Nicotine Dependence and Its Impact on Poly-Tobacco Use Among US Adults.

BACKGROUND

Poly-tobacco use (PTU), the consumption of multiple tobacco products, is linked to higher mortality rates compared to single product use. Existing cross-sectional studies have demonstrated a relationship between PTU and nicotine dependence (ND). This study explores whether higher levels of ND increase the risk of transitioning to PTU using a longitudinal cohort.

METHODS

We utilized data from waves 1-6 (2013-2021) of the Population Assessment of Tobacco and Health study adult data. A standardized ND score, calculated from 16 items, was assigned to each participant at baseline. ND was treated as a continuous variable ranging from 1 (least dependent) to 5 (most dependent). Participants who were single product users at Wave 1 and had no prior history of PTU were included and followed through Waves 2-6. Any transition to PTU was defined as a case. Cox proportional hazard regression was used to assess the risk of transitioning to PTU, adjusting for potential confounders.

RESULTS

A one-unit increase in ND was associated with a 41% increased risk of transitioning to PTU (aHR =1.411, 95% CI: [1.245, 1.599]). Younger age, family below poverty level, and substance use were also associated with increased risks of transitioning to PTU.

CONCLUSIONS

These findings underscore the importance of ND as a key factor in the progression to PTU. Interventions targeting individuals with high ND levels may be effective in preventing the transition to PTU.