Changes in patterns of youth multiple tobacco and/or e-cigarette product use in the US between 2014 and 2020: a multiple-group latent class analysis

Correspondence to Tianze Sun, National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia; [email protected]

WHAT IS ALREADY KNOWN ON THIS TOPIC

• Previous research on multiple tobacco and/or e-cigarette product (MTEP) use differs in how product use is operationalised and in sampling frames and methodology, making it difficult to track trends in patterns of MTEP over a long period of time.

WHAT THIS STUDY ADDS

• Multigroup latent class analysis identified three distinct classes of youth from the US from 2014 to 2020, with the largest class comprising of minimal/non-users (~89.8%), followed by mostly occasional e-cigarette and cigarette users (MOEC: ~9%) and polytobacco users (POLY: ~1.2%).

• Greater perceived exposure to product marketing reduced tobacco danger perceptions, which in turn, increased the odds of being MOEC and POLY.

• The class proportions for MOEC and POLY decreased between the study period, however regular e-cigarette use increased in all three classes.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE AND/OR POLICY

• Tighter restrictions on marketing are needed to discourage uptake of youth e-cigarette use.

Introduction

Multiple tobacco and/or e-cigarette product (MTEP) use is the concurrent use of two or more different types of tobacco products and/or e-cigarettes.^1–3 MTEP use is common among young people in the US,⁴ with over half of US youth who used tobacco in the past 30 days identifying as MTEP users in 2012.⁵ In 2020, current MTEP use was reported by 5.9% of all middle and high school students in the US and current use of e-cigarettes or any tobacco products was 16.2%.⁶ E-cigarettes were the most commonly used (13.1%), followed by cigars (3.5%), cigarettes (3.3%), smokeless tobacco (2.3%), hookahs (2.1%) and pipe tobacco (0.6%).⁶

The recent emergence of new e-cigarette and tobacco products in the marketplace has changed patterns of use in ways that may pose different risks for young people. For example, the prevalence of cigarette smoking has substantially decreased from 2014 to 2020,⁷ but the use of nicotine has remained relatively stable due to an increase in e-cigarette use.^8–10 This rise in e-cigarette prevalence is attributed to e-cigarette marketing exposure^{11 12} which can reduce perceptions of e-cigarettes’ harm.¹³ Research using the 2014 US National Youth Tobacco Survey (NYTS)...