Tobacco use trajectories and related mechanisms among US adults and youth - SUMMARY/ABSTRACT The burden of tobacco-related diseases is well-documented, with differential impact among certain high-risk populations (e.g., Black or Hispanic individuals, low socioeconomic status groups, rural populations). However, the literature is limited by insufficient examination of: 1) differences across subpopulations in tobacco use, particularly use of the various tobacco products in the current tobacco market; 2) mechanisms (e.g., marketing exposure, differing product perceptions) underlying such differences; and 3) longitudinal associations, particularly using nationally-representative data. Regarding the former, groups particularly impacted are typically described by social identifiers that are visible and relatively static, like race. However, certain determinants (e.g., industry marketing) may especially impact high-risk subpopulations, thus requiring a more nuanced understanding of the mechanisms by which these subpopulations are impacted. This study’s objective is to test our central hypothesis that US adults and youth representing certain high-risk subpopulations will demonstrate distinct tobacco use behaviors (e.g., likelihood of use vs. no use of distinct products, polyproduct use profiles) and related mechanisms (e.g., marketing exposure and perceptions) over time. The rationale is that certain products may have specific characteristics (e.g., novelty, technology, flavors) that appeal to and/or are marketed toward different high-risk subgroups and thus shape their perceptions (e.g., risk, social norms) and use behaviors. We will use the Population Assessment of Tobacco and Health (PATH) study (both adult and youth survey data) – a nationally-representative longitudinal cohort study – to examine: 1) differences in tobacco use behaviors over time (i.e., trajectories in use of different products, any product, or multiple products; use of flavored products) among adults, including those representing high-risk populations; 2) pathways underlying differential tobacco use behaviors over time, including tobacco marketing exposure and product perceptions (i.e., risks, social norms); and 3) differences in marketing exposure and product perceptions over time as outcomes – and as mechanisms of use to the extent possible (due to lower youth use prevalence) – in youth, including those representing high-risk subpopulations. This proposal will advance our long-term goal of informing research, interventions, and regulations (such as restrictions on marketing that targets high-risk subpopulations), to ultimately catalyze the reduction of the burden of tobacco-related diseases and its population impact in the US.
