title: A Risk-Continuum Categorization of Product Use Among US Youth Tobacco Users.
abstract: To examine prevalence and correlates of five mutually exclusive tobacco-use patterns among US youth tobacco users.
  
  
  
  A nationally representative sample of tobacco users (N = 3202, 9-17 years) was classified into five product-use patterns. Weighted multinominal and multivariate logistic regression models were used to examine prevalence of product-use patterns by gender, race and ethnicity, and grade level; and associations between product-use patterns and perceived accessibility of tobacco products, exposure and receptivity to pro-tobacco marketing, social benefits of smoking, and tobacco-associated risks.
  
  
  
  Dual use (ie, use of two product categories) was the most prevalent pattern (30.5%), followed by non-cigarette combustible only (26.7%), polytobacco (ie, use of three product categories; 17.5%), cigarette only (14.9%), and noncombustible only (10.4%) use. Product-use patterns differed by gender, race, and ethnicity. Compared to cigarette only users, dual and polytobacco users were more likely to be exposed to and be receptive to pro-tobacco marketing, and were less likely to acknowledge tobacco-use related risks (Ps < .05).
  
  
  
  Curbing tobacco use warrants research on users of more than one tobacco-product categories according to the risk-continuum categorization.
  
  
  
  We present a risk-continuum categorization of product-use patterns among tobacco users not older than 17 years. We classify tobacco users into five mutually exclusive product-use patterns: cigarette only users, non-cigarette combustible only users, noncombustible only users, dual use, and polytobacco use. This categorization overcomes limitations in current literature on tobacco-use patterns, which include exclusion of certain products (eg, e-cigarettes) and product-use patterns (eg, exclusive users of non-cigarette products), and inconsistent classification of tobacco users. It is parsimonious yet complex enough to retain differential characteristics of sub-tobacco users based on number (single, dual, polytobacco) and categories (cigarettes, non-cigarette combustibles, noncombustibles) of tobacco products consumed.
authors.affiliation: Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD.
authors.forename: Sherine
authors.initials: S
authors.lastname: El-Toukhy
authors.affiliation: Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD Kelvin.choi@nih.gov.
authors.forename: Kelvin
authors.initials: K
authors.lastname: Choi
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D002648:Child; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D000074606:Smoking Prevention; D011795:Surveys and Questionnaires; D062789:Tobacco Products / Q000600:supply & distribution*; D014481:United States / Q000453:epidemiology