New Study Finds the Use of Multiple Tobacco Products Is Popular Among Teenagers

UNC Tobacco Prevention and Evaluation Program finds poly-tobacco use among teenagers is on the rise.

CHAPEL HILL – Researchers at the Tobacco Prevention and Evaluation Program (TPEP) at the University of North Carolina have published a paper in the International Journal of Environmental Research and Public Health discussing the use of multiple tobacco products, or poly-tobacco use, among North Carolina’s high school students.

The study, titled “Poly-Tobacco Use Among High School Students,” surveyed more than 4,000 students at 83 North Carolina high schools and found that one-third (29.7 percent) reported current tobacco use. Among all students, 19.1 percent reported current poly-tobacco use (more than one tobacco product), compared to only 10.6 percent who reported current use of only one product. 

“This study illustrated how much of a problem poly-tobacco use really is among adolescents,” said lead author Sarah Kowitt, who is a third-year doctoral student in the Health Behavior department at the UNC Gillings School of Global Public Health. “Adolescents are not just using cigarettes. They are using cigarettes and other tobacco products – some of which are new and unregulated. We need to be thinking about how to tackle this problem from multiple dimensions, garnering support from policy, research, and practice.”

Cigarette use among adolescents has declined substantially over the past few decades; however, tobacco products such as snus, e-cigarettes, and hookah are growing in popularity among youth. The most common combination of products used by poly-tobacco users was cigarettes and cigars or cigarillos (little cigars), followed by cigarettes and e-cigarettes. A 2012 study found that 21.7 percent of high schoolers had ever used and 8.8 percent were currently using one or more of these products.

Additionally, only 68.8 percent of poly-users reported believing that “all tobacco products are dangerous,” compared to 81.5 percent of single-users and 91.4 percent of non-users. Poly-users were also significantly more likely than single-users or non-users to report that they believed that “smoking cigarettes makes young people look cool” and that “young people who smoke cigarettes have more friends.” Males were significantly more likely than female students to use one or more tobacco products.

The researchers suggest that several reasons may be behind this high rate of poly-tobacco use in North Carolina students. North Carolina is a major tobacco-growing state and has one of the lowest cigarette taxes in the country. The state also lacks comprehensive tobacco-free workplace policies, and money earmarked for tobacco use prevention programs has been diverted to other programs during recent budget cuts.

These findings could have major implications for communication campaigns, policy efforts, and future research for prevention, regulation, and control of poly-tobacco use among adolescents.

The University of North Carolina Tobacco Prevention and Evaluation Program (TPEP), housed in the UNC Department of Family Medicine, has provided expertise in formative and summative evaluation for tobacco control, prevention, and cessation initiatives since 1995.

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