Sociodemographic Patterns of Exclusive, Dual, and Polytobacco Use Among U.S. High School Students: A Comparison of Three Nationally Representative Surveys



      This study examines sociodemographic patterns of exclusive/dual/polytobacco use among U.S. high school students using multiple national surveys.


      Using three national youth surveys (Population Assessment of Tobacco and Health [PATH] Wave 4 [2016–2017], 2017 Youth Risk Behavior Survey, and 2017 National Youth Tobacco Survey), we classified tobacco products into four groups: (1) electronic nicotine delivery systems (ENDS), (2) conventional cigarettes (CCs), (3) other combustible tobacco products, and (4) smokeless tobacco products. We created 16 categories of non/exclusive/dual/polytobacco use within the past 30 days using the four product groups and calculated weighted population prevalence by sex and race/ethnicity (all surveys) and parental education and income (PATH), based on variable availability.


      The results from 9,331, 12,407, and 9,699 high school students in PATH, Youth Risk Behavior Survey, and National Youth Tobacco Survey, respectively, largely agreed and pointed to similar conclusions. ENDS was the most prevalent exclusive use product (3.8%–5.2% across surveys), with CCs falling to second or third (1.2%–2.0% across surveys). By sex, exclusive, dual, and poly smokeless tobacco product use were more common for males, whereas exclusive CC use was more common for females. By race/ethnicity, non-Hispanic Whites had a higher prevalence of exclusive ENDS use and ENDS/CC dual use than non-Hispanic Blacks. As income and parental education levels increased from low to high, the prevalence of exclusive CC use decreased, whereas the prevalence of exclusive ENDS use increased.


      Understanding sociodemographic patterns of tobacco use can help identify groups who may be at greater risk for tobacco-related health outcomes.


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      Linked Article

      • Corroborating Adolescent Tobacco Use and Sociodemographic Patterns From Multiple National Surveys
        Journal of Adolescent HealthVol. 68Issue 4
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          Increasing tobacco use among adolescents is attributed to the rising popularity of e-cigarette products; in contrast, conventional combustible cigarette use has declined over the past two decades. To illustrate this point, e-cigarette use among high school students increased from 1.5% in 2011% to 19.6% in 2020, whereas adolescent combustible cigarette use declined from 10.5% in 2011% to 3.3% in 2020 [1]. Not only have rising rates of adolescent e-cigarette use been accorded the status of an epidemic [2], but given the emergence of these new tobacco products and the multiple different types of e-cigarette devices proliferating the market over the past few years, precise and continuous surveillance of different patterns of tobacco use remains important to inform public health, prevention, and policy.
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