Patterns of poly tobacco use among adults in the Population Assessment of Tobacco and Health (PATH) study, 2013-2017: A multistate Markov transition analysis

• Published in: Tobacco Control
• Main Authors: Shafie Khorassani, Fatema, Brouwer, Andrew F, Hirschtick, Jana L, Jeon, Jihyoun, Jimenez-Mendoza, Evelyn, Meza, Rafael, Fleischer, Nancy L
• Format: Text
• Language: unknown
• Published: Advocate Aurora Health Institutional Repository 2023
• Subjects: smoking cessation; co-substance use; disparities; electronic nicotine delivery devices; Population Health and Public Health; Advocate Aurora Research Institute; Aurora Research Institute
• Online Access: https://institutionalrepository.aah.org/allother/512; https://doi.org/10.1136/tc-2022-057822; https://libkey.io/libraries/1712/10.1136/tc-2022-057822

Background: A better understanding of sociodemographic transition patterns between single, dual and poly tobacco product use may help improve tobacco control policy interventions. Methods: HRs of transition between never, non-current (no past 30-day use), cigarette, e-cigarette, other combustible, smokeless tobacco (SLT), dual and poly tobacco use states in adults were estimated for age, sex, race/ethnicity, education and income using a multistate model for waves 1-4 of the Population Assessment of Tobacco and Health study (2013-2017), a US-based cohort study, accounting for complex survey design. Results: Sole cigarette and SLT use were persistent, with 77% and 78% of adults continuing use after one wave. Other use states were more transient, with 29%-48% of adults reporting the same pattern after one wave. If single-product users transitioned, it was most likely to non-current use while dual or poly cigarette users were most likely to transition to exclusive cigarette use. Males were more likely than females to initiate combustible product use after a history of no use, and after a period of tobacco use cessation. Hispanic and non-Hispanic black participants initiated cigarette use at higher rates than non-Hispanic white participants, and had higher rates of experimentation with tobacco products between study waves. Lower socioeconomic status was associated with higher rates of transition into combustible tobacco use. Conclusions: Dual and poly tobacco use is largely transient, while single-use patterns are more stable over time. Transitions differ by age, sex, race/ethnicity, education and income, which may influence the impact of current and future tobacco control efforts.