Use of emerging tobacco products among adolescents who do not smoke conventional cigarettes.

Although youth cigarette smoking has steadily declined across the US, use of emerging tobacco products, most notably e-cigarettes and hookah, has increased.1 In 2015, 25.3% of US high school youth currently used at least one tobacco product.1 E-cigarettes were the most commonly used product (16.0%), surpassing all other products including cigarettes (9.3%), cigars (8.6%), hookah (7.2%), and smokeless tobacco (6.0%). From 2011-2015, youth use of e-cigarettes and hookah substantially increased, while use of cigarettes, cigars, and smokeless tobacco declined. Increased use of emerging products has essentially canceled out decreases in cigarette use, resulting in no change in overall tobacco use among youth.1 In Rhode Island (RI), current cigarette use among high school students declined from 8.0% in 2013 to 4.8% in 2015 – one of the lowest youth smoking rates in the country. E-cigarette data were collected for the first time on the 2015 RI Youth Risk Behavior Survey (YRBS). Despite the fact that most RI high school students do not smoke conventional cigarettes, 25.1% of all youth reported current use of tobacco (cigarettes, cigars, smokeless, or e-cigarettes) in 2015. E-cigarettes were the most commonly used product (19.3%), followed by hookah (11.8%), cigars (8.4%), smokeless tobacco (5.3%), and cigarettes (4.8%). Youth use of any tobacco or nicotine product is unsafe. Exposure to nicotine during adolescence can harm brain development and lead to more severe levels of nicotine addiction.2 Research suggests that e-cigarette use among youth who do not smoke conventional cigarettes may act as a gateway to initiation of combustible tobacco products.3 Because RI’s youth cigarette smoking rate is so low, yet one in four adolescents report using tobacco, it is important to understand what other tobacco products are used by adolescents who are not current cigarette smokers. This study aimed to 1) describe current use of four tobacco products among RI high school youth who do not smoke conventional cigarettes (hereby referred to as “nonsmokers”) and 2) identify factors associated with e-cigarette use among nonsmokers.