Latent transition analysis of use frequencies for multiple nicotine and tobacco products among US adults

Abstract

Background: Given the many nicotine and tobacco products in use, studies of the interdependence of use patterns and transitions are needed.

Methods: Using Waves 1-4 of the PATH Study, we analyzed latent transitions among adults who ever regularly used nicotine or tobacco products at Wave 1 to identify latent use states (n = 12,358) and estimated one-wave transition probabilities. Multinomial logistic regression identified demographic factors associated with transitions.

Results: We identified seven latent states: Non-current (42.5% in Wave 1); Daily Cigarette (29.7%); Non-daily Cigarette (9.8%); Daily Cigarette and Non-daily Polytobacco (DCNP, 7.4%), Daily Smokeless Tobacco (SLT, 4.9%); Non-daily Cigar (3.2%); and Daily ENDS (Electronic Nicotine Delivery Systems) and Non-daily Cigarette (DENC, 2.4%). Among Daily Cigarette, 93% did not transition, 2.2% transitioned to Non-daily cigarette, 1.7% to DENC, and 2.2% to Non-current. Among DENC, 87.4% did not transition, 7.3% transitioned to Daily Cigarette, and 3.8% to Non-current. Lower income was associated with lower odds of transitioning from Daily Cigarette and DCNP to Non-daily Cigarette and DENC use. Lower education was associated with higher odds of relapse. Non-Hispanic Blacks were more likely than Non-Hispanic Whites to transition from Daily Cigarette to DCNP and less likely to transition to DENC.

Conclusions: Most individuals remained in their latent use state. The polytobacco and non-daily use states were most likely to transition. Non-Hispanic Blacks were more likely to make harmful transitions, and lower socioeconomic status was associated with a lower probability of transitioning to less harmful states. These differences in transitions may influence tobacco- and nicotine-related health disparities.

Keywords: Adults; Behavioral transitions; Nicotine use; Population-based survey; Tobacco use.