title: Youth tobacco product use in the United States.
abstract: BACKGROUND
  Noncigarette tobacco products are increasingly popular among youth, especially cigarette smokers. Understanding multiple tobacco product use is necessary to assess the effects of tobacco products on population health. This study examines multiple tobacco product use and associated risk factors among US youth.
  
  
  METHODS
  Estimates of current use were calculated for cigarettes, cigars, smokeless tobacco, hookah, e-cigarettes, pipes, bidis, kreteks, snus, and dissolvable tobacco by using data from the 2012 National Youth Tobacco Survey (n = 24 658), a nationally representative sample of US middle and high school students. Associations between use patterns and demographic characteristics were examined by using multinomial logistic regression.
  
  
  RESULTS
  Among youth, 14.7% currently use 1 or more tobacco products. Of these, 2.8% use cigarettes exclusively, and 4% use 1 noncigarette product exclusively; 2.7% use cigarettes with another product (dual use), and 4.3% use 3 or more products (polytobacco use). Twice as many youth use e-cigarettes alone than dual use with cigarettes. Among smokers, polytobacco use was significantly associated with male gender (adjusted relative risk ratio [aRRR] = 3.71), by using flavored products (aRRR = 6.09), nicotine dependence (aRRR = 1.91), tobacco marketing receptivity (aRRR = 2.52), and perceived prevalence of peer use of tobacco products (aRRR = 3.61, 5.73).
  
  
  CONCLUSIONS
  More than twice as many youth in the United States currently use 2 or more tobacco products than cigarettes alone. Continued monitoring of tobacco use patterns is warranted, especially for e-cigarettes. Youth rates of multiple product use involving combustible products underscore needs for research assessing potential harms associated with these patterns.
authors: RTI International, Public Health Research Division, Research Triangle Park, North Carolina younlee@rti.org.
authors: Youn Ok
authors: YO
authors: Lee
authors: RTI International, Public Health Research Division, Research Triangle Park, North Carolina.
authors: Christine J
authors: CJ
authors: Hebert
authors: RTI International, Public Health Research Division, Research Triangle Park, North Carolina.
authors: James M
authors: JM
authors: Nonnemaker
authors: RTI International, Public Health Research Division, Research Triangle Park, North Carolina.
authors: Annice E
authors: AE
authors: Kim
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D016017:Odds Ratio; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D013334:Students / Q000706:statistics & numerical data*; D062789:Tobacco Products / Q000706:statistics & numerical data*; D064424:Tobacco Use / Q000453:epidemiology*; D014029:Tobacco Use Disorder / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology
keywords: bidis; cigarette smoking; cigars; dissolvable tobacco; electronic cigarettes; hookah; kreteks; pipes; smokeless tobacco; snus