1. I removed the quit attempt variable from the adjusted model. I removed the quit attempt variable from the adjusted model.e Sarah Kowitt, MPH 1 ; Tanha Patel, MPH 2 ; Leah M. Ranney, PhD 3 ; Li-Ling Huang, PhD, MPH 4 ; Adam O. Goldstein, MD, MPH 3 Dual Tobacco Use Among High School Students in North Carolina BackgroundResults Dataset: 2011 and 2013 North Carolina Youth Tobacco Survey (NCYTS), a public and charter school-based student survey Objectives: 1) assess patterns and trends of dual tobacco use; 2) determine relevant predictors, i.e. attitudes and beliefs of dual use Sampling: 2 stage clustering design 2011: n= 4,791 (overall response rate: 78.2%) 2013: n= 4,092 (overall response rate: 67.84%) Analysis: Bivariate/multivariate logistic regression analyses to examine correlates of dual and single tobacco use Dual use: Defined as use of 1+ tobacco products in last month Single use: Defined as use of 1 tobacco product in last month Methods Conclusions Limitations 1. University of North Carolina at Chapel Hill, Gillings School of Global Public Health; University of North Carolina at Chapel Hill, 2. North Carolina Department of Health and Human Services, Tobacco Prevention and Control Branch; 3. University of North Carolina at Chapel Hill, Department of Family Medicine; 4. Lineberger Comprehensive Cancer Center Decline in overall cigarette and tobacco use: cigarette use has been decreasing (15.5% for NC high school students in 2011; 13.5% in 2013). 1 Emerging tobacco products: There is increased awareness and popularity of emerging tobacco products. 2 Dual Use: Students may use more than one tobacco product at a time. 3 Attitudes: Anti-smoking campaigns and behavioral health theories suggest that targeting attitudes can change tobacco related behavior. High Prevalence of Dual Tobacco Use and a Potentially Growing Problem: 19.1% (95% CI: 17.3, 20.8) in 2013 compared to a prevalence of 17.30% (95% CI: 15.2, 19.3) in 2011. Dual Use Higher than Single Use: The prevalence of dual use (19.10%, 95% CI: 17.3, 20.8) was greater than the prevalence of single use (10.62%, 95% CI: 9.32, 11.92) in 2013. Attitudes were Significant Predictors: Dual users were significantly more likely to believe that tobacco companies are not trying to get young people to use tobacco products (OR, 1.38; 95% CI, 1.15, 1.64), believe that breathing smoke from other people’s cigarettes or other tobacco products is not very or not harmful to one’s health (OR, 2.61; 95% CI, 1.98, 3.43), think that smoking cigarettes makes young people look cool or fit in (OR, 3.37; 95% CI, 2.07, 5.49), and strongly disagree or disagree that all tobacco products are dangerous (OR, 3.44; 95% CI, 2.73, 4.33). Causality is difficult to conclude from a cross-sectional survey. The findings are subject to self-reported, recall biases and social desirability. Results may not generalize to youth in other populations other than NC high school students Communication campaigns: Dual use of tobacco products should be targeted rather than single use only. Interventions: Targeting students’ attitudes may be a way for public health programs to intervene and reduce dual use Surveillance: Needed to monitor uptake of dual tobacco use to determine which products may be used in combination Further Research: Qualitative studies may be helpful in elucidating mechanisms leading to dual tobacco use Results and Discussions Results Figure 3. Prevalence of Dual and Single Tobacco Product Use Funding: Research reported in this publication was supported by Office Of The Director, National Institutes of Health (OD) and FDA Center for Tobacco Products (CTP). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the Food and Drug Administration. The NCYTS was administered with support from the Centers for Disease Control and Prevention Grant or Cooperative Agreement Number, DP 14-1415. Reference: 1.Arrazola RA, Kuiper NM, Dube SR. Patterns of current use of tobacco products among U.S. high school students for 2000-2012--findings from the National Youth Tobacco Survey. The Journal of adolescent health : official publication of the Society for Adolescent Medicine. Jan 2014;54(1):54-60.e59. 2.Wang B, King BA, Corey CG, Arrazola RA, Johnson SE. Awareness and use of non-conventional tobacco products among U.S. students, 2012. Am J Prev Med. Aug 2014;47(2 Suppl 1):S36-52. 3.Soneji S, Sargent J, Tanski S. Multiple tobacco product use among US adolescents and young adults. Tobacco control. Oct 31 2014. Conflicts of Interest: None. Figure 1. Cigarettes, Cigars and Tobacco in a Pipe Image Source: Pipes Magazine VariableDual-User vs. Single and Non-user Odds Ratio (95% CI) Dual User vs. Single User Odds Ratio (95% CI) Gender FemaleRef Male1.79 * (1.42, 2.26) 1.29 (0.87, 1.91) Age1.32 * (1.20, 1.44) 1.10 (0.99, 1.21) Race Non-Hispanic White2.10 * (1.69, 2.62) 2.20 * (1.74, 2.79) Non-Hispanic BlackRef Non-Hispanic Other1.25 (0.70, 2.22) 1.84 * (1.21, 2.78) Hispanic1.49 * (1.14, 1.94) 1.17 (0.60, 2.28) Believe tobacco companies are trying to get young people to use tobacco products No1.38 * (1.15, 1.64) 1.04 (0.79, 1.37) Believe that breathing smoke from other people’s cigarettes or other tobacco products is Not very or not harmful to one’s health 2.61 * (1.98, 3.43) 3.08 * (2.10, 4.51) Think that smoking cigarettes makes young people look cool or fit in Definitely yes or probably yes3.37 * (2.07, 5.49) 1.77 * (1.13, 2.77) Think that young people who smoke cigarettes have more friends Definitely yes or probably yes1.29 (0.98, 1.69) 1.07 (0.80, 1.44) Believe that “All tobacco products are dangerous” Strongly disagree or disagree3.44 * (2.73, 4.33) 1.69 * (1.13, 2.54) Note. Age is treated as a continuous variable in the logistic regression model. Data are weighted to enable generalization to all students at public and charter middle schools and high schools in North Carolina. CI, Confidence Interval Table 1. Weighted Multivariable Logistic Regression Results Figure 2. Frequency of Tobacco Products Being Used in Combination with Other Products: from most to least