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Alternative Tobacco Product Use among Adolescents and Young Adults


There is a changing landscape of tobacco use among adolescents and young adults in the United States. Non-cigarette, alternative tobacco product (ATP) use such as such as electronic cigarettes (e-cigarettes), smokeless tobacco (chewing tobacco, dissolvable or dipping tobacco, moist snuff, and snus), tobacco pipes, cigars (traditional, filtered, and cigarillos or little cigars), and hookah (water pipes) has increased in the past decade among AYAs. This changing tobacco landscape threatens decades of public health campaigns and gains in tobacco control dedicated to denomormilize smoking and lowering rates of tobacco use. Research shows positive relationships among marketing receptivity through ownership of tobacco promotional items, tobacco retail environment, and risk and benefit perceptions with cigarette use among adults. Limited studies have assessed these relationships with ATP use among adolescents and young adults.

This dissertation aims to illustrate the relationships between marketing receptivity and ATP initiation, identify a hierarchical relationship between individual-level, neighborhood-level, and school-level covariates and ATP initiation; and assess the relationship between risk and benefit perceptions with cigarette or ATP switching. These aims were examined using a prospective longitudinal cohort study of adolescents and young adults from California designed to assess adolescents’ use and perceptions of a variety of tobacco products. This dissertation further analyzes data from this longitudinal cohort, linked with the Census Bureau’s American Community Survey, the state retailer-licensing database maintained by California’s Board of Equalization, and school-level data from the California Department of Education.

These findings suggest marketing receptivity, tobacco retail environment, and risk and benefit perceptions may predict individual ATP use among adolescents and young adults. Results of this dissertation indicate adolescents and young adults with increased marketing receptivity, who reside in neighborhoods with increased retail access to ATPs, and who have lower ATP risk perceptions and greater benefit perceptions exhibit greater ATP initiation, product switching, and use over time. These findings may help inform the Food and Drug Administration’s regulations of new and emerging tobacco products by regulating marketing efforts, informing health campaigns, and regulating the tobacco retail environment.

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