Patterns of tobacco product single and co-use – Findings from the Population Assessment of Tobacco and Health Study (PATH) wave 7 data

Objective This study aimed to comprehensively assess and describe exclusive and combined use patterns across the full range of tobacco products, including emerging ones, to inform tobacco product surveillance. Methods We analyzed Wave 7 data (collected between January 2022 and April 2023) from the Population Assessment of Tobacco and Health Study, including 10,453 youth and 29,645 adults. We reported the frequency and weighted prevalence of current use across up to eleven tobacco products and used UpSet plots to visualize intersections of current tobacco use. We also examined the intersections among current nicotine pouch users, as a secondary analysis. Among current tobacco users, we fit multinominal logistic regression models to assess the association between sociodemographic characteristics and tobacco use patterns, with the single-product use as the reference category. Results Among youth, we identified 41 distinct patterns of single and combined use, representing 6.0% of the U.S. youth overall; single-, dual-, and poly-use accounted for 4.9%, 0.8%, and 0.3%, respectively. Compared with single-product users, dual-users were more likely to have lower annual household incomes, and poly-users were more likely to be male. Among adults, we identified 183 distinct patterns of single and combined use, representing 24.7% of US adults overall; single-, dual-, and poly-use accounted for 17.2%, 5.5%, and 2.0%, respectively. Compared with single-product users, dual- or poly-users were more likely to be older, male, non-Hispanic Black, and have low annual household income. Conclusions Tobacco surveillance and research should routinely assess a broad range of products, including emerging products, and explicitly characterize co-use patterns. Our findings support policies and intervention strategies that address multiple-product use and target high-risk subgroups, rather than focusing on single-product use.