Global Patterns and Prevalence of Dual and Poly-Tobacco Use: A Systematic Review

Hit me with your best puff: Personality predicts preference for cigar vs. cigarette smoking

In this study, we examine the association between Big Five personality traits and cigar or cigarette smoking in a sample of 9,918 older adults across 11 European countries derived from the Survey of Health, Ageing and Retirement in Europe (SHARE) dataset. We find significant associations between several traits and smoking groups. Smoking was associated with lower scores on Conscientiousness and Agreeableness and higher Extraversion scores. In addition, cigar smokers exhibit lower Neuroticism and higher Openness compared to both cigarette smokers and non-smokers. These findings suggest that both personality traits are antecedents of smoking behavior, offering implications for targeted public health interventions and social policies aimed at combating the global tobacco epidemic.

Associations between vaping and daily cigarette consumption among individuals with psychological distress

INTRODUCTION

Individuals with behavioral health conditions smoke at significantly higher rates and have been resistant to existing smoking cessation efforts. A clearer understanding of associations between vaping and daily cigarette consumption in this vulnerable population is warranted.

METHODS

We analyzed data from the 2014-2018 National Health Interview Survey (NHIS) to examine whether vaping was associated with differences in number of cigarettes smoked per day (CPD) among adults who smoke daily and have varying levels of psychological distress.

RESULTS

After adjustment for sociodemographic covariates, individuals who vaped every day smoked on average 1.48 fewer cigarettes per day than individuals who never vaped (p<0.01), while individuals who vaped some days and individuals who ever but no longer vaped smoked 0.77 and 1.48 more CPD, respectively, than individuals who never vaped. Differences between those who vaped every day and those who never vaped were even greater among those with moderate psychological distress (-2.21 CPD, p<0.01).

CONCLUSIONS

Our findings suggest that use of vaping devices may be associated with lower daily cigarette use among individuals with psychological distress, potentially supporting smoking harm reduction efforts.

Dual and poly-nicotine and tobacco use among adolescents in the United States from 2011 to 2022

BACKGROUND

Adolescent nicotine and tobacco product use remains common despite declining smoking rates in the United States, likely due to the emergence of novel products. Concurrent use of multiple products may increase the risk of nicotine dependency and subsequent substance use.

AIM

To identify patterns and trends of dual and poly nicotine and tobacco use among adolescents in the US and explore associations of dual and poly nicotine and tobacco use with sociodemographic factors.

METHODS

12 years of annual National Youth Tobacco Survey data (2011-2022) from 242,637 respondents were used to examine prevalence trends of different combinations of nicotine or tobacco product use among adolescents in the US using weighted point estimates for each year. Poisson regression models examined sociodemographic factors associated with different patterns of dual and poly-product use from 2011 to 2022.

RESULTS

Overall, the prevalence of dual (i.e. at least two products) and poly (i.e. at least three products) use decreased between 2011 and 2021 (from 9.5 % to 2.8 % and from 5.1 % to 1.1 %, respectively), but showed signs of increase between 2021 and 2022 (3.7 % for dual and 1.7 % for poly use). The most common combinations included a combustible product with either a novel or noncombustible product. The risk for dual and poly-product use was higher among non-Hispanic Whites, males, and high school students.

CONCLUSIONS

Previously declining trends in the prevalence of tobacco/nicotine dual and poly use may have been reversed. Close monitoring and targeted tobacco control policies are essential to tackle multiple product use among adolescents.

Tobacco endgame measures and their adaptation in selected European countries: A narrative review synthesis

Due to the continued detrimental effects of tobacco use, a growing number of countries are embracing the idea of tobacco endgame, meaning ending the tobacco epidemic instead of controlling it. This narrative review aims to synthesize and update the evidence from earlier scientific reviews on effective tobacco endgame measures, as well as to assess their integration to current national strategies among European countries with official tobacco endgame goals. The synthesis of the prior scientific literature found most evidence on product-focused and some evidence for supply-focused policies. Little evidence was detected for user- and institutional-focused measures. An update for the tobacco-free generation measure showed uncertainty in reducing smoking prevalence, especially for adolescents' reactions to age-restrictive laws. All the countries that established a tobacco endgame strategy have included product standards in their measures, predominantly based on European Union regulations on conventional tobacco products, yet standards above this level and considering other products were also common. Cessation measures were given strong emphasis in strategies, yet none of the countries linked these to specific endgame measures. Despite commonly mentioning vulnerable groups, such as youth and pregnant women, adoption of measures to reduce tobacco use among these groups was scarce. Lastly, the decline in tobacco use seems to be modest, implying challenges in meeting the endgame goals. To meet these goals, European countries should reinforce the implementation of known effective tobacco control measures such as tax increases. Furthermore, new innovative strategies and measures to meet the objective of an endgame should be explored.

