Research paper
CC-BY-NC 4.0

Reasons for Polytobacco Use among Young Adults: Scale Development and Validation

Carla J Berg 1  ,  
Matt Masters 2,  
Jill Shah 2,  
Raina Sarmah 2,  
Department of Behavioral Sciences and Health Education, Emory University
Emory University
Battelle Research Institute
Tob. Prev. Cessation 2016;2(July):67
Publish date: 2016-07-20
Limited research has examined reasons for polytobacco use, an increasing public health problem, particularly among young adults. We examined reasons for polytobacco use among users of more than one tobacco product in the past 4 months enrolled in an ongoing six-wave longitudinal study of 3,418 students aged 18-25 from seven US colleges and universities.

An expert panel generated items related to reasons for polytobacco use, included in Wave 3 (administered in Summer 2015). Participants reporting use of more than one tobacco product in the past four months (n=540) were asked to complete the Reasons for Polytobacco Use scale and measures related to tobacco/nicotine use/dependence, use motives, perceptions of tobacco, parental/friend use, other substance use, and mental health. We conducted a factor analysis and then examined convergent and discriminant validity for the derived factors.

Our sample was an average age of 20.40 (SD=1.84), 48.0% male, and 21.9% Black. Four factors were identified: Instrumentality, Social Context, Displacement, and Experimentation. Instrumentality was the only factor associated with little cigar/cigarillo and marijuana use. Displacement and Social Context showed similar associations; however, Social Context was associated with having friends who used tobacco while Displacement was not. Experimentation was associated with greater perceived addictiveness and harm of using tobacco products as well as greater perceived social acceptability of tobacco use.

Each of the four factors identified demonstrated unique convergent and discriminant validity. The use of this scale to characterize polytobacco using young adults may help inform and target cessation or prevention interventions.

