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Master of Public Health

Racial/Ethnic Differences in Associations of Noncigarette Tobacco Product Use with Subsequent Initiation of Cigarettes in US Youths

AUTHORS

Stokes A , 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 , . Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco. 2020 9 19; ().

ABSTRACT

INTRODUCTION: Understanding which noncigarette 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 noncigarette 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 (OR, 2.76; 95% 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 noncigarette 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 noncigarette 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 vs. white tobacco use and further exacerbate inequities in tobacco-related disease. Thus, contemporary policy development and discourse about the effects of noncigarette tobacco products on cigarette initiation should consider cigar and other noncigarette products as well as e-cigarettes.

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