Three year trends in the use of emerging tobacco products

Background: Snus and electronic cigarettes have recently been introduced to the US market. These products and hookah waterpipes have been heavily promoted; however, to date, FDA only has regulated snus. We assess three year trends in use of these products among US adults, and current predictors of electronic cigarette use.

Methods: In 2010-2012, we applied a mixed-mode survey to obtain annual, representative samples of US adults.

Results: In weighted analysis, lifetime prevalence of snus use (5.1% to 6.5%) and water pipe (8.8% to 9.9%) did not significantly change from 2011-12. Lifetime prevalence of electronic cigarettes increased from 1.8% to 10.8%, p <.001. In 2012, daily smokers (44.8%) and nondaily smokers (24.5%) were the most likely to have tried electronic cigarettes, compared to former smokers (7.5%) and never smokers (1.7%). Younger (12.8%) and middle aged adults (13.4%) compared to older adults (2.4%) and those without a high school degree (10.9% vs 7.4%) were more likely to have tried electronic cigarettes (p<.05 for all comparisons). In multivariable analysis, current daily (OR=53.3 , 95% CI = 34.0–83.6), nondaily (20.2, 11.0–37.2), and former smoking status (6.6, 4.1–10.5) remained significant, as did young (7.2, 3.5–15.0) and middle aged adults (6.7, 3.9-11.3).

Conclusion: Use of emerging tobacco products raises concerns about nonsmokers being at risk for nicotine dependence, current smokers maintaining their dependence, and the impact of poly-tobacco use. Greater awareness of emerging tobacco product prevalence and the high risk demographic user groups will inform efforts to determine appropriate public health policy and regulatory action.