El-Toukhy Sherine, Choi Kelvin
Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD.
Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
Nicotine Tob Res. 2016 Jul;18(7):1596-605. doi: 10.1093/ntr/ntw008. Epub 2016 Jan 13.
To examine prevalence and correlates of five mutually exclusive tobacco-use patterns among US youth tobacco users.
A nationally representative sample of tobacco users (N = 3202, 9-17 years) was classified into five product-use patterns. Weighted multinominal and multivariate logistic regression models were used to examine prevalence of product-use patterns by gender, race and ethnicity, and grade level; and associations between product-use patterns and perceived accessibility of tobacco products, exposure and receptivity to pro-tobacco marketing, social benefits of smoking, and tobacco-associated risks.
Dual use (ie, use of two product categories) was the most prevalent pattern (30.5%), followed by non-cigarette combustible only (26.7%), polytobacco (ie, use of three product categories; 17.5%), cigarette only (14.9%), and noncombustible only (10.4%) use. Product-use patterns differed by gender, race, and ethnicity. Compared to cigarette only users, dual and polytobacco users were more likely to be exposed to and be receptive to pro-tobacco marketing, and were less likely to acknowledge tobacco-use related risks (Ps < .05).
Curbing tobacco use warrants research on users of more than one tobacco-product categories according to the risk-continuum categorization.
We present a risk-continuum categorization of product-use patterns among tobacco users not older than 17 years. We classify tobacco users into five mutually exclusive product-use patterns: cigarette only users, non-cigarette combustible only users, noncombustible only users, dual use, and polytobacco use. This categorization overcomes limitations in current literature on tobacco-use patterns, which include exclusion of certain products (eg, e-cigarettes) and product-use patterns (eg, exclusive users of non-cigarette products), and inconsistent classification of tobacco users. It is parsimonious yet complex enough to retain differential characteristics of sub-tobacco users based on number (single, dual, polytobacco) and categories (cigarettes, non-cigarette combustibles, noncombustibles) of tobacco products consumed.
研究美国青少年烟草使用者中五种相互排斥的烟草使用模式的流行情况及相关因素。
对全国具有代表性的烟草使用者样本（N = 3202，9至17岁）进行分类，分为五种产品使用模式。采用加权多项和多变量逻辑回归模型，按性别、种族和民族以及年级水平来研究产品使用模式的流行情况；以及产品使用模式与烟草产品的可及性认知、对烟草营销的接触和接受程度、吸烟的社会效益以及烟草相关风险之间的关联。
双重使用（即使用两类产品）是最常见的模式（30.5%），其次是仅使用非香烟类可燃产品（26.7%）、多种烟草使用（即使用三类产品；17.5%）、仅使用香烟（14.9%）以及仅使用非可燃产品（10.4%）。产品使用模式因性别、种族和民族而有所不同。与仅使用香烟的使用者相比，双重和多种烟草使用者更有可能接触并接受烟草营销，且不太可能认识到与烟草使用相关的风险（P < 0.05）。
根据风险连续体分类，遏制烟草使用需要对使用不止一类烟草产品的使用者进行研究。
我们提出了17岁及以下烟草使用者产品使用模式的风险连续体分类。我们将烟草使用者分为五种相互排斥的产品使用模式：仅使用香烟的使用者、仅使用非香烟类可燃产品的使用者、仅使用非可燃产品的使用者、双重使用以及多种烟草使用。这种分类克服了当前烟草使用模式文献中的局限性，这些局限性包括排除某些产品（如电子烟）和产品使用模式（如非香烟产品的独家使用者），以及烟草使用者分类不一致问题。它既简洁又复杂，足以根据所消费烟草产品的数量（单一、双重、多种烟草）和类别（香烟、非香烟类可燃产品、非可燃产品）保留亚烟草使用者的不同特征。