Carla J Berg   
Department of Behavioral Sciences and Health Education, Emory University, 1518 Clifton Road NE, 30322 Atlanta, United States
1. Rigotti, N., J.E. Lee, and H. Wechsler, US college students’ use of tobacco products: Results of a national survey. JAMA, 2000. 284: p. 699-705. doi:10.1001/jama.284.6.699.
2. Smith-Simone, S., et al., Waterpipe tobacco smoking: knowledge, attitudes, beliefs, and behavior in two U.S. samples. Nicotine Tob Res, 2008. 10(2): p. 393-8. doi: 10.1080/14622200701825023.
3. Knishkowy, B. and Y. Amitai, Water-pipe (narghile) smoking: an emerging health risk behavior. Pediatrics, 2005. 116(1): p. e113-9.doi: 10.1542/peds.2004-2173.
4. Etter, J.F., Electronic cigarettes: a survey of users. BMC Public Health, 2010. 10: p. 231. doi: 10.1186/1471-2458-10-231
5. Schoenborn, C.A. and R.M. Gindi, Electronic Cigarette Use Among Adults: United States, 2014. NCHS Data Brief, 2015. 217.
6. Hoffmann, D. and I. Hoffman, Chemistry and toxicology. Cigars: health effects and trends, in Smoking and Tobacco Control Monograph No. 9 1998, U.S. DHHS, National Institutes of Health, National Cancer Institute: Rockville, MD. p. 55-104.
7. Benowitz, N.L. and M.L. Goniewicz, The regulatory challenge of electronic cigarettes. JAMA, 2013. 310(7): p. 685-6. doi: 10.1001/jama.2013.109501
8. Farsalinos, K.E. and R. Polosa, Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: a systematic review. Ther Adv Drug Saf, 2014. 5(2): p. 67-86. doi: 10.1177/2042098614524430
9. Bullen, C., et al., Electronic cigarettes for smoking cessation: a randomised controlled trial. Lancet, 2013. 382(9905): p. 1629-37. doi: 10.1016/s0140-6736(13)61842-5
10. Caponnetto, P., et al., EffiCiency and Safety of an eLectronic cigAreTte (ECLAT) as tobacco cigarettes substitute: a prospective 12-month randomized control design study. PLoS One, 2013. 8(6): p. e66317. doi: 10.1371/journal.pone.0066317
11. Berg, C.J., et al., Attitudes toward E-Cigarettes, Reasons for Initiating E-Cigarette Use, and Changes in Smoking Behavior after Initiation: A Pilot Longitudinal Study of Regular Cigarette Smokers. Open J Prev Med, 2014. 4(10): p. 789-800. doi: 10.4236/ojpm.2014.410089
12. Food and Drug Administration, Summary of Results: Laboratory Analysis of Electronic Cigarettes Conducted By FDA. 2009, Food and Drug Administration: Silver Spring, MD.
13. Jensen, R.P., et al., Hidden formaldehyde in e-cigarette aerosols. N Engl J Med, 2015. 372(4): p. 392-4. doi: 10.1056/NEJMc1413069.
14. Grana, R., N. Benowitz, and S.A. Glantz, E-cigarettes: a scientific review. Circulation, 2014. 129(19): p. 1972-86. doi: 10.1161/CIRCULATIONAHA.114.007667.
15. Agaku, I.T., et al., Tobacco product use among adults--United States, 2012-2013. MMWR Morb Mortal Wkly Rep, 2014. 63(25): p. 542-7. PMID: 24964880.
16. Enofe, N., C.J. Berg, and E. Nehl, Alternative tobacco product use among college students: Who is at highest risk? Am J Health Behav, 2014. 38(2): p. 180-189. doi: 10.5993/ajhb.38.2.3
17. Rath, J.M., et al., Patterns of tobacco use and dual use in US young adults: the missing link between youth prevention and adult cessation. J Environ Public Health, 2012. 2012: p. 679134. doi: 10.1155/2012/679134
18. Richardson, A., et al., The next generation of users: prevalence and longitudinal patterns of tobacco use among US young adults. Am J Public Health, 2014. 104(8): p. 1429-36. doi: 10.2105/AJPH.2013.301802
19. Lee, Y.O., et al., Youth tobacco product use in the United States. Pediatrics, 2015. 135(3): p. 409-15. doi: 10.1542/peds.2014-3202d
20. Lee, Y.O., et al., Multiple tobacco product use among adults in the United States: cigarettes, cigars, electronic cigarettes, hookah, smokeless tobacco, and snus. Prev Med, 2014. 62: p. 14-9. doi: 10.1016/j.ypmed.2014.01.014
21. Soneji, S., J. Sargent, and S. Tanski, Multiple tobacco product use among US adolescents and young adults. Tob Control, 2016. 25(2): p. 174-80. doi: 10.1136/tobaccocontrol-2014-051638
22. Sung, H.Y., et al., Polytobacco Use of Cigarettes, Cigars, Chewing Tobacco, and Snuff Among US Adults. Nicotine Tob Res, 2016. 18(5): p. 817-26. doi: 10.1093/ntr/ntv147
23. Tomar, S.L., H.R. Alpert, and G.N. Connolly, Patterns of dual use of cigarettes and smokeless tobacco among US males: findings from national surveys. Tob Control, 2010. 19(2): p. 104-9. doi: 10.1136/tc.2009.031070
24. Fagerstrom, K. and T. Eissenberg, Dependence on tobacco and nicotine products: a case for product-specific assessment. Nicotine Tob Res, 2012. 14(11): p. 1382-90. doi: 10.1093/ntr/nts007
25. Etter, J.F. and T. Eissenberg, Dependence levels in users of electronic cigarettes, nicotine gums and tobacco cigarettes. Drug Alcohol Depend, 2015. 147: p. 68-75. doi: 10.1016/j.drugalcdep.2014.12.007
26. Ramo, D.E., H. Liu, and J.J. Prochaska, Validity and reliability of the nicotine and marijuana interaction expectancy (NAMIE) questionnaire. Drug Alcohol Depend, 2013. 131(1-2): p. 166-70. doi: 10.1016/j.drugalcdep.2012.12.018
27. Valjent, E., et al., Behavioural and biochemical evidence for interactions between Delta 9-tetrahydrocannabinol and nicotine. Br J Pharmacol, 2002. 135(2): p. 564-78. doi: 10.1038/sj.bjp.0704479
28. Schauer, G.L., et al., Differences in the relationship of marijuana and tobacco by frequency of use: a qualitative study with young adults. Psychol Addict Behav, In press. doi: 10.1037/adb0000172.
