Illustrating the Changing Tobacco Landscape: Risk Characterizations of Youth Single, Dual, and Poly Tobacco Users

Little is known about the growing phenomenon of concurrent tobacco use or distinctions among youth who are single, dual, or poly tobacco users. With widespread availability of a myriad of tobacco products, effective prevention and intervention strategies can no longer center on cigarette smoking alone. Tobacco control initiatives must reflect this changing tobacco landscape. It is critical to understand distinct risk profiles of concurrent tobacco users and determine differences in the functional value of various tobacco products. Using data from the 2012 National Youth Tobacco Survey (n=24,658), including US Middle and High School youth, ages 9 to 18 the present study developed mutually exclusive categories of single, dual, and poly tobacco use defined as use of only one, only two, and any three or more tobacco products in the last 30 days. Multinomial logistic regression established three exclusive tobacco groupings characterized by established risk domains. Resulting risk characterizations were transposed into visual illustrations to foster translation of distinct user profiles to research and practice audiences. Among youth using tobacco in the past 30 days (n=5,030), the majority were poly users (55.9%), followed by single (28.4%), and dual users (16.1%). Multivariable models showed higher levels of nicotine dependence among poly users compared to single (RRR=3.14, p\u3c0.001) and dual users (RRR=2.48, p\u3c0.001). Poly users were less likely to express quit intent compared to single (RRR 0.68, p\u3c0.001) or dual users (RRR=0.77, p\u3c0.05). High tobacco harm perceptions were more likely among dual relative to single product users (RRR=1.54, p\u3c0.05); poly users were less likely to perceive harm (RRR=0.56, p\u3c.0001). Visual illustrations convey distinct profiles, including racial and gender differences. Compared to poly, dual users expressed higher quit intent and risk perceptions suggesting different use motivations. Significant distinctions among single, dual, and poly users suggest tobacco control research should consider these characterizations and the expanding role of non-cigarette tobacco products in future strategies to reduce nicotine addiction among US youth