Evaluating the predictive value of measures of susceptibility to tobacco and alternative tobacco products. (September 2019) - Barrington-Trimis, Jessica L.
Abstract: Background: The "cigarette susceptibility index" has been adapted for other products, yet, the validity of these adapted measures–particularly among youth who have used other tobacco products–has not been evaluated. Methods: We used prospective data from the Southern California Children's Health Study to evaluate the association of questionnaire measures assessing susceptibility to e-cigarette, cigarette, hookah and cigar/cigarillo/little cigar use at wave 1 (W1; 11th/12th grade) with subsequent initiation between W1 and W2 (16 months later, N = 1453). We additionally examined whether each effect estimate differed by use of other tobacco products at W1. Results: Odds ratios, attributable risk%, and risk differences for product initiation among susceptible vs. non-susceptible youth were consistently higher among never users of any tobacco product than among youth with any tobacco use history. For example, susceptible (vs. non-susceptible) youth with no prior tobacco use had 3.64 times the odds of subsequent initiation of e-cigarettes (95%CI:2.61, 5.09), while among users of another product, susceptible (vs. non-susceptible) youth had 1.95 times the odds of e-cigarette initiation (95%CI:0.98, 3.89; p-interaction = 0.016). 60.4% of e-cigarette initiation among never users of any product could be attributed to susceptibility, compared to 19.8% among users of another product. The e-cigarette absolute risk difference between susceptible and non-susceptible youth was 21.9%(15.2, 28.6) for never users, vs. 15.4%(0.2, 30.7) for users of another product. Conclusion: Tobacco product-specific susceptibility associations with initiation of use at W2 were markedly attenuated among prior users of other products, demonstrating reduced utility for these measures among subjects using other products. Highlights: Performance of the susceptibility index differed by use of other tobacco products. Associations of susceptibility with initiation were stronger for never-tobacco-users. Susceptibility measures may be inappropriate among users of other tobacco products.