Prevalence, regional patterns and socio-demographic factors associated with poly-tobacco use in India: A secondary data analysis

BACKGROUND

Tobacco use is associated with early, intermediate and long-term complications throughout the life course. With an influx of newer products containing nicotine, poly-tobacco use is slowly emerging as a public health concern, that is defined as existing tobacco users currently using two or more tobacco or nicotine products. While many studies have investigated single use tobacco, there is a paucity of research on regional patterns and socio-demographic factors associated with poly-tobacco use in India.

OBJECTIVES

To assess prevalence of poly-tobacco use and determine the socio-demographic factors associated with poly-tobacco use in India.

METHODS

Data from the Global Adult Tobacco Survey 2 (GATS, 2016-17) was analysed, which included information on tobacco use among people aged >15 years. The pattern of current tobacco status was described using descriptive statistics. Multiple logistic regression models were estimated to determine factors associated with poly-tobacco use.

RESULTS

The prevalence of poly-tobacco use in India was found to be 9.8%. Among the current tobacco users, the prevalence was 33%. Significant socio-demographic factors associated with poly-tobacco use included younger age, male gender, religion and backward caste. North-eastern region reported highest prevalence of poly-tobacco use in the country, followed by the central region.

CONCLUSION

The number of poly-tobacco users in India is considerably high and a matter of concern, more so in north east and central regions of the country. There is a need to create awareness about dangerous effects of all types of tobacco products and strengthen implementation of tobacco control policies with special focus on regions with high burden.

Trends in the use and dual use of factory-made combustible cigarettes, other tobacco products and electronic cigarettes: Results from South African Social Attitudes Surveys during 2007 to 2018

INTRODUCTION

Using more than one tobacco product increases the risk of tobacco-related diseases. We investigated trends in the prevalence and dual use of factory-made (FM) cigarettes, other tobacco products, and electronic cigarettes (e-cigarettes) in South Africa over a 12-year period.

METHODS

Data from five waves (2007, 2010, 2011, 2017, and 2018) of the South African Social Attitudes Survey (n=14582) were analyzed. The use of FM, roll-your-own (RYO) cigarettes, cigars, waterpipe, smokeless tobacco (SLT), any combustible tobacco products (CTP), any tobacco product (ATP) use, and e-cigarettes was investigated. The dual use of FM cigarettes with either SLT, waterpipe or e-cigarettes was also explored. Chi-squared analyses and regression models were used to explore trends in prevalence over the 12-year period.

RESULTS

About 51% of the participants were female, and 51.9% were aged 16-34 years. CTP smoking significantly increased from 18.1% (2010) to 23.6% (2018) (p=0.015), while ATPU increased from 20.2% (2010) to 25.9% (2018) (p=0.005). Though dual use of FM cigarettes and SLT, waterpipe, or e-cigarettes was generally low, the prevalence of dual use significantly increased for all product combinations investigated: FM cigarettes and SLT (0.5% in 2007 to 1.3% in 2018, p=0.017), FM cigarettes and waterpipe (0.9% in 2010 to 2.5% in 2018, p=0.014), FM cigarettes and e-cigarettes (0.4% in 2010 to 1.8% in 2018, p<0.001). Compared to 2010, the odds of the prevalence of CTP and ATP use significantly increased by 37% in 2018 (adjusted odds ratio, AOR=1.37; 95% CI: 1.06-1.77; p=0.018 and AOR=1.37; 95% CI: 1.08-1.73; p=0.009, respectively) during the 12-year period after adjusting for demographic characteristics.

CONCLUSIONS

The use and dual use of tobacco and electronic cigarette products have been increasing in recent years in South Africa. Interventions to help users quit and prevent young people from initiating use are urgently needed to curb these increases.

Recency measures matter: Variability in reported last use of tobacco and marijuana products among a nationally representative study of U.S. young adults

INTRODUCTION

Current use of tobacco and marijuana products is largely defined as use within the past 30-days or more recently. These products are not used in the same manner, frequency, or context especially among young adults who are increasingly at risk for poly-product use. The purpose of this study was to examine patterns of most recent product use across select tobacco and marijuana products.

MATERIALS AND METHODS

Data used in this study come from a cross-sectional survey conducted among a nationally representative sample of young adults ages 18-34 (n = 1,189) in the U.S. from October-November 2020. Respondents were asked about past product and most recent use of select tobacco/nicotine products (cigarettes, little filtered cigars and cigarillos, large cigars, e-cigarettes, hookah/water pipes) and marijuana products (blunts, e-cigarettes with marijuana, and other products with marijuana).

