Prevalence and correlates of concurrent use of cigarettes, electronic cigarettes, and waterpipes among Serbian youth

Abstract

INTRODUCTION

Concurrent use of tobacco products is associated with an increased risk of nicotine dependence and smoking-related health complications. Growing popularity of concurrent use of cigarettes and electronic cigarettes and/or waterpipe tobacco is of concern, especially due to the adolescents’ exposure to nicotine and call for the better understanding of patterns and predictors of multiple product use.

METHODS

This is a secondary analysis of cross-sectional data obtained through the 2017 Global Youth Tobacco Survey conducted in Serbia on a nationally representative sample of 3362 students aged 13–15 years. Students were categorized into eight groups based on their experience with cigarette, e-cigarette and waterpipe use. To explore differences in sociodemographic and psychosocial characteristics, students were further placed in four groups: non-users; exclusive cigarette users; users of e-cigarette and/or waterpipe who do not smoke cigarettes; cigarette and other product users.

RESULTS

We show that among the 13–15 years old students, the most common pattern of tobacco/nicotine use is waterpipe and/or e-cigarette use with no cigarette smoking (7.5%, 95% CI: 6.6–8.4) followed by exclusive cigarette use (5.8 %, 95% CI: 5.0–6.6). Among cigarette smokers, 52.8% were exclusive cigarette smokers. Having the majority of their friends smoking is a mutual predictor for exclusive cigarette (AOR=33.2, 95% CI: 14.52–75.90) waterpipe and/or e-cigarette (AOR=2.57, 95% CI: 1.56–4.25) and cigarette and other products use (AOR=52.3, 95% CI:12.28–223.22) compared to no use of any product, and the same in the case of exposure at the point-of-sale marketing: exclusive cigarette vs not any product users (AOR=1.82, 95% CI: 1.22–2.73); waterpipe and or/e-cigarette vs not any product users (AOR=1.64, 95% CI:1.18–2.28); and cigarette and other products vs not any product users (AOR=3.40, 95% CI: 1.99–5.80).

CONCLUSIONS

Tobacco control interventions should address dual- and poly-tobacco use with special focus on inter-personal factors and protection from exposure to advertising of e-cigarettes and waterpipes.