Study data published in JAMA Network Open underline the many trajectories multiple nicotine product use (MNPU) may take among adolescents in the US. In an analysis of longitudinal survey data, 6 distinct trajectories of MNPU use were identified, with a significant proportion of respondents belonging to trajectories defined by increasing use.

Investigators extracted data from waves 1 through 4 of the Population Assessment of Tobacco and Health study, a US-based longitudinal survey study that captures nicotine and tobacco use in adolescents. Participants were aged 12 to 17 years at wave 1 (2013-2014) and followed up annually in wave 2 (2014-2015), wave 3 (2015-2016), and wave 4 (2016-2018).

Sociodemographic characteristics were collected at wave 1, including sex, age, race/ethnicity, and tobacco accessibility. Outcome variables included past-month self-reported use of cigarettes, e-cigarettes, cigars, and smokeless tobacco. Multitrajectory latent class growth analysis was used to identify subgroups of participants with similar use patterns over time. Logistic regression models were used to identify predictors of class membership.

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The study cohort comprised 10,086 participants, among whom 5142 (51.2%) were boys, 4792 (54.7%) were non-Hispanic White, and 5315 (50.6%) were aged 12 to 14 years at baseline.

A total of 6 distinct classes of MNPU use were identified: (1) nonuse (n=8056; 78.2%), characterized by consistent low frequency of use; (2) experimentation (908; 9.8%), defined as less than 1 day of use of all products per wave; (3) increasing e-cigarette/cigarette use (359; 4.0%), defined by an increasing number of use days for e-cigarettes and/or cigarettes across waves; (4) increasing cigarette/cigar use (320; 3.3%), defined by an increasing number of use days for cigarettes and/or cigars across waves; (5) decreasing cigarette/e-cigarette/cigar use (302; 3.2%), defined by a decreasing number of days of use across waves; and (6) stable smokeless tobacco/cigarette use (141; 1.6%), characterized as a consistent number of days of use across waves.

Compared with the nonuse class, participants in the other classes were more likely to be 15 to 17 years of age, with odds ratios (ORs) ranging from 2.54 (95% CI, 1.94-3.32) to 9.49 (6.03-14.93), depending on use class. Girls were less likely than boys to belong to any use class (OR range, 0.06 [95% CI, 0.03-0.14] to 0.71 [0.53-0.94]).

Compared with other race/ethnicity strata, non-Hispanic Black respondents were more likely to belong to classes 4 through 6 (OR range, 0.11 [95% CI, 0.04-0.30] to 0.43 [0.29-0.65]). Additional predictors of belonging to a use class were living with a tobacco user (OR range, 1.43 [95% CI, 1.11-1.83] to 4.94 [3.43-7.13]), and having relaxed rules about tobacco use at home (OR range, 1.41 [95% CI, 1.02-1.94] to 3.42 [1.74-6.75]).

Results from this study highlight the heterogeneity of nicotine use trajectories among youth in the US. In addition to a stable use trajectory, latent class analyses also identified patterns of increasing use for e-cigarettes, cigarettes, and cigars. As study limitations, investigators noted that quantity of use was not captured. Further, only annual use data were available, rather than month-to-month patterns.

“Understanding changes in use patterns and the unique combinations of associated risk factors provides targets for regulatory policies as well as prevention programs directed at youths,” investigators wrote. “Given the limited time that clinicians have during tobacco use screening and counseling, intervention research may find that it is more efficient to provide guidance around the risk factors that are specific to patients’ presenting use patterns.”

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Simon P, Jiang Y, Buta E, Sartor CE, Krishnan-Sarin S, Gueorguieva R. Longitudinal trajectories of multiple nicotine product use among youths in the population assessment of tobacco and health study. JAMA Netw Open. 2022;5(3):e223549. doi:10.1001/jamanetworkopen.2022.3549