29. Martinasek, M.P., R.J. McDermott, and L. Martini, Waterpipe (hookah) tobacco smoking among youth. Curr Probl Pediatr Adolesc Health Care, 2011. 41(2): p. 34-57. doi: 10.1016/j.cppeds.2010.10.001.
30. Klein, J.D., Hookahs and waterpipes: cultural tradition or addictive trap? J Adolesc Health, 2008. 42(5): p. 434-5. doi: 10.1016/j.jadohealth.2008.02.006.
31. Smith, J.R., et al., Increasing Hookah Use in California. Am J Public Health, 2011. doi: 10.2105/ajph.2011.300196.
32. Berg, C.J., et al., Perceived harm, addictiveness, and social acceptability of tobacco products and marijuana among young adults: marijuana, hookah, and electronic cigarettes win. Subst Use Misuse, 2015. 50(1): p. 79-89. doi: 10.3109/10826084.2014.958857.
33. Berg, C.J., et al., Cigarette users interest in using or switching to electronic nicotine delivery systems (ENDS) or smokeless tobacco for harm reduction, cessation, or novelty. Nicotine Tob Res, 2014. doi: 10.1093/ntr/ntu103.
34. Berg, C.J., Preferred flavors and reasons for e-cigarette use and discontinued use among never, current, and former smokers. Int J Public Health, 2016. 61(2): p. 225-36. doi: 10.1007/s00038-015-0764-x.
35. Montano, D.E. and D. Kasprzyk, The theory of reasoned action and the theory of planned behavior, in Health behavior and health education: Theory, research, and practice, K. Glanz, B.K. Rimer, and F.M. Lewis, Editors. 2002, Jossey-Bass: San Francisco. p. 67-98.
36. Ajzen, I., The theory of planned behavior. Organizational Behavior and Human Decision Processes, 1991. 50: p. 179-211. doi: 10.1016/0749-5978(91)90020-t
37. Bandura, A., Social foundations of thought and action: A social cognitive theory. . 1986, Englewood Cliffs, NJ: Prentice Hall.
38. Stone, A.L., et al., Review of risk and protective factors of substance use and problem use in emerging adulthood. Addict Behav, 2012. 37(7): p. 747-75. doi: 10.1016/j.addbeh.2012.02.014.
39. Hallfors, D.D., et al., Which comes first in adolescence--sex and drugs or depression? Am J Prev Med, 2005. 29(3): p. 163-70. doi: 10.1016/j.amepre.2005.06.002
40. Windle, M. and M. Wiesner, Trajectories of marijuana use from adolescence to young adulthood: predictors and outcomes. Dev Psychopathol, 2004. 16(4): p. 1007-27. doi: 10.1017/s0954579404040118
41. Wu, L.T. and J.C. Anthony, Tobacco smoking and depressed mood in late childhood and early adolescence. Am J Public Health, 1999. 89(12): p. 1837-40. doi: 10.2105/ajph.89.12.1837.
42. Creswell, J.W. and V.L.P. Clark, Designing and Conducting Mixed Methods Research, 2nd Edition. 2011, Thousand Oaks, CA: Sage Publications.
43. Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, 2014. 2014, Centers for Disease Control and Prevention: Atlanta, GA.
44. Berg, C.J., et al., DECOY: Documenting Experiences with Cigarettes and Other Tobacco in Young Adults. American Journal of Health Behavior, 2016. 40(3): p. 310-321. doi: 10.5993/ajhb.40.3.3.
45. Wellman, R.J., et al., A comparison of the psychometric properties of the hooked on nicotine checklist and the modified Fagerstrom tolerance questionnaire. Addict Behav, 2006. 31(3): p. 486-95. doi: 10.1016/j.addbeh.2005.05.031.
46. Wellman, R.J., et al., Measuring adults' loss of autonomy over nicotine use: the Hooked on Nicotine Checklist. Nicotine Tob Res, 2005. 7(1): p. 157-61. doi: 10.1080/14622200412331328394.
47. Piko, B.F., T.A. Wills, and C. Walker, Motives for smoking and drinking: Country and gender differences in samples of Hungarian and US high school students. Addict Behav, 2007. 32: p. 2087–2098. doi: 10.1016/j.addbeh.2007.01.013.
48. Wills, T.A., J.M. Sandy, and O. Shinar, Cloninger's constructs related to substance use level and problems in late adolescence: a mediational model based on self-control and coping motives. Exp Clin Psychopharmacol, 1999. 7(2): p. 122-34. doi: 10.1037//1064-1297.7.2.122.
49. Prochaska, J.O. and C.C. DiClemente, Self change processes, self-efficacy and decisional balance across five stages of smoking cessation, in Advances in Cancer Control-1983. 1984, Alan R. Liss, Inc: New York, NY. p. 131-140. doi: 10.1007/bf01204849.
50. Kroenke, K., R.L. Spitzer, and J.B. Williams, The Patient Health Questionnaire-2: validity of a two-item depression screener. Medical care, 2003. 41(11): p. 1284-1292. doi: 10.1097/01.mlr.0000093487.78664.3c.
51. Haardörfer, R., et al., Polytobacco, marijuana, and alcohol use patterns in college students: A latent class analysis. Addict Behav, In press. doi: 10.1016/j.addbeh.2016.03.034.
52. Evans-Polce, R., S. Lanza, and J. Maggs, Heterogeneity of alcohol, tobacco, and other substance use behaviors in U.S. college students: A latent class analysis. Addict Behav, 2016. 53: p. 80-5. doi: 10.1016/j.addbeh.2015.10.010.
53. Berg, C.J., et al., Smoker self-identification versus recent smoking among college students. Am J Prev Med, 2009. 36(4): p. 333-6. doi: 10.1016/j.amepre.2008.11.010.
54. Schauer, G.L., et al., Assessing the overlap between tobacco and marijuana: Trends in patterns of co-use of tobacco and marijuana in adults from 2003-2012. Addict Behav, 2015. 49: p. 26-32. doi: 10.1016/j.addbeh.2015.05.012.
55. Schauer, G.L., et al., Differences in Tobacco Product Use Among Past Month Adult Marijuana Users and Nonusers: Findings From the 2003-2012 National Survey on Drug Use and Health. Nicotine Tob Res, 2015. doi: 10.1093/ntr/ntv093.