Who Uses Tobacco Products? Using Peer Crowd Segmentation to Identify Youth at Risk for Cigarettes, Cigar Products, Hookah, and E-Cigarettes

Abstract

Background: Understanding which adolescents are at greatest risk for cigarettes and other tobacco products is critical to inform tailored and targeted interventions. Objectives: We used peer crowds (macro-level subcultures) to identify subgroups of adolescents at-risk for using and being open to using cigarettes; cigars, cigarillos, and little cigars (cigar products); hookah; e-cigarettes; any tobacco product; and multiple products. Methods: In 2017, youth ages 12-17 in five U.S. states completed cross-sectional surveys (n = 1,167). Participants provided data on cigarette use (experimentation) and openness to use (susceptibility); cigar product, hookah, and e-cigarette use (ever use) and openness to use (curiosity); and identification with five peer crowds (Alternative, Country, Hip Hop, Mainstream, Popular). We used chi-square tests to compare rates by peer crowd, and multivariate logistic regressions to assess odds of use and openness for each crowd (reference: Mainstream). Results: Risk differed by peer crowd. Hip Hop youth reported high rates of use, ranging from 12.8% (cigarettes) to 33.4% (e-cigarettes). Regressions revealed increased odds of use for Hip Hop compared to Mainstream for all products, especially cigar products and multi-product use. Popular (cigar products, e-cigarettes) and Alternative (cigarettes) demonstrated increased odds of use compared to Mainstream. We also observed elevated odds of cigarette openness among Alternative, Country, and Hip Hop youth, and of hookah openness among Hip Hop and Popular youth compared to Mainstream. Conclusions/Importance: Peer crowd-tailored cigarette education campaigns can be extended to address other tobacco product risk, especially for higher-risk peer crowds such as Hip Hop.

Keywords:

• Peer crowd
• adolescent
• cigarette
• cigar
• cigarillo
• hookah
• e-cigarette
• vape
• tobacco

Acknowledgements

Disclaimer: This publication represents the views of the authors and does not represent FDA/CTP position or policy. The authors would like to thank the staff at FDA CTP and Rescue Agency who made this research and the Fresh Empire campaign possible.

Disclosure statement

Authors CAS and DEW are employees of Rescue Agency, the agency of record for the Fresh Empire campaign funded by the U.S. Food and Drug Administration and mentioned in this article. Authors MAN and MWW work for the study funder, the U.S. Food and Drug Administration. There are no other conflicts of interest to report.

Additional information

Funding

This work was supported by the U.S. Food and Drug Administration under IDIQ Contract HHSF223201210006I.