Youth susceptibility to tobacco use: Is it general or specific?

Importance Susceptibility to tobacco use can help identify youth that are at risk for tobacco use. Objective To estimate the extent of overlap in susceptibilities across various tobacco products, investigate correlates with susceptibilities, and examine whether the relationship linking susceptibility with the onset of use is product specific or is accounted for by a general susceptibility-onset relationship. Design Prospective cohort study. Setting Analysis of data from the longitudinal Population Assessment of Tobacco and Health study wave 4 (December 2016 to January 2018) and wave 4.5 youth surveys (December 2017 to November 2018). Participants A nationally representative sample of non-institutionalized youth 12-17 years old who had never used a tobacco product at baseline assessment. Main variable of interest Susceptibility to the use of each type of tobacco product assessed at wave 4. Main outcomes Onset of use of various tobacco products defined as the first use occurring between waves 4 and 4.5 assessments. Results Cigarettes and e-cigarettes were the most common (∼25%), while snus was the least common (<5%), tobacco product to which youth were susceptible. There was a high degree of overlap in susceptibilities across tobacco products (65% of tobacco-susceptible youth were susceptible to more than one tobacco product). Tobacco-susceptible youth were more likely to have used cannabis or consumed alcohol in the past 30 days or to have tobacco-using peers. Susceptibility to use predicted the onset of use (incidence ratio = 3.2 to 12.9). Estimates for the product-specific path were null, except for e-cigarettes (β=0.08, 95% CI=0.04 to 0.13) and filtered cigars (β= -0.09, 95% CI= -0.13 to -0.05), after accounting for the general susceptibility-to-tobacco-onset relationship (β=0.50, 95% CI=0.42 to 0.58). Conclusions and Relevance Youth susceptibility to tobacco use overlaps widely across different tobacco products and other risky behaviors. Public health efforts may benefit from a holistic approach to risk behavior prevention planning. Key Points Question Is susceptibility to tobacco use product specific, or does it represent a general openness to tobacco use? Findings There was a large degree of overlap in the susceptibility to tobacco use across various product categories. Associations linking susceptibility and the onset of use of a tobacco product were not statistically robust once the general level of susceptibility to tobacco use was considered. Meaning Susceptibility to tobacco use is better conceived as a general openness to tobacco use rather than product specific.