This study utilized a socioecological approach to prospectively identify intrapersonal, familial, and environmental factors associated with single nicotine product use (NPU) and multiple NPU among U.S. youth. Participants were 10,029 youths (ages 12–17 years) who had completed the Population Assessment of Tobacco Health study's Wave 1 (2013–2014) and Wave 4 (2016–2018) assessments and data on past 30-day nicotine product use. Multinomial logistic regression was fit for the 3-level outcome (no use, single NPU, multiple NPU) to estimate adjusted associations between the predictors and the outcome. The current study found that intrapersonal (sex, age, race/ethnicity, internalizing symptoms, sensation seeking, harm perceptions, lifetime history of using two or more tobacco products), familial (parental discussion about not using tobacco and living with someone who uses tobacco products) and environmental factors (exposure to tobacco advertising) commonly associated with tobacco use differentiated between individuals who later reported past 30-day NPU (either multiple or single NPU) from those who did not report past 30-day NPU. One familial factor only differentiated between lifetime users who were single NPUs from those who reported no NPU: non-combustible tobacco product use allowed anywhere in the home. Intrapersonal factors differentiated multiple NPU from single NPU: older age, being male, lifetime history of using nicotine product and less harm perceptions. This study identified factors that may be studied to prevent any NPU, along with factors that may be studied to promote harm reduction by preventing escalation of single NPU to problematic patterns of multiple NPU.

中文翻译：

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与美国青少年使用多种尼古丁产品相关的社会生态因素：2013-2018 年烟草与健康人口评估 (PATH) 研究的结果

本研究采用社会生态学方法前瞻性地确定美国青少年中与单一尼古丁产品使用 (NPU) 和多种 NPU 相关的个人、家庭和环境因素。参与者是 10,029 名青少年（12-17 岁），他们完成了烟草健康人口评估研究的第一波（2013-2014 年）和第四波（2016-2018 年）评估和过去 30 天尼古丁产品使用的数据。多项逻辑回归适合 3 水平结果（无使用、单个 NPU、多个 NPU），以估计预测变量与结果之间的调整后关联。目前的研究发现，个人内部（性别、年龄、种族/民族、内化症状、感觉寻求、伤害感知、使用两种或多种烟草产品的终生史）、家庭（父母讨论不使用烟草以及与吸烟者一起生活）产品）和环境因素（接触烟草广告）通常与烟草使用相关，后来报告过去 30 天 NPU（多个或单个 NPU）的个体与那些没有报告超过 30 天 NPU 的个体之间存在差异。唯一区分单一 NPU 的终生使用者和报告无 NPU 的终生使用者的一个家庭因素是：允许在家中任何地方使用不可燃烟草产品。个人因素将多个 NPU 与单个 NPU 区分开来：年龄较大、男性、终生使用尼古丁产品的历史以及较少的危害认知。这项研究确定了可以研究以防止任何 NPU 的因素，以及可以研究以通过防止单个 NPU 升级为多个 NPU 的问题模式来促进减少危害的因素。