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Introduction: Although smoking prevalence has declined, very light smoking (5 or fewer cigarettes per day) is still very common among young adults. The limited available literature indicates that emerging alternative tobacco use may play a role in the prevalence and progression of very light smoking among young adults. However, the trends of popular tobacco use patterns (i.e., very light smoking and alternative tobacco use) among young adults have not been fully explored. The purpose of this study is to describe the trends in very light smoking and use of alternative tobacco products (ATPs) among young adult smokers.
Methods: Young adults aged 18-25 who reported that they used cigarette in the past 30 days were selected from the National Survey of Drug Use and Health (NSDUH), 2002 – 2015. Trend analyses of very light smoking and alternative tobacco use were conducted among current smokers. Additional analysis was conducted to compare trends of ATP use by smoking level. Data were weighted to account for the complex survey design of NSDUH.
Results: A significant linear increase occurred between 2002 and 2015 for the prevalence of very light smoking among young adult current smokers from 50.6% in 2002 to 64.7% in 2015 (p < 0.01). The increase was at a significantly lower rate for Hispanic than for Non-Hispanic White current smokers among young adults. Among very light smokers, the prevalence of current ATP use increased at a relatively high rate from 2002 to 2005 [APC (annual percent change) = 4.16, p < .05]. After 2005, the increase slowed down but continued to be significant (APC = 0.66, p < .05). Among heavier smokers, the prevalence increased significantly from 2002 to 2010 and then showed a decreasing trend from 2010 to 2015. The prevalence of ATP use became higher among very light smokers than among heavier smokers since 2012.
Conclusion: Although most young adult smokers are very light smokers, they may progress into being regular or heavier smokers and impact future trends of tobacco use. The results of this study support the need for continued prevention efforts regarding tobacco use, with a specific focus on alternative tobacco products.