Patterns of poly tobacco use among adults in the Population Assessment of Tobacco and Health (PATH) study, 2013-2017: A multistate Markov transition analysis

Authors

Fatema Shafie Khorassani, Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA fshafie@umich.edu.
Andrew F. Brouwer, Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.Follow
Jana L. Hirschtick, Advocate Aurora HealthFollow
Jihyoun Jeon, Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.
Evelyn Jimenez-Mendoza, Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.
Rafael Meza, Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.
Nancy L. Fleischer, Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.

Recommended Citation

Shafie Khorassani F, Brouwer AF, Hirschtick JL, et al. Patterns of poly tobacco use among adults in the Population Assessment of Tobacco and Health (PATH) study, 2013-2017: a multistate Markov transition analysis [published online ahead of print, 2023 Apr 24]. Tob Control. 2023;tc-2022-057822. doi:10.1136/tc-2022-057822

Abstract

Background: A better understanding of sociodemographic transition patterns between single, dual and poly tobacco product use may help improve tobacco control policy interventions.

Methods: HRs of transition between never, non-current (no past 30-day use), cigarette, e-cigarette, other combustible, smokeless tobacco (SLT), dual and poly tobacco use states in adults were estimated for age, sex, race/ethnicity, education and income using a multistate model for waves 1-4 of the Population Assessment of Tobacco and Health study (2013-2017), a US-based cohort study, accounting for complex survey design.

Results: Sole cigarette and SLT use were persistent, with 77% and 78% of adults continuing use after one wave. Other use states were more transient, with 29%-48% of adults reporting the same pattern after one wave. If single-product users transitioned, it was most likely to non-current use while dual or poly cigarette users were most likely to transition to exclusive cigarette use. Males were more likely than females to initiate combustible product use after a history of no use, and after a period of tobacco use cessation. Hispanic and non-Hispanic black participants initiated cigarette use at higher rates than non-Hispanic white participants, and had higher rates of experimentation with tobacco products between study waves. Lower socioeconomic status was associated with higher rates of transition into combustible tobacco use.

Conclusions: Dual and poly tobacco use is largely transient, while single-use patterns are more stable over time. Transitions differ by age, sex, race/ethnicity, education and income, which may influence the impact of current and future tobacco control efforts.

Document Type

Article

PubMed ID

37094934