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.