Background: Enforcement of retail access laws is essential to preventing adolescent tobacco use. A growing proportion of adolescent tobacco users report using two or more products. However, research has yet to explore the relationship between retail access and multiple tobacco product use.

Methods: Data were obtained from the 2018 National Youth Tobacco Survey. Participants were 2,199 middle and high school tobacco users. Multivariate, multinomial logistic regression models were used to examine the relationship between tobacco retail access and past 30-day single, dual, and poly (three or more) tobacco product use. Covariates included sex, race/ethnicity, grade level, and tobacco marketing exposure.

Results: Overall, 27.9% of adolescent tobacco users self-reported tobacco retail access. Further, 42.6% were single tobacco product users, 23.8% were dual tobacco product users, and 33.6% were poly tobacco product users. Retail access was associated with greater relative risk of being a dual (RRR: 1.78; 95% CI: 1.33 – 2.38) and poly tobacco product user (RRR: 2.25; 95% CI: 1.62 – 3.11), relative to a single tobacco product user, adjusting for covariates.

Conclusion: Tobacco retail access was associated with greater risks of multiple tobacco product use among a nationally representative sample of adolescents. Descriptive findings reveal a gap in enforcement of tobacco age restrictions. Analytic findings suggest this gap in enforcement may be a contributing factor for multiple tobacco product use among adolescents.

Key Take Away Points

1. Retail access to tobacco products is common among youth.

2. Adolescents with retail access to tobacco used significantly more tobacco products.

3. Greater enforcement of age restrictions is critically needed to reduce adolescent tobacco use.

Author Biography

Dale S Mantey, PhD MPA, is a National Cancer Institute postdoctoral fellow the University of Texas School of Public Health. He completed a predoctoral fellowship at the Texas Tobacco Center of Regulatory Science. Onyema Greg Chido-Amajuoyi is trained as a physician and epidemiologist. He is currently a cancer prevention postdoctoral fellow at MD Anderson Cancer Center, Houston, Texas, USA. Dr. Chido-Amajuoyi’s research interests are centered on global health and the epidemiology of cancer prevention indicators, such as tobacco control, vaccination and cancer screening. Cristina S. Barroso, DrPH, is an Associate Professor in the Department of Public Health at the University of Tennessee in Knoxville. Her research aims to improve the lives of underrepresented individuals, placing a priority around health disparities. Specially, she researches the interrelations among diverse personal, social, and environmental factors in health, primarily among Latinos and other underrepresented groups.


Funding Statement: University of Texas Health Science Center at Houston School of Public Health Cancer Education and Career Development Program – National Cancer Institute/NIH Grant – National Cancer Institute/NIH Grant T32/CA057712. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health. Additional support was provided via a cancer prevention fellowship award supported by the Mrs. Harry C. Wiess Cancer Research Fund and the Laura and John Arnold Foundation [to OG Chido-Amajuoyi]