title: Patterns of Alternative Tobacco Product Use: Emergence of Hookah and E-cigarettes as Preferred Products Amongst Youth.
abstract: OBJECTIVE
  There is a growing public health concern related to the rapid increase in the use of multiple tobacco products among adolescents. This study examined patterns of adolescent use of cigarettes, e-cigarettes, cigars/cigarillo, hookah/waterpipe, and smokeless/dip/chewing tobacco in a population of southern California adolescents.
  
  
  METHODS
  Data from 2,097 11th- and 12th-grade participants in the Southern California Children's Health Study were collected via self-report in 2014. Study participants were asked about lifetime and current (past 30 days) use of cigarettes, cigars/cigarillos/little cigars, e-cigarettes, hookah/waterpipe, and smokeless/dip/chewing tobacco. Latent class analysis (LCA) was used to identify patterns of tobacco use.
  
  
  RESULTS
  Hookah/waterpipe tobacco use had the highest current prevalence (10.7%) followed by e-cigarettes (9.6%). The prevalence of use of smokeless/dip/chewing tobacco was lowest, with 2.2% of adolescents reporting current use. The LCA suggested four distinct classes, comprising nonusers (72.3% of the sample), polytobacco experimenters (13.9%), e-cigarette/hookah users (8.2%), and polytobacco users (5.6%). Multinomial logistic regression based on these four classes found that males had double the odds to be polytobacco users relative to nonusers compared to females (odds ratio, 2.3; 95% confidence interval, 1.26-4.25).
  
  
  CONCLUSIONS
  By identifying naturally occurring configurations of tobacco product use in teens, these findings may be useful to practitioners and policymakers to identify the need for tobacco control interventions that address specific tobacco products and particular combinations of polytobacco use. LCA can be used to identify segments of the population overrepresented among certain tobacco use classes (e.g., boys) that may benefit most from targeted polyproduct intervention approaches.
authors.affiliation: Department of Preventive Medicine, University of Southern California, Los Angeles, California. Electronic address: tgilreat@usc.edu.
authors.forename: Tamika D
authors.initials: TD
authors.lastname: Gilreath
authors.affiliation: Department of Preventive Medicine, University of Southern California, Los Angeles, California.
authors.forename: Adam
authors.initials: A
authors.lastname: Leventhal
authors.affiliation: Department of Preventive Medicine, University of Southern California, Los Angeles, California.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Barrington-Trimis
authors.affiliation: Department of Preventive Medicine, University of Southern California, Los Angeles, California.
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Unger
authors.affiliation: Department of Preventive Medicine, University of Southern California, Los Angeles, California.
authors.forename: Tess Boley
authors.initials: TB
authors.lastname: Cruz
authors.affiliation: Department of Preventive Medicine, University of Southern California, Los Angeles, California.
authors.forename: Kiros
authors.initials: K
authors.lastname: Berhane
authors.affiliation: Department of Preventive Medicine, University of Southern California, Los Angeles, California.
authors.forename: Jimi
authors.initials: J
authors.lastname: Huh
authors.affiliation: Department of Preventive Medicine, University of Southern California, Los Angeles, California.
authors.forename: Robert
authors.initials: R
authors.lastname: Urman
authors.affiliation: Department of Preventive Medicine, University of Southern California, Los Angeles, California.
authors.forename: Kejia
authors.initials: K
authors.lastname: Wang
authors.affiliation: Department of Preventive Medicine, University of Southern California, Los Angeles, California.
authors.forename: Steve
authors.initials: S
authors.lastname: Howland
authors.affiliation: Department of Preventive Medicine, University of Southern California, Los Angeles, California.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Pentz
authors.affiliation: Department of Preventive Medicine, University of Southern California, Los Angeles, California.
authors.forename: Chih Ping
authors.initials: CP
authors.lastname: Chou
authors.affiliation: Department of Preventive Medicine, University of Southern California, Los Angeles, California.
authors.forename: Rob
authors.initials: R
authors.lastname: McConnell
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D002140:California / Q000453:epidemiology; D066300:Electronic Nicotine Delivery Systems / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D057566:Self Report; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology*; D062789:Tobacco Products / Q000706:statistics & numerical data*
keywords: Adolescent; Polytobacco