Examination of Lifetime Established Use Criteria for Adult Tobacco Product Users

Background: Lifetime established use criteria are essential to distinguish tobacco product experimental and established users; however, these criteria are not as well defined for some tobacco product categories. The objective of this analysis is to examine various lifetime use criteria to facilitate an objective characterization of experimental versus established use behaviors. Methods: Our analyses were conducted using the Population Assessment of Tobacco and Health (PATH) Study Waves 1 to 5 datasets. We first examined the level of agreement between non-numerical (having smoked/used the product fairly regularly) and numerical ( having smoked/used the product 20/50/100 times ( e.g ., use occasions) or product units) lifetime established use criteria among ever-, current-, and former-tobacco product users of various tobacco products. Logistic regression models were constructed to compare demographics, socioeconomic status, and tobacco product use patterns among current experimental versus current established users. Longitudinal analyses were performed to investigate the association between numerical or non-numerical criteria and discontinuation of past 30-day use at follow-up waves. Results: For tobacco product categories other than cigarette, we identified the following numerical thresholds as the objective characterization of established use: 50 for cigars and pipe products and 20 times for hookah, electronic nicotine products, smokeless, snus, and dissolvable tobacco products, based on level of agreement with the non-numerical criterion (kappa coefficients ranging from 0.3 to 0.6) and also with consideration of existing consensus. Significant differences were observed in demographics, socioeconomic status, tobacco product use and discontinuation of past 30-day use patterns when comparing current experimental and current established users with either non-numerical or numerical criteria. Conclusions: This study is the first PATH data analysis to derive quantitative thresholds of lifetime established use criteria to characterize experimental versus established use behaviors. Consistent applications of the lifetime established use criteria in data analysis and reporting would improve harmonization in research findings.