title: Risk Profiles of Youth Single, Dual, and Poly Tobacco Users.
abstract: Given widespread availability and uptake of myriad tobacco products among youth, a comprehensive tobacco control agenda necessitates an in-depth exploration of the phenomenon of concurrent tobacco use.
  
  
  
  Multinomial logistic regression generated distinct concurrent tobacco use risk profiles of single, dual, and poly use, defined as use of only one, only two, and any three or more tobacco products in the last 30 days, from the 2012 National Youth Tobacco Survey (n = 24 658).
  
  
  
  Among youth using tobacco in the past 30 days (n = 5030), the majority were poly tobacco product users (55.9%, n = 2813), followed by single (28.4%, n = 1406), and dual users (16.1%, n = 811). Multivariable models showed higher levels of nicotine dependence among poly users compared to single (relative risk ratio [RRR] = 3.14, P < .001) and dual users (RRR = 2.48, P < .001). Poly users were less likely to express quit intent compared to single (RRR = 0.68, P < .01) or dual users (RRR = 0.77, P < .05). Tobacco harm perceptions were more likely among dual users relative to single product users (RRR = 1.54, P < .05); poly users were less likely to perceive harm (RRR = 0.56, P < .001). Racial and gender differences also emerged.
  
  
  
  As the number of tobacco products increased, nicotine dependence and perceived tobacco use among peers increased, whereas quit intentions decreased. Dual users had greater tobacco harm perceptions than poly and single users and higher prevalence of electronic cigarette use. Results suggest that poly use may be driven by addiction whereas dual use may be motivated by intentions to quit. Focused risk assessments may inform tailored interventions for distinct types of tobacco users.
  
  
  
  This study provides an in-depth look at the risks for concurrent tobacco use among youth by creating unique risk profiles for single, dual and poly use. Results from this study can inform tailored interventions for distinct types of tobacco users.
authors.affiliation: Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC mali12@gwu.edu.
authors.forename: Maliha
authors.initials: M
authors.lastname: Ali
authors.affiliation: Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC.
authors.forename: Tiffany R
authors.initials: TR
authors.lastname: Gray
authors.affiliation: Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC.
authors.forename: Diane J
authors.initials: DJ
authors.lastname: Martinez
authors.affiliation: Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC.
authors.forename: Laurel E
authors.initials: LE
authors.lastname: Curry
authors.affiliation: Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Horn
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D016739:Behavior, Addictive; D002648:Child; D003430:Cross-Sectional Studies; D005006:Ethnicity; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D015995:Prevalence; D011795:Surveys and Questionnaires; D062789:Tobacco Products / Q000706:statistics & numerical data*; D014029:Tobacco Use Disorder / Q000453:epidemiology* / Q000208:ethnology; D014481:United States / Q000453:epidemiology