The use of multiple nicotine products among youth has been linked to higher levels of nicotine dependence and increased mortality compared to using a single product alone. Researchers at Yale have identified factors that contribute to adolescents using multiple nicotine products, which will help inform efforts to prevent escalation from single to multiple product use. These findings were published in Preventative Medicine on April 24. Patricia Simon, an assistant professor of psychiatry at Yale School of Medicine, emphasized the importance of understanding the negative consequences of multiple product use and the need for effective interventions to prevent young people from progressing to using multiple products.
The researchers analyzed data from over 10,000 individuals who participated in the Population Assessment of Tobacco and Health (PATH) Study, which began in 2013 and is funded by the National Institutes of Health (NIH) and the U.S. Food and Drug Administration (FDA). Among the study group, nearly 11% reported using multiple nicotine products, over 13% reported using one product, and just over 76% reported not using any nicotine products in the previous 30 days. Cigarettes were the most commonly used product, followed by e-cigarettes, cigars, hookah, and smokeless tobacco. Ralitza Gueorguieva, a senior research scientist at Yale School of Public Health, highlighted the personal, familial, and environmental factors that contribute to nicotine product use and the use of multiple products among youth.
Individuals who reported using nicotine products in Wave 4 of the study were more likely to have problems with sleep, anxiety, or feelings of hopelessness, less likely to have discussed not using tobacco products with their parents or guardians, and more likely to have seen tobacco product advertisements in Wave 1 compared to those who did not report nicotine use. Comparing individuals who used multiple products with those who used just one, the researchers found that the former group was more likely to be male, in the older age group of 15- to 17-year-olds, and had previously used a nicotine product at the start of the study. Additionally, those who used multiple products rated the harm of using various nicotine products as less severe than those who used only one product.
Elina Stefanovics, a research scientist at Yale School of Medicine, emphasized the importance of differentiating between those who use single products versus multiple products, as it provides a new perspective on nicotine use in adolescents. The researchers suggested that these findings should be considered by regulators, clinicians, and prevention scientists to develop targeted strategies to prevent both the initiation and escalation of nicotine product use among youth. By understanding the factors that contribute to multiple product use among adolescents, more effective public health strategies and regulatory policies can be implemented to reduce the prevalence of this behavior among young people.
The study was supported by grants from the National Institute on Drug Abuse (NIDA) and the Center for Tobacco Products, which is part of the FDA. Partial support was also provided by the National Cancer Institute and NIDA. The authors emphasized the importance of using these findings to shape interventions aimed at preventing the use of multiple nicotine products among adolescents. This research provides crucial evidence for developing effective strategies to reduce the prevalence of multiple product use among young people and aligning policies with modern usage patterns. By understanding the factors that contribute to this behavior, interventions can be tailored to address specific risk factors for youth.
