Sociodemographic differences in single, dual, and poly tobacco use among Appalachian youth
Joy L. Hart 1, 2, 3  
Lindsey A. Wood 1, 3
Kandi L. Walker 1, 2, 3
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Department of Communication, University of Louisville, Louisville, United States
American Heart Association Tobacco Center for Regulatory Science, Dallas, United States
School of Medicine, Envirome Institute, University of Louisville, Louisville, United States
Joy L. Hart   

University of Louisville, Department of Communication, Louisville, KY 40292, United States
Publication date: 2020-07-28
Submission date: 2020-04-29
Final revision date: 2020-06-10
Acceptance date: 2020-06-29
Tob. Prev. Cessation 2020;6(July):45
Patterns of youth tobacco use, including use of multiple products, have likely shifted as e-cigarettes have grown in popularity. However, there is limited understanding of dual and poly tobacco use and the associated disparities, especially among Appalachian youth.

We analyzed Youth Appalachian Tobacco Study data (n=1116) to estimate prevalence of current (past-30 day) cigarette, e-cigarette, and smokeless tobacco use by gender, race/ethnicity, age, school type, state, smartphone use, and number of household tobacco users. We created a pattern of tobacco use variable (i.e. never, former, single, dual, poly) based on all possible combinations of the included products. Using multivariable multinomial logistic regression (outcome reference: never use), we evaluated associations between sociodemographic characteristics and patterns of tobacco use.

Former (16.2%) was the most common tobacco use group, followed by single (10.8%), dual (4.5%), and poly (2.4%) use. Dual and poly use were more prevalent among males, Whites/Caucasians, older participants, and participants living in households with tobacco users. Kentucky residents (vs New York) had higher odds of dual use (OR=5.15; 95% CI: 1.72–15.44), and youth who used smartphones for ≥20 hours/week (vs <20 hours/week) had greater odds of poly use (OR=3.02; 95% CI: 1.34–6.80).

Differences in single, dual, and poly tobacco use were evidenced by sociodemographic characteristics. Additional inquiry should further examine these disparities so that tobacco prevention interventions can be appropriately tailored.

We thank Clara Sears, Alex Lee, Courteney Smith, and Allison Siu for assisting with data collection and Shesh Rai for assisting with the analyses. We also acknowledge the University of Louisville's research computing group and the Cardinal Research Cluster, whose resources facilitated our work.
The authors have each completed and submitted an ICMJE form for disclosure of potential conflicts of interest. The authors declare that they have no competing interests, financial or otherwise, related to the current work. J. L. Hart and K. Walker report grants from the National Institutes of Health during the conduct of the study.
This work was supported, in part, by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH) and FDA Center for Tobacco Products under Award Numbers P50HL120163 and U54HL120163. The content is solely the responsibility of the authors and does not necessarily represent the official views of the the NIH, the Food and Drug Administration, or the American Heart Association. The funding sponsors had no role in study design; data collection, analyses, or interpretation; manuscript preparation; or the decision to publish the results.
Not commissioned; externally peer reviewed.
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