Trends in alternative tobacco use among light, moderate, and heavy smokers in adolescence, 1999-2009

Objective: To examine trends in alternative tobacco product (ATP) use (smokeless tobacco, cigars, and bidis/cloves) among a national sample of adolescent cigarette smokers (light, moderate, and heavy) during 1999-2009. Method: A secondary analysis of data from the 1999-2009 National Youth Tobacco Survey was performed to investigate the tobacco behaviors of 6th through 12th graders enrolled in public and private schools in the United States. Long-term trends in ATP use were analyzed using logistic regression - controlling for sex, grade, and race/ethnicity - and simultaneously assessing linear and higher order time effects and their interaction with cigarette smoking status. Results: During 1999-2009, increases in smokeless tobacco use and decreases in bidis/cloves use were observed across all smoking groups. For cigars, declines were observed for heavy and moderate smokers, but levels returned to baseline levels in 2009. Cigar use among light smokers was less variable. Rates of any ATP were highest among heavy smokers and lowest among light smokers. Conclusion: Trends in cigarette and SLT use increased dramatically in the past decade, and this increase is evident across all cigarette smoker types. Implications for tobacco surveillance, prevention and cessation programs, and tobacco control policies are discussed. (C) 2012 Elsevier Ltd. All rights reserved.