Initial Use of Smokeless Tobacco Among Adolescents is Associated With Later Multiple Nicotine Product Use and Higher Nicotine Dependence

Up to a quarter of US high school students use nicotine products in a given month; multiple product use is associated with higher levels of nicotine dependence,* which negatively impacts cessation efforts. This study used data from the Population Assessment of Tobacco and Health (PATH) to investigate the association between the type of first nicotine product tried and subsequent multiple nicotine product use and dependence.

  • Combustible cigarettes were the most common product of first use (48 percent), followed by e-cigarettes (16 percent), cigars (12 percent), hookah (15 percent), and smokeless tobacco (9 percent).
  • Adolescents who first tried smokeless tobacco were more likely to report subsequent multiple nicotine product use (adjusted odds ratio, 1.92).
  • Those who first tried smokeless tobacco had higher nicotine dependence scores once dependence was established.

* Defined as having ≥1 symptom of nicotine dependence according to the 7-item version of the Wisconsin Inventory of Smoking Dependence Motives (WISDM).

Comments: While most public health efforts are aimed at combustible and e-cigarette prevention, this study highlights the need for prevention of use of other nicotine products, including smokeless tobacco. Of note, the dataset used for this study was collected during the early phases of e-cigarette introduction to the US; e-cigarette use has since surpassed that of other nicotine products among youth.

Corey McBrayer, DO, MPH** & Darius A. Rastegar, MD

** Rich Saitz Editorial Intern & Grant Medical Center Addiction Medicine Fellow, OhioHealth.

Reference: Simon P, Buta E, Jackson A, et al. The first nicotine product tried is associated with current multiple nicotine product use and nicotine dependence among a nationally representative sample of U.S. youthsPrev Med. 2023;169:107437.

Article source: