Tobacco use initiation by youth: Which product comes first?

Youth have the opportunity to be introduced to nicotine in many different ways. In addition to “traditional” products, such as cigarettes and chewing tobacco, several new products have hit the market in the past decade. Many of these novel products, including hookah tobacco and little cigars, are highly flavored, making them ideal “starter products” for youth. The goals of this study were to identify the first tobacco products used and to assess associations of first tobacco products with gender and current cigarette smoking. In fall 2010, 3,154 freshmen from 11 colleges in North Carolina and Virginia completed a web-survey. Data were collected as part of a cohort study that oversampled smokeless users (14.2%) and cigarette smokers (34.1%). Among those surveyed, 62.7% reported ever trying a tobacco product. Cigarettes were the most common first product (43.9%), followed by cigars (25.7%), hookahs (18.0%), and snuff (6.8%). Preliminary analyses revealed a significant association between first product and gender (x2(4)=216.5, p<.001). Among females, the most prevalent first products were cigarettes (57.3%), hookahs (21.7%) and cigars (14.4%). Among males, the most prevalent first products were cigars (34.5%), cigarettes (32.5%), and hookah (14.9%). There was also an association between first product and current cigarette smoking (x2(4)=442.6, p<.001). Among current cigarette smokers, 62% tried a cigarette first. However, 17% tried a cigar first and 11% tried a hookah first, suggesting that for some, these products may have served as a gateway to cigarette smoking. These results highlight the need for longitudinal studies to better evaluate this hypothesis.