Cigarette smokers more tobacco dependent vs. other tobacco product users
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Key takeaways:
- Cigarette smokers relied on their tobacco product more than smokeless tobacco and multiple product users.
- Tobacco cessation programs should consider the tobacco product predominantly used.
Tobacco dependence was greater among adults who smoked cigarettes than adults who used smokeless tobacco and multiple tobacco products, according to results published in Nicotine & Tobacco Research.
“The findings suggest that tailored harm reduction and tobacco cessation approaches are needed for individuals with different tobacco use profiles,” Bian Liu, PhD, MSc, associate professor of population health science and policy and of environmental medicine and public health, and Lihua Li, PhD, associate professor of population health science and policy and of geriatrics and palliative medicine, both at Icahn School of Medicine at Mount Sinai, told Healio in a statement. “For example, interventions, such as targeting the dominant cigarette smokers for tobacco dependence reduction and reducing the transition from poly users or smokeless dominant users to cigarette dominant group may need to be prioritized in order to increase the success of tobacco use cessation. In addition, tailored patient-provider discussions should be provided to individuals that may fit a particular tobacco use-tobacco dependence profile. Screening for dominant cigarette users may help prioritize intervention effort given their elevated tobacco dependence levels.”
Liu, Li and colleagues evaluated 3,463 adults who used tobacco within the last 30 days from the Population Assessment of Tobacco and Health (PATH) study to determine differences in tobacco dependency across several tobacco products from 2013 to 2018.
Researchers used latent class analysis to identify which tobacco product — cigarette, electronic-nicotine delivery systems, traditional cigar, cigarillo/filtered cigar, pipe, hookah, snus pouches, smokeless/dissolvable tobacco — each adult predominantly and consistently used during each of the four survey waves.
To capture tobacco dependence, researchers utilized two measures: a composite index and the total score from a 16-item assessment.
Tobacco product usage
Assessing product use patterns from 2013 to 2018, researchers found steady usage levels from dominant cigarette users (n = 2,212; 62%-68%), dominant smokeless product users (n = 265; 7%-9%) and users of cigarettes, e-cigarettes and cigars , or “poly users”(n = 986; 24%-31%).
“It’s a little bit surprising that three tobacco use patterns or profiles were consistent across the four survey waves at the population level, despite [the fact] that individuals can switch among the three profiles from year to year,” Liu and Li told Healio.
Among the three tobacco product groups, more poly users were aged 18 to 24 years old (24.76% vs. cigarette users, 9.73% vs. smokeless tobacco users, 7.94%), whereas more users of smokeless products were non-Hispanic white (86.53% vs. cigarette users, 67.54% vs. poly users, 69.56%). The prevalence of adult men was higher among those who used smokeless tobacco (95.29%) and multiple products (78.61%) compared with cigarette smokers (46.22%).
Tobacco dependence
In terms of tobacco dependency, dominant cigarette smokers had the highest scores for both tobacco dependence measures (mean total, 45.84; index, 0.12), whereas poly users had the lowest scores (mean total, 39.59; index, 0.05). As years passed, these relationships stayed consistent, Liu and Li told Healio.
The observed relationships between tobacco dependence and these specific tobacco products continued to be seen in generalized estimating equations regression models that accounted for age at interview, age at tobacco usage, sex, race/ethnicity, BMI, highest education level, total household income, health insurance and residential region.
“The current study established that, at the population-level, there existed three latent tobacco use profiles, and their associated tobacco dependence levels were also stable across four survey waves,” Liu and Li told Healio. “As individuals may change tobacco use profiles over time, future studies should examine patterns of tobacco use profile transitions including whether transitions differ by sociodemographic factors and investigate how tobacco use profile transitions impact tobacco dependence levels over time, in the context of other smoking behaviors, including quit attempt, relapse and smoking cessation.
“[Further], it would be interesting to conduct a similar study on the youth population since the current study focuses on adult tobacco users who are 18 years or older,” Liu and Li added.
For more information:
Bian Liu, PhD, MSc, can be reached at bian.liu@mountsinai.org.
Lihua Li, PhD, can be reached at lihua.li@mountsinai.org.