Trends of Single, Dual, and Polytobacco Use among School-based Students in the United States: An Ana

Cook S, Ortiz Chavez S, Zavala-Arciniega L, Hirschtick JL, Fleischer NL.
Trends of Single, Dual, and Polytobacco Use among School-based Students in the United States: An Analysis of the National Youth Tobacco Survey
Am J Health Promot. 2023 Nov;37(8):1078-1090. doi: 10.1177/08901171231191557. Epub 2023 Jul 26. PMID: 37495509.

Purpose: To examine trends in single, dual, and polytobacco use between 2014-2020 for US youth and to identify disparities in these trends by grade level, sex, and race/ethnicity.

Design: A secondary analysis of the National Youth Tobacco Survey (NYTS).

Subjects: A total of 122 566 students.

Measures: Past 30-day exclusive use of cigarettes, e-cigarettes, other combustibles (cigars, little cigars, cigarillos, hookah, pipe tobacco, bidis) and smokeless tobacco (snus, smokeless, dissolvable); dual use of each product with e-cigarettes; polyuse with e-cigarettes; dual/polyuse without e-cigarettes.

Analysis: Multivariable modified Poisson regression.

Results: Compared to 2014, exclusive e-cigarette use (APR = 2.51, 95% CI: 1.96, 3.21) trended upward while exclusive cigarette (APR = .34, 95% CI: .23, .50), 'other' combustibles (APR = .47, 95% CI: .37, .58), and smokeless tobacco (APR = .40, 95% CI: .25, .65) use trended downward in 2020. Polytobacco use with and without e-cigarettes trended downward in 2020 compared to 2014. We also saw differences in trends across sociodemographic groups. Comparing 2020 to 2014, exclusive e-cigarette use was higher for females than males, 'other' combustible tobacco use remained stable for Non-Hispanic Black students but decreased for other racial/ethnic groups, and dual e-cigarette/cigarette use trended upward more for middle school students than high school students.

Conclusions: Despite decreased trends in tobacco product use without e-cigarettes between 2014-2020, differences in tobacco product use trends by grade level, sex, and race/ethnicity were identified. Prevention efforts targeting disparities in tobacco product use are needed.