摘要：Objectives. We monitored the prevalence and patterns of use of the array of tobacco products available to young adults, who are at risk for initiation and progression to established tobacco use. Methods. We used data from waves 1 to 3 of GfK’s KnowledgePanel (2011–2012), a nationally representative cohort of young adults aged 18 to 34 years (n = 2144). We examined prevalence and patterns of tobacco product use over time, associated demographics, and state-level tobacco policy. We used multivariable logistic regression to determine predictors of initiation of cigarettes as well as noncombustible and other combustible products. Results. The prevalence of ever tobacco use rose from 57.28% at wave 1 to 67.43% at wave 3. Use of multiple products was the most common pattern (66.39% of tobacco users by wave 3). Predictors of initiation differed by product type and included age, race/ethnicity, policy, and use of other tobacco products. Conclusions. Tobacco use is high among young adults and many are using multiple products. Efforts to implement policy and educate young adults about the risks associated with new and emerging products are critical to prevent increased initiation of tobacco use. The 2009 Family Smoking Prevention and Tobacco Control Act (FSPTCA) 1 gave the US Food and Drug Administration (FDA) the authority to regulate tobacco and marked a new beginning in the field of tobacco control. A number of restrictions arising from the FSPTCA have already taken place, including banning characterizing flavors in cigarettes and tobacco brand sponsorships of sports and entertainment events. 1 At the same time, there has been increased use of noncigarette combustible products, such as cigars, 2 and the introduction of several noncombustible tobacco products (NCPs), including e-cigarettes and snus. A spokesman for Phillip Morris recently called NCPs their “most exciting growth opportunity,” 3 (p5) and several tobacco companies have endorsed their development for harm reduction. 4–6 However, rather than promoting these products as a substitution for cigarettes, they are often advertised as an extension of major cigarette brands 7 and promoted for use alongside cigarettes. 8,9 These new products—as well as other noncigarette combustible products such as cigars and hookahs—also may be especially attractive to young adults. 10–12 Since the 1998 Master Settlement Agreement put forth restrictions on tobacco industry marketing to youths, 13 young adults have become an increasingly important target audience. 14,15 This is evident in the data, as approximately 20% of young adults still smoke cigarettes, 16 and recent national data show that young adults aged 18 to 25 years had the highest prevalence of current tobacco use (40.8%) compared with youths (ages 12–17 years) or adults (ages 26 years and older). 17 Use of certain noncigarette products are particularly high; for example, data from a nationally representative sample found that 30% of young adults aged 18 to 34 years had ever used cigars; 26% had used little cigars, cigarillos, or bidis; and 18% had used a hookah. 18 This last finding corroborates other studies reporting high rates of hookah use among young adults, 19–23 reaching past 30-day rates of 8.5% among college-age students. 19 Young adults were also more likely than older adults to have ever used snus, 10 and expressed interest in experimenting with the product. 24 e-Cigarette use has also been reported to be inversely related to age, 25,26 with rates in adults decreasing by 2% to 3% with every year of increased age. 11 Tobacco use is the number one cause of preventable death in America 27 and results in almost 5.2 million years of potential life lost each year. 28 In light of the increasingly diversified tobacco product marketplace, and the introduction of products that currently fall outside FDA regulatory authority, it is critical to monitor tobacco product use among young adults. This includes not only current, regular use but also experimentation. To decrease the prevalence and improve long-term health outcomes, focus should be extended to understanding to what extent consumers are using multiple tobacco products (poly-use). Little is known about patterns of poly-use, but studies suggest that this is becoming increasingly prevalent among young adults. For example, a recent study found that 30% of young adult current tobacco users had ever used multiple tobacco products, 18 which corroborates findings in other samples. 29,30 Another nationally representative study reported the highest prevalence of poly-use among those aged 18 to 24 years compared with those aged 25 years and older. 17 This has implications as poly-users may have higher rates of nicotine addiction, 7,31 may have more withdrawal symptoms during quit attempts, 31 and may be less likely to quit. 32 Young adulthood marks a critical developmental period, 33 one that often coincides with the both the initiation 34–36 and establishment of regular tobacco use. 35–37 Prevention efforts directed at this audience will depend on a precise understanding of the degree to which young adults are using different tobacco products. To address this, we examined the prevalence and patterns of tobacco product use over time, demographic correlates of use, and predictors of initiation among a large, nationally representative cohort of young adults. Data will help inform program planners and policymakers on the impact of new and alternative tobacco product use among young adults.
