Dual- and Polytobacco/Nicotine Product Use Trends in a National Sample of High School Students

Purpose: The study purpose was to examine changes in patterns of ever and current dual- and polyproduct use over time and to examine demographic and modifiable risk factors including tobacco smoke exposure (TSE). Design: A secondary analysis of the 2013 to 2015 National Youth Tobacco Survey data. Setting: Nationwide high schools were selected. Subjects: A total of 31 022 high school students. Measures: Ever and current (past 30 days) tobacco/nicotine product use, home tobacco/nicotine product use, TSE and e-cigarette vapor exposure, and demographic characteristics were measured. Analysis: Multivariable logistic regression and multinomial logistic regression models. Results: Of the students, 9.4% were ever dual users and 18.6% were ever poly users. Rates of ever/current use of e-cigarettes and hookah increased from 2013 to 2015 (all Ps < .001). In 2015, participants were 4.8 times (95% confidence interval [CI], 4.5-5.2) and 4.0 times (95% CI, 3.5-4.4) more likely to report ever/current e-cigarette use and 1.61 times (95% CI, 1.5-1.7) and 1.48 times (95% CI, 1.3-1.7) more likely to report ever/current hookah use. Participants reporting TSE were 15.4 times (95% CI, 11.5-21.0) more likely to report current poly use, and those with e-cigarette exposure were 10.4 times (95% CI, 7.8-13.8) more likely to report current poly use. Conclusion: From 2013 to 2015, rates of ever and current use of e-cigarettes and hookah increased. Tobacco smoke and e-cigarette exposure were associated with higher rates of dual and poly use. Prevention efforts targeting these products are needed.