Use of multiple products dominates youth tobacco patterns

National data show that past 30-day e-cigarette use among youth increased between 2011 and 2014, but decreased in the last two years, leaving many wondering how e-cigarettes affect youth tobacco use patterns overall.

Researchers at the Schroeder Institute® for Tobacco Research and Policy Studies at Truth Initiative® used data from the 2014 National Youth Tobacco Survey (NYTS) to compare numbers on the use patterns of e-cigarettes and various tobacco products, including cigarettes, cigars and smokeless tobacco.

Published in Nicotine & Tobacco Research, the study found that the majority of U.S. middle and high school students (83 percent) had not used tobacco or e-cigarettes in the last 30 days.

Most of those who reported using e-cigarettes had also used other tobacco products, primarily cigarettes. Of the 9.3 percent of youth who used e-cigarettes at any time in the last month, 63 percent of them had also used a tobacco product. Of the 3.3 percent of youth who used e-cigarettes exclusively in the last month, 65 percent of them had a history of tobacco product use.

The majority of respondents who used e-cigarette, cigarette, cigar or smokeless products in the last 30 days reported poly-use (the use of more than one product), making it the most popular pattern of tobacco and e-cigarette use among U.S. middle and high school students.

Researchers note that different use patterns may reflect how products are commonly available in youth social contexts, or other influences like point-of-sale, marketing and digital media. For e-cigarettes, curiosity, harm perceptions and flavors may help explain higher rates of past 30-day use and experimentation compared with cigarettes.

Understanding the differences in cigar, cigarette, smokeless and e-cigarette patterns of use can more precisely inform policy and practice, according to the researchers.

“This study highlights the complexity of tobacco use patterns in U.S. middle and high school students,” said Dr. Andrea Villanti, director of regulatory science and policy at Schroeder Institute and lead author of the study. “Future studies addressing the full public health impact of tobacco use will require longitudinal data with appropriate measures to determine how use of individual products, like e-cigarettes, impact progression into or out of more regular patterns of tobacco or e-cigarette use.”