title: Adult Cigarette Smokers at Highest Risk for Concurrent Alternative Tobacco Product Use Among a Racially/Ethnically and Socioeconomically Diverse Sample.
abstract: BACKGROUND
  Rates of alternative tobacco product use (ATPs; eg, cigars, cigarillos, pipes) among cigarette smokers are on the rise but little is known about the subgroups at highest risk. This study explored interactions between demographic, tobacco, and psychosocial factors to identify cigarette smokers at highest risk for ATP use from a racially/ethnically and socioeconomically diverse sample of adult smokers across the full smoking spectrum (nondaily, daily light, daily heavy).
  
  
  METHODS
  Two-thousand three-hundred seventy-six adult cigarette smokers participated in an online cross-sectional survey. Quotas ensured equal recruitment of African American (AA), white (W), Hispanic/Latino (H) as well as daily and nondaily smokers. Classification and Regression Tree modeling was used to identify subgroups of cigarette smokers at highest risk for ATP use.
  
  
  RESULTS
  51.3% were Cig+ATP smokers. Alcohol for men and age, race/ethnicity, and discrimination for women increased the probability of ATP use. Strikingly, 73.5% of men screening positive for moderate to heavy drinking and 62.2% of younger (≤45 years) African American/Hispanic/Latino women who experienced regular discrimination were Cig+ATP smokers.
  
  
  CONCLUSIONS
  Screening for concurrent ATP use is necessary for the continued success of tobacco cessation efforts especially among male alcohol users and racial/ethnic minority women who are at greatest risk for ATP use.
authors.affiliation: Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Kansas City, KS; nnollen@kumc.edu.
authors.forename: Nicole L
authors.initials: NL
authors.lastname: Nollen
authors.affiliation: Department of Epidemiology, Rutgers School of Public Health, Piscataway, NJ;
authors.forename: Jasjit S
authors.initials: JS
authors.lastname: Ahluwalia
authors.affiliation: Department of Biostatistics, University of Kansas School of Medicine, Kansas City, KS.
authors.forename: Yang
authors.initials: Y
authors.lastname: Lei
authors.affiliation: Department of Biostatistics, University of Kansas School of Medicine, Kansas City, KS.
authors.forename: Qing
authors.initials: Q
authors.lastname: Yu
authors.affiliation: Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Kansas City, KS;
authors.forename: Taneisha S
authors.initials: TS
authors.lastname: Scheuermann
authors.affiliation: Department of Biostatistics, University of Kansas School of Medicine, Kansas City, KS.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Mayo
mesh_terms: D000328:Adult; D001741:Black or African American / Q000208:ethnology / Q000523:psychology; D003430:Cross-Sectional Studies; D005006:Ethnicity / Q000523:psychology; D005260:Female; D006630:Hispanic or Latino / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D044469:Racial Groups / Q000208:ethnology* / Q000523:psychology; D012307:Risk Factors; D012907:Smoking / Q000208:ethnology* / Q000523:psychology; D016540:Smoking Cessation / Q000208:ethnology* / Q000523:psychology; D012959:Socioeconomic Factors; D062789:Tobacco Products / Q000191:economics*; D014029:Tobacco Use Disorder / Q000208:ethnology / Q000523:psychology; D044465:White People / Q000208:ethnology / Q000523:psychology; D055815:Young Adult