RESULTS

A high proportion of young adults reported having used at least one tobacco (79.6%) or marijuana (68.6%) products. There is variability in the distribution of most recent use across different tobacco and marijuana users even within the past 3 to past 6 months where nearly one in five users of any product report last use. The average number of tobacco/nicotine products used as well as concurrent marijuana use were lowest when looking at those whose most recent use was within the past 30-days. As the measures of most recent use became more broad, the number of tobacco/nicotine products used increased as did the prevalence of concurrent marijuana use which extended through the past 6-months.

CONCLUSION

Measures of current use may need to be expanded beyond the past 30-days to include through the past 6-months to better encapsulate usage patterns when considering poly-tobacco and marijuana co-use.

Perceptions and reasons for quitting and transitioning between smoking and smokeless tobacco products: Findings from four waves of the ITC Bangladesh survey

INTRODUCTION

Transitions between different tobacco products are frequent among tobacco users in Bangladesh; however, the reasons leading to such transitions and why they quit are not well researched. The aim of the study is to examine perceptions and reasons reported by tobacco users in Bangladesh to transition to other products or quit.

METHODS

Data from four waves (2009-2015) of the International Tobacco Control (ITC) Bangladesh Survey were used. Repeated data on perceptions and reasons for exclusive cigarette (n=520), bidi (n=130), and SLT users (n=308) to either start using other products or quit were analyzed with sampling weights. The percentages of responses across waves were used to calculate the pooled proportion data using a meta-analysis approach.

RESULTS

Common reasonsig for respondents switching to other tobacco products were influence of friends/family (73.8-86.0%), and curiosity (44.4-71.3%). The perceived calming effect of smoking cigarettes and bidis (43.2-56.9%), and the impression that bidis were less harmful (52.3%) and taste better (71.2%) were major reasons for exclusive SLT users to switch products. Health concerns (16.5-62.7%) and disapproval from friends/family (29.8-56.4%) were generally the main reasons for quitting. For smoked tobacco users, doctor's advice (41.6%), package warning labels (32.3%), and price (32.4%) seemed to be the major driving factors to quit.

CONCLUSIONS

Results highlight that the reasons for switching between tobacco products and quitting include social factors (e.g. friends/family) and (mis) perceptions regarding the products. Tobacco control policy could emphasize cessation support, increased price and education campaigns as key policies to reduce overall tobacco use in Bangladesh. Data from four waves (2009-2015) of the International Tobacco Control (ITC) Bangladesh Survey were used. Repeated data on perceptions and reasons for exclusive cigarette (n=520), bidi (n=130), and SLT users (n=308) to either start using other products or quit were analyzed with sampling weights. The percentages of responses across waves were used to calculate the pooled proportion data using a meta-analysis approach.

Patterns of tobacco or nicotine-based product use and their quitting behaviour among adults in India: a latent class analysis

OBJECTIVES

The aims of the study were to identify latent classes of adult tobacco or nicotine-based product users in India, compare their sociodemographic distribution and quitting behaviour and explore the association of quitting behaviour and time to first tobacco use with class membership.

STUDY DESIGN

This was a nationally representative cross-sectional survey.

METHODS

Data from the Global Adult Tobacco Survey 2016-2017 in India, which covered adults aged >15 years, were analysed. Latent class analysis was used to examine patterns of tobacco or nicotine-based product use (cigarette, bidi, cigar, e-cigarette, chewable tobacco and snuff) among current tobacco users. Classes were compared across sociodemographic and tobacco use-related characteristics. Various model fit statistics (Akaike, Bayesian and Sample Size-Adjusted Bayesian Information Criteria, Likelihood Ratio Tests and Entropy) and meaningfulness of the classes were used to select the number of latent classes.

RESULTS

Of 21,857 current tobacco users, five latent classes were extracted: 'poly-tobacco use' (103, 0.5%), 'oral chewable products predominantly' (11,306, 51.7%), 'bidi predominantly' (4965, 22.7%), 'cigarette predominantly' (5318, 24.3%) and 'snuff and chewable products' (165, 0.8%). Significant differences between classes emerged on sociodemographics (age, sex, residence, education, wealth quintile, region). 'Bidi predominantly' class was associated with higher likelihood of quit attempts. Compared with 'cigarette predominantly' class, other classes were significantly associated with time to first tobacco use.

CONCLUSION

We found that people in India could be grouped into five classes based on their tobacco or nicotine-based product use pattern. It may be efficient to tailor messages to different latent classes and address the distinct profiles of these groups of tobacco product users.

