Patterns of youth tobacco and polytobacco usage: The shift to alternative tobacco products.
Despite significant declines in youth cigarette smoking, overall tobacco usage remains over 20% as non-cigarette tobacco product usage is increasingly common and polytobacco use (using 1+ tobacco product) remains steady.



The present study was designed to identify patterns of youth tobacco use and examine associations with sociodemographic characteristics and tobacco dependence.



The current analysis uses Latent Class Analysis (LCA) to examine the 6,958 tobacco users (n = 2,738 female) in the National Youth Tobacco Survey (2012 and 2013). We used as indicators past month use of tobacco products (cigarettes, cigars, smokeless tobacco, e-cigarettes, hookah, snus, pipes, bidis, and kreteks) and regressed resulting classes on sociodemographic characteristics and tobacco dependence.



Nine classes emerged: cigarette smokers (33.4% of sample, also included small probabilities for use of cigars and e-cigarettes), cigar smokers (16.8%, nearly exclusive), smokeless tobacco users (12.3%, also included small probabilities for cigarettes, cigars, snus), hookah smokers (11.8%), tobacco smokers/chewers (10.7%, variety of primarily traditional tobacco products), tobacco/hookah smokers (7.2%), tobacco/snus/e-cig users (3.3%), e-cigarette users (2.9%,), and polytobacco users (1.7%, high probabilities for all products). Compared to cigarette smokers, tobacco/hookah smokers and hookah smokers were more likely to report Hispanic ethnicity. Polytobacco users were more likely to report dependence (AOR:2.77, 95% CI:[1.49-5.18]), whereas e-cigarette users were less likely (AOR:0.49, 95% CI:[0.24-0.97]).



Findings are consistent with other research demonstrating shifts in adolescent tobacco product usage towards non-cigarette tobacco products. Continuous monitoring of these patterns is needed to help predict if this shift will ultimately result in improved public health.
a Department of Pediatrics, Eastern Virginia Medical School , Norfolk , VA , USA.
Paul T
0000-0001-6588-7878
PT
Harrell
b Department of Statistics/Biostatistics, College of Nursing , University of South Florida , Tampa , FL , USA.
Syeda Mahrukh Hussnain
SMH
Naqvi
a Department of Pediatrics, Eastern Virginia Medical School , Norfolk , VA , USA.
Andrew D
AD
Plunk
b Department of Statistics/Biostatistics, College of Nursing , University of South Florida , Tampa , FL , USA.
Ming
M
Ji
c Department of Epidemiology , Columbia University Mailman School of Public Health , New York , NY , USA.
Silvia S
SS
Martins
D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors; D011795:Surveys and Questionnaires; D062789:Tobacco Products / Q000706:statistics & numerical data*; D064424:Tobacco Use / Q000453:epidemiology* / Q000523:psychology*; D014029:Tobacco Use Disorder / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D055815:Young Adult
Non-cigarette tobacco products; addiction; co-substance use; electronic nicotine delivery systems; priority/special populations
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