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Changes in patterns of youth multiple tobacco and/or e-cigarette product use in the US between 2014 and 2020: a multiple-group latent class analysis
  1. Tianze Sun1,2,3,
  2. Carmen C W Lim1,2,3,
  3. Brienna N Rutherford1,2,
  4. Benjamin Johnson1,2,
  5. Jason Connor2,
  6. Coral E Gartner3,
  7. Wayne D Hall2,
  8. Janni Leung2,
  9. Gary Chan2
  1. 1 School of Psychology, The University of Queensland, Saint Lucia, Queensland, Australia
  2. 2 National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia
  3. 3 NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, Faculty of Medicine, Herston, Queensland, Australia
  1. Correspondence to Tianze Sun, National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia; tianze.sun{at}


Background Multiple tobacco and e-cigarette product (MTEP) use, the concurrent use of two or more different types of tobacco and/or e-cigarettes products, is common among young people in the US. Changes in patterns of MTEP use among US youth between 2014 and 2020 were identified and the determinants of MTEP use were examined.

Methods Four years of repeated cross-sectional data from the US National Youth Tobacco Survey of middle and high school students from grade 6 to 12 (Ntotal=77 402). Multigroup latent class analysis (LCA) was applied to the data series to allow for simultaneous identification of MTEP use patterns between 2014 and 2020. Logistic regression was used to predict class membership on demographic and tobacco-related variables.

Findings Over the 7-year period, LCA identified three patterns: minimal/non-users (MNU: ~89.8%), mostly occasional e-cigarette and cigarette users (MOEC: ~9%) and polytobacco users (POLY: ~1.2%). From 2014 to 2020, MNU increased from 86.4% to 92% (p<0.05), while MOEC and POLY decreased from 11.2% to 7.9% and from 2.4% to 0.1%, respectively. The probability of regular e-cigarette use increased from 0 to 2.3% among MNU, 6% to 31.9% among MOEC and 29.6% to 67.6% among POLY (p<0.05). In binomial logistic regression, being male, in high school, non-heterosexual, living with someone who uses tobacco at home, having cognitive difficulties, having lower perceptions of tobacco’s danger and exposure to tobacco marketing were associated with greater odds of MOEC and POLY than MNU.

Conclusions There was an increase in regular e-cigarette use in all three classes, but a corresponding decrease in the proportion of MTEP use. Public health interventions to discourage uptake of e-cigarettes, such as tighter restrictions on marketing to minors, are warranted and there is a need to consider disparities in the determinants of MTEP use.

  • Co-substance use
  • Advertising and Promotion
  • Electronic nicotine delivery devices
  • Addiction
  • Public policy

Data availability statement

Data are available in a public, open access repository.

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Data availability statement

Data are available in a public, open access repository.

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  • Twitter @TianzeSun, @Brie_Rutherford, @benjohnson235, @CoralGartner, @GaryCKChan

  • Contributors TS—conceptualisation, study registration, statistical analysis and writing initial draft. GC—conceptualisation, study registration and statistical analysis, writing and review. CCWL—statistical analysis, investigation, writing and review. BNR, BJ, JL, JC, CEG and WDH—writing, review and editing. All authors contributed to the data interpretation, writing and revisions of the report.

  • Funding GC was funded by a National Health and Medical Research Council (NHMRC) Investigator Grant (GNT1176137). CEG was funded by an NHMRC Centre of Research Excellence Grant. CCWL was funded by NHMRC postgraduate scholarship (GNT2005317). JPC and WDH were funded by the Department of Health, Australia. TS and BNR were funded by postgraduate scholarships provided by the University of Queensland.

  • Disclaimer The funders had no input into the design, implementation or running of the study, in the writing of the manuscript, or decision to publish.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.