:Electronic Nicotine Delivery Systems; D005260:Female; D033161:Government Regulation; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology* / Q000331:legislation & jurisprudence / Q000523:psychology; D000074606:Smoking Prevention; D011795:Surveys and Questionnaires; D062789:Tobacco Products / Q000331:legislation & jurisprudence; D014030:Tobacco, Smokeless; D014481:United States / Q000453:epidemiology; D014486:United States Food and Drug Administration; D055815:Young Adult
keywords: Electronic nicotine delivery devices; Health Services; Non-cigarette tobacco products; Public policy