Racial/Ethnic Differences in Associations of Non-cigarette Tobacco Product Use with Subsequent Initi
Saturday, June 19, 2021
Posted by: Natalia Gromov
Stokes
AC, Wilson AE, Lundberg DJ, Xie W, Berry KM, Fetterman JL, Harlow AF, Cozier
YC, Barrington-Trimis JL, Sterling KL, Benjamin EJ, Blaha MJ, Hamburg NM,
Bhatnagar A, Robertson RM.
Racial/Ethnic Differences
in Associations of Non-cigarette Tobacco Product Use with Subsequent Initiation
of Cigarettes in US Youths.
Nicotine Tob Res. 2021 May 24;23(6):900-908. doi: 10.1093/ntr/ntaa170. PMID:
32948872; PMCID: PMC8150136.
Introduction.
Understanding which non-cigarette tobacco products precede smoking in youth
across different racial/ethnic groups can inform policies that consider
tobacco-related health disparities.
Methods.
We used nationally representative, longitudinal data from the Population
Assessment of Tobacco and Health Study waves 1-4. The sample was a dynamic
cohort of cigarette-naïve youth aged 12-17 years. Mixed-effects models were
used to assess non-cigarette product (e-cigarette, cigar product, or other
product) use with cigarette use over 1-year intervals.
Results.
Of the 28 788 observations pooled across waves 1-4, respondents were 48.7%
non-Hispanic white, 13.9% non-Hispanic black, and 23.1% Hispanic. Odds of
cigarette initiation over 1-year follow-up were higher among youth with prior
use of e-cigarettes (odds ratio [OR], 2.76; 95% confidence interval [CI],
2.21-3.45), cigars (OR, 2.00; 95% CI, 1.42-2.80), or other products (OR, 1.66;
95% CI, 1.28-2.14) compared to never users. At the population level, 20.6% of
cigarette initiation was attributable to e-cigarette use among white youth and
21.6% among Hispanic youth, while only 3.5% of cigarette initiation was
attributable to e-cigarette use among black youth. In contrast, 9.1% of
cigarette initiation for black youth was attributable to cigar use compared to
only 3.9% for both white and Hispanic youth.
Conclusions.
Prior use of e-cigarettes, cigars, and other non-cigarette products were all
associated with subsequent cigarette initiation. However, white and Hispanic
youth were more likely to initiate cigarettes through e-cigarette use (vs.
cigar or other product use), while black youth were more likely to initiate
cigarettes through cigar use (vs. e-cigarette or other product use).
Implications.
Our findings suggest that previous studies on effects of non-cigarette tobacco
products may overlook the critical role of cigar products as a pathway into
cigarette smoking among US youth, particularly black youth. While our data
support the importance of e-cigarette use as a pathway into smoking, regulatory
actions aimed at addressing youth e-cigarette use alone may contribute to
disparities in black versus white tobacco use and further exacerbate inequities
in tobacco-related disease. Thus, contemporary policy development and discourse
about the effects of non-cigarette tobacco products on cigarette initiation
should consider cigar and other non-cigarette products as well as e-cigarettes.
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