How does Indian news media report smokeless tobacco control? A content analysis of the gutka ban enforcement

Smokeless tobacco (SLT) products like gutka and paan masala are a growing public health crisis in India. Despite enacting a ban-the highest form of regulation-little is known about implementation progress. The purpose of this study was to look at how enforcement of gutka ban is covered in Indian news media and if media is a reliable source of data. We conducted a content analysis of online news reports (n = 192) from 2011 to 2019. News characteristics such as name and type of publication, language, location, slant and beat coverage, visuals, and administrative focus were quantified. Similarly, news contents were inductively coded to examine dominant themes and the implementation landscape. We found that coverage was initially low but increased after 2016. Overall, news reports were in favor of the ban. Five leading English newspapers covered the majority of the ban enforcement reports. Prominent themes like consumption, health hazards, tobacco control responses, impact on livelihoods, and illicit trade were drawn from the textual analysis as the main arguments in relation to the ban. Gutka is largely seen as an issue of crime reflected by the contents, sources, and frequent use of pictures depicting law enforcement. The interconnected distribution channels of the gutka industry hindered enforcement, highlighting the need to study the complexities of regional and local SLT supply chains.

Sex and Sexual Identity Differences in Poly-tobacco Use and Psychological Distress in U.S. Adults: Results From the National Health Interview Survey

INTRODUCTION

Poly-tobacco use (PTU), or the concomitant use of two or more nicotine and tobacco products, are a growing public health concern. Adults reporting increased psychological distress (PD) experience profound nicotine and tobacco health-related disparities. Sexual minority (SM) adults report more PTU and higher levels of PD than heterosexuals, yet little is known about patterns of nicotine and tobacco use and its relationship to PD in SM populations.

AIMS AND METHODS

The purpose of this study was to investigate sexual identity differences in PD and PTU. Data were drawn from the 2016-2018 National Health Interview Survey (N = 83 017), an annual cross-sectional survey of a nationally representative sample of U.S. adults. PD was assessed using the Kessler Psychological Distress Scale (K6). We fit sex-stratified, weighted, adjusted logistic models to compare PTU and PD by sexual identity.

RESULTS

PTU was more prevalent in adults with higher K6 scores. Female adults and SM adults had significantly higher K6 scores and were significantly more likely to experience serious PD when compared to their male and heterosexual counterparts.

CONCLUSIONS

The current study provides a snapshot of trends in PTU in relation to PD, gender, and sexual identity. Findings suggest higher rates of both PD and PTU in SM adults. Further research examining the mechanisms underlying this disparity is critical to the development of effective intervention and prevention strategies.

IMPLICATIONS

Little is known about sex and sexual identity differences in the relations between patterns of tobacco product use and PD. This study is the first to examine the effect of gender and sexual identity on both PD and PTU. SMs reported higher rates of PD and were more likely to be poly-tobacco users. As new ways of engaging nicotine/tobacco continue to proliferate, health risks will endure especially for marginalized populations. An increased understanding of the psychological and social correlates of PTU in SMs is warranted.

Introduction to the Special Issue "Emerging Trends in Combustible Tobacco and Vaping Product Use"

Tobacco use remains a leading cause of preventable death and disease worldwide [...].

Trends in Exclusive, Dual and Polytobacco Use among U.S. Adults, 2014-2019: Results from Two Nationally Representative Surveys

Although increases in the variety of tobacco products available to consumers have led to investigations of dual/polytobacco use patterns, few studies have documented trends in these patterns over time. We used data from the 2014/2015 and 2018/2019 Tobacco Use Supplement to the Current Population Survey (TUS-CPS) and the 2015–2019 National Health Interview Survey (NHIS) to estimate trends in the following use patterns: exclusive use of cigarettes, electronic nicotine delivery systems (ENDS), other combustibles (cigars/cigarillos/little filtered cigars and traditional pipes/hookah), and smokeless tobacco (four categories); dual use (two product groups) of each product group with cigarettes (three categories); polyuse with cigarettes (all four product groups; one category); and dual/polyuse without cigarettes (one category). We estimated trends in product use patterns overall and by age, sex, and race/ethnicity using two-sample tests for differences in linear proportions. From 2014/2015 to 2018/2019, exclusive ENDS use increased, whereas cigarettes and ENDS dual use decreased. Furthermore, polyuse with cigarettes decreased, whereas dual/polyuse without cigarettes increased, with trends varying by age, sex, and race/ethnicity. Our findings suggest that patterns of dual/polyuse with and without cigarettes have changed in recent years, indicating the need for further surveillance of concurrent tobacco product use patterns.