Factors associated with tobacco product use patterns among criminal legal system impacted adults in Kentucky

The tobacco use landscape is rapidly shifting, with growing numbers of people using multiple forms of nicotine delivery (e.g., combustible, electronic nicotine delivery, smokeless). In general populations, multi-product use is associated with high-risk behaviors and poorer health outcomes. Individuals in the criminal legal system (CLS) are a high-risk and vulnerable population with high rates of tobacco use, but little is known about existing tobacco use patterns and associated correlates. We sought to characterize the tobacco use patterns of CLS-involved persons in Kentucky from 2012 to 2019 ( N = 28,678). Data were from the Criminal Justice Kentucky Treatment Outcome Study (CJKTOS). Individuals who participate in the Department of Corrections’ (DOC) six-month therapeutic community models complete a baseline assessment with DOC staff upon entry to the program. Using self-reported data on tobacco use in the year prior to incarceration, we used multinomial regression to compare mono (single product), dual (use of two products), and poly tobacco use (use of combustible, smokeless, and electronic cigarettes) as compared to no tobacco use. Demographics, substance use, and mental health characteristics were examined. Mann-Kendall trend test examined changes over the years. The majority of the sample used tobacco prior to incarceration; 13.9% reported no tobacco use, 61.2% reported mono-tobacco use, 20.3% engaged in dual-use, and 4.5% in poly-use. Non-tobacco use decreased ( p = 0.019) and poly-tobacco use increased ( p = 0.002) significantly over this period. The most common tobacco product used was combustible (83.3%). Persons who lived in rural areas prior to incarceration ( p < 0.01) and those who had a greater number of medical problems ( p < 0.01) were more likely to engage in dual and poly-tobacco use. Males ( p < 0.01) were more likely than females to engage in poly-use. The use of multiple forms of tobacco remains an understudied area of research among this population. Tobacco cessation interventions that consider multiple product use and the stressors of CLS-impacted populations are needed to reduce tobacco-related morbidity and mortality among this population.