Multilevel stress influences on longitudinal trajectories of tobacco use among young adults throughout the US - The US tobacco market has evolved over the past decade with declines in cigarette use coupled with increases in the use of other tobacco products (e.g., e-cigarettes, cigars, hookah, smokeless tobacco). Young adulthood is a critical period for tobacco use initiation, escalations in use frequency, transitions from noncombustible to combustible tobacco product use, and polytobacco use. Young adults with greater mental health symptoms, stress from peers, and receipt of negative parenting behaviors display greater risk for tobacco use. However, this research has historically focused on: 1) associations of stress with the use of single tobacco products; 2) unidirectional associations of stress predicting tobacco use; and 3) young adults who reside in areas with ample access to tobacco cessation programs. This is a significant limitation, as: 1) young adults commonly use multiple tobacco products simultaneously (i.e., polytobacco use); 2) research in other populations indicates potential bidirectional associations of stress with tobacco use; and 3) a significant portion of young adults reside in areas with limited access to tobacco cessation programs. This proposal is informed by the socioecological framework and life course theory, and leverages our team’s expertise in young adult tobacco use, mental health, interpersonal stress, as well as multiple methods, including longitudinal survey and ecological momentary assessment (EMA) studies. The overall goal of this work is to address knowledge gaps in prevention and cessation efforts targeting young adults by assessing longitudinal trajectories of tobacco use across a range of tobacco products, the multiple components of individual and interpersonal stress that may contribute to such use, and the bidirectional associations of stress and tobacco use among young adults with and without access to tobacco cessation programs. The proposed study will involve a 2-year, 5-wave longitudinal survey study among 2,000 young adults residing in the US, as well as tobacco users, susceptible nonusers, and non-susceptible nonusers. A subset of 150 young adult tobacco users will complete a 21-day EMA study following Wave 2, where they will track tobacco use and daily stressors to elucidate context-specific fluctuations in tobacco use and related mechanisms in real time. We will address 2 specific aims: 1) Examine individual and interpersonal stress (i.e., mental health problems, peer stress, receipt of negative parenting behaviors) in relation to tobacco use outcomes (i.e., any current use, specific product use, changes in use status/level, patterns of single vs. polytobacco use) among young adults over time; and 2) Among tobacco users, examine day-to-day and within-day fluctuations in the aforementioned individual and interpersonal stressors and tobacco use outcomes, as they occur in real time and in naturalistic settings among young adults residing in areas with and without tobacco cessation access. Led by a uniquely-poised research team, this proposal will lead to the development of targeted and geographically tailored prevention and cessation efforts to reduce tobacco use during a time when individuals are at risk for tobacco use initiation and escalation.
