With cigarette use declining and new tobacco products continuing to emerge, youth and young adults are often turning to other tobacco products like e-cigarettes, cigars and hookah.

To examine when and how youth and young adults switch between different tobacco products, a Truth Initiative® study published in Nicotine & Tobacco Research used survey data on the use of combustible tobacco products (cigarettes, hookah and all types of cigars) and electronic products (e-cigarettes and e-hookah) among 15- to 21-year-olds. The survey collected data from participants every six months for two and a half years between 2014 and 2017, and put them into 1 of 5 groups:

  • Never use (never used any combustible or electronic product)
  • Noncurrent use (used a combustible or electronic product, but not currently)
  • Electronic-only use (currently using only an electronic product)
  • Combustible-only use (currently using only a combustible product)
  • Dual use (currently using both a combustible and electronic product)

The results revealed insights into the relationship between current and future use, and how long participants used certain tobacco products.

Current use vs. future use

The study shows that observing which tobacco products youth and young adults currently use can predict what products they use six months to two years in the future. For example, over shorter time periods — 12 months or less — electronic-only users were most likely to switch to noncurrent use, compared with combustible-only and dual users, who were more likely to remain users.

After a year, electronic-only users had a higher chance of transitioning to combustible use than those who had never used any tobacco products. Combustibles were the products most likely to be used by those who remained active tobacco users during the study and by those who became tobacco users during the study. However, participants who used an electronic or combustible product were most likely — at 60 percent — to be noncurrent users in two years.

Previous studies show that e-cigarette use increases the risk of ever using combustible tobacco cigarettes among youth and young adults, and that young adults who use e-cigarettes are more than four times as likely to begin smoking cigarettes within 18 months, compared with their peers who do not vape.

Duration of product use

Participants were electronic-only users for shorter periods of time than they were combustible-only and dual users. Those who used only electronic products did so for three months before changing their tobacco use behavior. Those who used only combustible products and those who used both electronic and combustible products did so for six months before changing. Noncurrent users had the longest use time, at 18 months.

The short periods that youth and young adults are currently using one or more tobacco products suggest they are changing their use patterns frequently. The longer time for noncurrent use suggests that youth and young adults are experimenting with tobacco products infrequently, or going long periods of time between uses.

Understanding “how youth transition between different products is critical to identifying priorities in tobacco control policies,” researchers wrote.

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