Heated tobacco product use among US adolescents in 2019: The new tobacco risk

INTRODUCTION There is growing public health concern about adolescent use of heated tobacco products (HTPs) after the US Food and Drug Administration approved the leading HTPs, IQOS, as a modified risk tobacco product. Extending the previous studies examining the correlates of HTP use among adolescents, this study aims to investigate potential risk factors for HTP use among US adolescents, including the use of multiple tobacco and flavored tobacco products. METHODS We analyzed the 2019 National Youth Tobacco Survey (n=19018) and conducted a series of logistic regression models on awareness and use of HTPs as a function of tobacco use status (none, single, dual/poly) and past 30 days flavored tobacco use (e.g. menthol cigarette use, flavored e-cigarettes), controlling for sociodemographics. RESULTS In multivariable analyses, awareness of HTPs was associated with usual menthol cigarette use (AOR=1.77; 95% CI: 1.23-2.53) and past 30 days flavored tobacco use (AOR=1.44; 95% CI: 1.16-1.80). Risk factors for ever HTP use included single (AOR=2.52; 95% CI: 1.19-5.33) and dual/poly tobacco use (AOR=4.94; 95% CI: 2.56-9.54), usual menthol cigarette use (AOR=2.50; 95% CI: 1.66-3.76), and past 30 days flavored tobacco use (AOR=1.61; 95% CI: 1.07-2.44). Risk factors for current HTP use included single (AOR=10.84; 95% CI: 6.72-17.49) and dual/poly tobacco use (AOR=31.96; 95% CI: 17.79-57.43), and usual menthol cigarette use (AOR=2.50; 95% CI: 1.63-3.85). CONCLUSIONS This study documents HTP use in adolescents and contributes insight and urgency into prioritizing at-risk adolescents for interventions, including current users of other tobacco products and flavored tobacco users.