ECPN poster contestant: Age Trends in Nicotine/Tobacco Product Use in the United States: Differences Across Geographic Region

Introduction. Although cigarette smoking is the predominant form of tobacco use for adults in the US, products such as e-cigarettes, cigars, and smokeless tobacco (ST) are becoming increasingly popular. Previous work has demonstrated differences in specific product use by geographic region, particularly with regards to smokeless tobacco use. However, few studies document how prevalence rates for various products differ by age, within the context of geographic region. The current study examines past year prevalence rates of cigarettes, e-cigarettes, cigars, and ST as a continuous function across age. Geographic differences are examined; such information is imperative for the effective targeting of health promotion messages and prevention/intervention efforts.

Methods. Data are from the National Epidemiological Survey on Alcohol and Related Conditions III, a cross-sectional, nationally representative survey of alcohol and drug use in US adults. The analytic sample contained 30,999 respondents ages 18 to 65 years. Nicotine/tobacco product use was assessed via the questions “During the last 12 months, did you [smoke/use] at least one [cigarette / cigar / wad or chew / e-cigarette cartridge or e-liquid]”. Geographic location was determined by census region. Time-varying effect models were used to estimate age-varying prevalence rates as a function of geographic region.

Results. Prevalence of cigarette use varied strongly by age, with a first peak at age 30 (45%), and again at age 50 (40%). Although rates of cigar use were generally low, prevalence also had a bimodal trend, peaking at 5% at ages 27 and 57. Use of ST peaked at age 18 (4%) and decreased across age. E-cigarette peaked at 6% at age 23 and decreased across age; e-cigarette use was significantly higher than cigar and ST use between ages 20 and 27. Age trends in cigarette, cigar, and ST use varied by region. The rate of cigarette use was significantly higher in the Midwest compared to all regions from ages 20 to 65. Compared to the Northeast, the rate of cigar use was significantly higher in the Midwest and in the South between ages 22-49. Compared to the Midwest, rates of ST use were significantly lower in the Northeast between ages 20-60 and significantly higher in the South between ages 55-65.

Conclusions. Cigarette smoking continues to be the most prevalent form of tobacco use among adults in the US, across all geographic regions and ages. However, cigarette smoking is particularly prevalent at ages 30 and 50, and among those living in the Midwest. Cigar, ST, and e-cigarette use decrease across age. Cigar and ST use also differ by region, whereas e-cigarette use is a geographically independent product. We discuss possible historical effects and present implications for policy and prevention.