Evolving Patterns of Adolescent Nicotine Use in the United States: An Ecological Perspective.

INTRODUCTION: Adolescent nicotine use in the U.S. has diversified over the past two decades, with the rise of electronic nicotine delivery systems (ENDS) and oral nicotine products (ONPs) such as pouches, lozenges, candies, and gum. Declining vaping rates alongside growing ONP use signal shifting consumption patterns and necessitate an updated profile of the modern adolescent polynicotine user.

METHODS: Data came from the 2023 National Youth Tobacco Survey (n = 8,585 high school students). Latent class analysis (LCA) identified subgroups based on patterns of nicotine product use. Multivariable analyses examined associations between class membership and socioenvironmental and individual-level factors, including neighborhood disorder, school-level nicotine visibility, household tobacco exposure, social media use, mental health, and executive functioning.

RESULTS: Four distinct classes emerged: abstainers, dual users (combustible and electronic cigarettes), generalists (multi-modal users), and vape-focused youth. Generalists represented a small but high-risk subgroup characterized by multiple forms of use, higher exposure to neighborhood disorder, permissive school norms, and tobacco use within the home.

CONCLUSIONS: Findings highlight the growing complexity of adolescent nicotine use and the need for ecological approaches that consider contextual and behavioral influences. Continued surveillance and targeted interventions are essential to address multi-modal use and anticipate emerging trends in youth nicotine consumption.