{"doi":"10.1093/ntr/ntaa170","title":"Racial/Ethnic Differences in Associations of Non-cigarette Tobacco Product Use With Subsequent Initiation of Cigarettes in US Youths","abstract":"INTRODUCTION: Understanding which non-cigarette tobacco products precede smoking in youth across different racial/ethnic groups can inform policies that consider tobacco-related health disparities. METHODS: We used nationally representative, longitudinal data from the Population Assessment of Tobacco and Health Study waves 1-4. The sample was a dynamic cohort of cigarette-naïve youth aged 12-17 years. Mixed-effects models were used to assess non-cigarette product (e-cigarette, cigar product, or other product) use with cigarette use over 1-year intervals. RESULTS: Of the 28 788 observations pooled across waves 1-4, respondents were 48.7% non-Hispanic white, 13.9% non-Hispanic black, and 23.1% Hispanic. Odds of cigarette initiation over 1-year follow-up were higher among youth with prior use of e-cigarettes (odds ratio [OR], 2.76; 95% confidence interval [CI], 2.21-3.45), cigars (OR, 2.00; 95% CI, 1.42-2.80), or other products (OR, 1.66; 95% CI, 1.28-2.14) compared to never users. At the population level, 20.6% of cigarette initiation was attributable to e-cigarette use among white youth and 21.6% among Hispanic youth, while only 3.5% of cigarette initiation was attributable to e-cigarette use among black youth. In contrast, 9.1% of cigarette initiation for black youth was attributable to cigar use compared to only 3.9% for both white and Hispanic youth. CONCLUSIONS: Prior use of e-cigarettes, cigars, and other non-cigarette products were all associated with subsequent cigarette initiation. However, white and Hispanic youth were more likely to initiate cigarettes through e-cigarette use (vs. cigar or other product use), while black youth were more likely to initiate cigarettes through cigar use (vs. e-cigarette or other product use). IMPLICATIONS: Our findings suggest that previous studies on effects of non-cigarette tobacco products may overlook the critical role of cigar products as a pathway into cigarette smoking among US youth, particularly black youth. While our data support the importance of e-cigarette use as a pathway into smoking, regulatory actions aimed at addressing youth e-cigarette use alone may contribute to disparities in black versus white tobacco use and further exacerbate inequities in tobacco-related disease. Thus, contemporary policy development and discourse about the effects of non-cigarette tobacco products on cigarette initiation should consider cigar and other non-cigarette products as well as e-cigarettes.","journal":"Nicotine & Tobacco Research","year":2020,"id":102605,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":26,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.5585,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":501958,"name":"Anna E Wilson","orcid":null,"position":1,"is_corresponding":false},{"id":334216,"name":"Dielle J. Lundberg","orcid":"0000-0003-1494-4443","position":2,"is_corresponding":false},{"id":500877,"name":"Wubin Xie","orcid":"0000-0002-1089-5149","position":3,"is_corresponding":false},{"id":500878,"name":"Kaitlyn M. Berry","orcid":"0000-0002-2928-6773","position":4,"is_corresponding":false},{"id":500879,"name":"Jessica L. Fetterman","orcid":"0000-0002-9286-7538","position":5,"is_corresponding":false},{"id":426663,"name":"Alyssa F. Harlow","orcid":"0000-0001-6744-6988","position":6,"is_corresponding":false},{"id":341421,"name":"Yvette C. Cozier","orcid":"0000-0003-0625-7256","position":7,"is_corresponding":false},{"id":240000,"name":"Jessica L. Barrington‐Trimis","orcid":"0000-0002-3331-0326","position":8,"is_corresponding":false},{"id":500880,"name":"Kymberle L. Sterling","orcid":"0000-0001-6305-5082","position":9,"is_corresponding":false},{"id":1034,"name":"Emelia J. Benjamin","orcid":"0000-0003-4076-2336","position":10,"is_corresponding":false},{"id":71977,"name":"Michael J. Blaha","orcid":"0000-0001-5138-9683","position":11,"is_corresponding":false},{"id":455411,"name":"Naomi Hamburg","orcid":"0000-0001-5504-5589","position":12,"is_corresponding":false},{"id":355675,"name":"Aruni Bhatnagar","orcid":"0000-0001-6818-0384","position":13,"is_corresponding":false},{"id":422572,"name":"Rose Marie Robertson","orcid":"0000-0002-8855-0933","position":14,"is_corresponding":false},{"id":98931,"name":"Andrew Stokes","orcid":"0000-0002-8502-3636","position":0,"is_corresponding":true}],"reference_count":51,"raw_metadata":null,"created_at":"2026-07-18T22:41:53.173268Z","pmid":"32948872","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}