Longitudinal associations between exclusive, dual, and polytobacco use and asthma among US youth

Delvon T. Mattingly, Steven Cook, Jana L. Hirschtick, Akash Patel, Douglas A. Arenberg, Geoffrey D. Barnes, David T. Levy, Rafael Meza, Nancy L. Fleischer

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Little is known about the respiratory health effects of dual (two products) and polytobacco (three or more products) use among youth in the United States. Thus, we followed a longitudinal cohort of youth into adulthood using data from Waves 1–5 (2013–2019) of the Population Assessment of Tobacco and Health Study, examining incident asthma at each follow-up (Waves 2–5). We classified past 30-day tobacco use as 1) no products (never/former use), 2) exclusive cigarettes, 3) exclusive electronic nicotine delivery systems (ENDS), 4) exclusive other combustible (OC) tobacco products (cigars, hookah, pipe), 5) dual cigarettes/OC and ENDS, 6) dual cigarettes and OCs, and 7) polytobacco use (cigarettes, OCs, and ENDS). Using discrete time survival models, we analyzed the incidence of asthma across Waves 2–5, predicted by time-varying tobacco use lagged by one wave, and adjusted for potential baseline confounders. Asthma was reported by 574 of the 9141 respondents, with an average annual incidence of 1.44% (range 0.35% to 2.02%, Waves 2–5). In adjusted models, exclusive cigarette use (HR: 1.71, 95% CI: 1.11–2.64) and dual cigarette and OC use (HR: 2.78, 95% CI: 1.65–4.70) were associated with incident asthma compared to never/former use, while exclusive ENDS use (HR: 1.50, 95% CI: 0.92–2.44) and polytobacco use (HR: 1.95, 95% CI: 0.86–4.44) were not. To conclude, youth who use cigarettes with or without OCs had higher risk of incident asthma. Further longitudinal studies on the respiratory health effects of ENDS and dual/polytobacco use are needed as products continue to evolve.

Original languageEnglish
Article number107512
JournalPreventive Medicine
StatePublished - Jun 2023

Bibliographical note

Publisher Copyright:
© 2023 Elsevier Inc.


  • Asthma
  • Cigarettes
  • Cigars
  • E-cigarettes
  • Epidemiology
  • Health effects
  • Polytobacco
  • Tobacco

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health


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