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We propose to quantify population-level trends in tobacco use in order to inform both California’s tobacco control policies and the FDA’s regulatory actions over tobacco products. The proposed studies will analyze the large federally-sponsored surveys of tobacco use, including the new FDA-sponsored PATH longitudinal survey. We aim to target specific questions of direct relevance to both state level tobacco control policy and to potential FDA regulatory action. Our broad area of investigation is association of marketing and use of non-cigarette tobacco products with smoking initiation among youth and young adults, and with smoking cessation behavior among established smokers. The analyses will control for known predictors of tobacco use behaviors which are susceptible to state-level tobacco control efforts, such as local smoking prevalence or presence of a smoke-free home. Specific areas of potential interest to policy makers and regulators include measuring the susceptibility to tobacco industry marketing efforts among youth and young adults; investigating how concurrent use of cigarettes and other tobacco products affects cigarette smoking behavior; and documenting changing patterns of cigarette smoking cessation in response to the new tobacco products on the market, at the population level. We propose to document and quantify these associations within the US population as a whole, and to identify trends and associations that have disproportionate impact among vulnerable subgroups. The targeted demographic groups for which we expect to have adequate sample sizes include racial/ethnic minorities, those with poor mental health, and less educated and less affluent populations. Specific Aims AIM 1: To quantify patterns of cigarette smoking initiation among youth and young adults, particularly in relation to susceptibility to experimentation and use of non-cigarette tobacco products. We will focus on the detailed measures of susceptibility to initiation and use across multiple tobacco products which are included in the PATH survey. We will identify trends in initiation of e-cigarettes and other non-cigarette products, and identify how these relate to cigarette smoking curiosity, susceptibility to use, experimentation, and established smoking, by age. Of particular interest is use of flavored tobacco and differences in patterns of product initiation among targeted demographic subgroups. AIM 2: To quantify patterns of poly-tobacco use among cigarette smokers, particularly in relation to tobacco industry marketing of e-cigarettes and other non-cigarette products. Using the available national surveys, including the PATH public use data file, we will explore receptivity to tobacco marketing across different products among youth, young adults, and older adults. We will explore whether marketing receptivity is associated with curiosity, susceptibility to use and experimentation with different products, as well as with later regular use of both new and traditional tobacco products. We will investigate differences in these patterns among targeted demographic subgroups. AIM 3: To quantify patterns of cigarette smoking cessation among established smokers, particularly in relation to use of non-cigarette tobacco products. We will quantify differences in attempted and successful cigarette smoking cessation between exclusive smokers and smokers who concurrently use other tobacco products, especially electronic nicotine delivery system products. We will study how other tobacco use relates to perceptions, attitudes and beliefs regarding cigarettes among current and former smokers. We will compare the role of new products as influences on cessation controlled for other established predictors of cessation (e.g. cigarette consumption level, methods used to quit, presence of a smoke-free home). We will investigate differences in these patterns among targeted demographic subgroups.
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