Single, Dual, and Poly Use of Flavored Tobacco Products Among Youths

INTRODUCTION: Flavoring has become the leading reason for current tobacco use among adolescents. This study sought to evaluate patterns of flavored tobacco product use and associated risk factors among youths. METHODS: Weighted estimates of single, dual, and poly use of flavored tobacco products were calculated from the 2014 National Youth Tobacco Survey (n = 21,926). Multinomial logistic regression was performed to assess factors associated with flavored product use. RESULTS: Among current tobacco users (n = 3,805), 70.0% of students were current users of flavored tobacco products: 42.6% used a single flavored product, 16.8% used 2 flavored products (dual users), and 10.6% used more than 2 flavored products (poly users). Flavored product use, especially dual and poly use, was higher among high school students compared with middle school students. Compared with single flavored tobacco product users (36%), dual (57%) and poly users (79%) of flavored tobacco products had higher prevalences of using flavored e-cigarettes (P < .001). Non-Hispanic blacks and those of other races had lower prevalences than non-Hispanic whites of using flavored products but not nonflavored products. Tobacco use by household members, no perception of harm from tobacco products, and more frequent exposure to tobacco advertisement in newspapers/magazines and stores were associated with increased odds of flavored product use. CONCLUSION: The concurrent use of flavored tobacco products is prevalent among youths. E-cigarettes were the leading flavored product and often concurrently used with other flavored tobacco products. Comprehensive control and prevention strategies to reduce flavored tobacco use among youths are needed.