Multiple Tobacco Product Use Among Youth E-Cigarette Users: National Youth Tobacco Survey, 2020

Limited information exists on multiple tobacco product use, particularly among youth. This study assessed the prevalence of current youth use of e-cigarettes with other tobacco products and their associated characteristics using 2020 National Youth Tobacco Survey data. Prevalence estimates were calculated for current e-cigarette users, by multiple tobacco product use status and product combination. Demographic characteristics, e-cigarette use behaviors, age at first combustible tobacco use, and tobacco dependence symptoms were compared between current users of both e-cigarettes and combustible tobacco (dual users) and current exclusive e-cigarette users. In 2020, 61.1% of all current e-cigarette users reported exclusive e-cigarette use, and 38.9% used e-cigarettes with other tobacco products. Among those who used e-cigarettes with other tobacco products, 85.0% used combustible tobacco, with cigarettes being the most commonly used other tobacco product. Compared with current exclusive e-cigarette users, higher proportions of dual users reported the following: frequent e-cigarette use; obtaining e-cigarettes from gas stations, persons other than a family member/friend, vape shops, or the internet; and having any tobacco dependence symptoms. Among dual users, 31.2% reported first combustible product use after e-cigarette initiation, and 34.3% reported first combustible product use prior to e-cigarette initiation. Approximately four in 10 youth current e-cigarette users reported using multiple tobacco products, with a majority using combustible tobacco. Frequent e-cigarette use and tobacco dependence symptoms were more prevalent among dual users of e-cigarettes and combustible tobacco.