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The purpose of this study is to evaluate and describe transitions in cigarette and smokeless tobacco (ST) use, including dual use, prospectively from adolescence into young adulthood.The current study utilizes four waves of the National Longitudinal Study of Adolescent Health (Add Health) to examine patterns of cigarette and ST use (within 30 days of survey) over time among a cohort in the United States beginning in 7th-12th grade (1995) into young adulthood (2008-2009). Transition probabilities were estimated using Markov modeling.Among the cohort (N=20,774), 48.7% reported using cigarettes, 12.8% reported using ST, and 7.2% reported dual use (cigarettes and ST in the same wave) in at least one wave. In general, the risk for transitioning between cigarettes and ST was higher for males and those who were older. Dual users exhibited a high probability (81%) of continuing dual use over time.Findings suggest that adolescents who use multiple tobacco products are likely to continue such use as they move into young adulthood. When addressing tobacco use among adolescents and young adults, multiple forms of tobacco use should be considered.

Background A growing body of evidence suggests that tobacco dependence symptoms can occur soon after smoking onset and with low levels of use. However, limited data are available nationally and among non-cigarette tobacco users. Purpose To examine the prevalence and determinants of tobacco dependence symptoms among adolescent tobacco users in the 2012 National Youth Tobacco Survey, a nationally representative, school-based survey of U.S. middle and high school students. Methods Multivariate logistic regression was used to identify independent predictors of dependence symptoms among current users (i.e., past 30-day use) of cigarettes, cigars, or smokeless tobacco. Analyses were conducted in 2013 using SAS-callable SUDAAN, version 11 to account for the complex survey design. Results Prevalence of tobacco dependence symptoms ranged from 20.8% (95% CI=18.6, 23.1) of current tobacco users reporting wanting to use tobacco within 30 minutes of waking to 41.9% (95% CI=39.3, 44.5) reporting recent strong cravings. Reporting of dependence symptoms was most consistently associated with polytobacco use, higher frequency of use, earlier initiation age, and female gender. A 2–4-fold increase in the odds of symptom reporting was found in adolescents using tobacco products on as few as 3–5 days compared to those who only used it for 1–2 of the past 30 days. Conclusions A substantial proportion of U.S. adolescent tobacco users, including those with low levels of use, report symptoms of tobacco dependence. These findings demonstrate the need for full implementation of evidence-based strategies to prevent both experimentation and progression to regular tobacco use among youth.

This paper examines the trends in concurrent use of cigarettes and other tobacco and sociodemographic variables associated with concurrent use among adult cigarette smokers in the United States. Data from the 1995/96, 1998, 2000, and 2001/02 Tobacco Use Supplements to the Current Population Survey were used to estimate concurrent use of tobacco among cigarette smokers among adults ages 18 years and older (n for all 4 survey groups = 552,804). Concurrent use of tobacco fluctuated over the survey periods for current smokers and ranged from 3.7% in 1995/96 to 7.9% in 1998. Results from the multivariate logistic regression indicate that male current, daily, and intermittent smokers had substantially higher odds of concurrent use (OR = 12.9, 11.7, 17.2, respectively) than their female counterparts. Age, race/ethnicity, geographic region, income, and survey years were significantly associated with concurrent use among current and daily smokers; for intermittent smokers, these variables and occupation were significantly associated with concurrent use. The strongest correlates for multiple tobacco use among cigarettes smokers were being male and Non-Hispanic White. These factors should be considered when planning tobacco prevention and control efforts. In addition, surveillance efforts should continue to monitor changes in concurrent use and further investigate the increased risk of cancer among smokers who also use other forms of tobacco.

Background: This research analyzed needlestick injuries sustained by employees working in the home health environment to determine to what extent existing infection control policies and procedures in home health care are effective in reducing the risk of transmission of blood-borne infections. Methods: In June and July 1992, a random sample of 600 directors of home health care agencies in the United States were sent questionnaires concerning written blood-borne infection control policies and procedures of home health care agencies. Agency characteristics were also identified. Results: A 46% response rate ( n = 278) was obtained. Of the 226 agencies that reported needlestick injury rates, 102 agencies reported no needlestick injuries to home health care agency employees in the "last year" and 124 agencies reported from one to 134 needlestick injuries, for a cumulative total of 475. Statistical analyses revealed that agencies with "safer" sharps containers, "safer" hypodermics, or "safer" access to intravenous administration lines did not have statistically significantly rates of lower needlestick injury than agencies without these "safer" products. Conclusions: This study should be considered exploratory; causal relationships cannot be established. Although written blood-borne infection control policies and procedures do not appear to provide protection to home health care workers from the risk of needlestick injury, limitations in the data exist. Consequently, results should be viewed with caution and additional research is needed.

The National Tobacco Cessation Collaborative identified six core strategies as part of its Consumer Demand Roundtable with the overarching goal of increasing the demand, reach, and use of evidence-based cessation treatments.1 Two of the six core strategies are especially relevant to the paper by Abroms and her colleagues2 in this issue of the American Journal of Preventive Medicine: (1) redesigning evidence-based products and services to better meet consumers’ needs and wants, and (2) marketing and promoting cessation products and services in ways that reach smokers. Emerging technologies such as smart phones may offer a resourceful means to achieve these strategies by providing smoking cessation services via a mobile platform that allows engagement of smokers in real time wherever smokers are.