Socioecological factors associated with multiple nicotine product use among US youth: Findings from the population assessment of tobacco and health (PATH) study 2013-2018

Objective: This study utilized a socioecological approach to prospectively identify intrapersonal, familial, and environmental factors associated with single nicotine product use (NPU) and multiple NPU among U.S. youth. Methods: Participants were 10,029 youths (ages 12 -17 years) who had completed the Population Assessment of Tobacco Health study 's Wave 1 (2013 -2014) and Wave 4 (2016 -2018) assessments and data on past 30 -day nicotine product use. Multinomial logistic regression was fit for the 3 -level outcome (no use, single NPU, multiple NPU) to estimate adjusted associations between the predictors and the outcome. Results: The current study found that intrapersonal (sex, age, race/ethnicity, internalizing symptoms, sensation seeking, harm perceptions, lifetime history of using two or more tobacco products), familial (parental discussion about not using tobacco and living with someone who uses tobacco products) and environmental factors (exposure to tobacco advertising) commonly associated with tobacco use differentiated between individuals who later reported past 30 -day NPU (either multiple or single NPU) from those who did not report past 30 -day NPU. One familial factor only differentiated between lifetime users who were single NPUs from those who reported no NPU: non-combustible tobacco product use allowed anywhere in the home. Intrapersonal factors differentiated multiple NPU from single NPU: older age, being male, lifetime history of using nicotine product and less harm perceptions. Conclusions: This study identified factors that may be studied to prevent any NPU, along with factors that may be studied to promote harm reduction by preventing escalation of single NPU to problematic patterns of multiple NPU.