title: Dual Trajectories of Cigarette Smoking and Smokeless Tobacco Use From Adolescence to Midlife Among Males in a Midwestern US Community Sample.
abstract: BACKGROUND
  Identifying trajectories of tobacco use is critical for understanding its natural history and targeting interventions, but research on trajectories of smokeless tobacco and dual use of smokeless tobacco and cigarettes is very limited. This study identified tobacco use trajectories from adolescence to midlife and tested correlates of trajectory group membership.
  
  
  METHODS
  This study included all male participants in a longitudinal study who reported cigarette smoking or smokeless tobacco use in 1987, 1993, 1999, 2005, or 2011 (N = 2230). Group-based trajectory analyses were conducted with zero-inflated Poisson models. Analysis of covariance was used to test adolescent health beliefs associated with trajectory group membership.
  
  
  RESULTS
  Five smoking trajectory groups were identified: (1) consistent abstinence from cigarettes; (2) late onset intermittent, then cessation; (3) early onset regular, then cessation; (4) delayed onset regular, then cessation; and (5) consistent regular. Four smokeless tobacco trajectory groups were identified: (1) early onset, then cessation; (2) consistent abstinence from smokeless tobacco; (3) late onset, escalating; and (4) consistent regular. The proportion of participants in trajectory groups representing dual use was low. Adolescent beliefs favorable to smoking and smokeless tobacco were associated with membership in consistent regular use groups.
  
  
  CONCLUSIONS
  The prevalence of dual use of cigarettes and smokeless tobacco was low, and there was little evidence to suggest switching between tobacco products. Participants who held more positive beliefs about smoking and smokeless tobacco as adolescents were more likely to be consistent regular users of cigarettes and smokeless tobacco into adulthood.
authors.affiliation: Department of Applied Health Science, Indiana University School of Public Health, Bloomington, IN; jtmacy@indiana.edu.
authors.forename: Jonathan T
authors.initials: JT
authors.lastname: Macy
authors.affiliation: Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, IN;
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, IN;
authors.forename: Pengcheng
authors.initials: P
authors.lastname: Xun
authors.affiliation: Department of Psychology, Arizona State University, Tempe, AZ.
authors.forename: Clark C
authors.initials: CC
authors.lastname: Presson
authors.affiliation: Department of Psychology, Arizona State University, Tempe, AZ.
authors.forename: Laurie
authors.initials: L
authors.lastname: Chassin
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D015146:Midwestern United States / Q000453:epidemiology; D015995:Prevalence; D012111:Residence Characteristics; D012907:Smoking / Q000453:epidemiology / Q000639:trends*; D014030:Tobacco, Smokeless / Q000706:statistics & numerical data*; D055815:Young Adult
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