Generational Differences in Tobacco Use Patterns: Results from Wave 6 (2021) of the Population Assessment of Tobacco...

Cigarette use has declined over the last decade, yet electronic nicotine delivery systems (ENDS) have gained popularity with younger individuals. Although age differences have been established, it is unclear if there are generational differences in ENDS and cigarette use patterns. The objective of this study was to describe tobacco use patterns by generation and examine factors associated with these patterns.

This study used data from the sixth wave of the Population Assessment of Tobacco and Health Study (PATH; N = 25,199). Adjusted multinomial logistic regression models were used to examine the association between factors, including demographics, tobacco use characteristics, and social influences, and tobacco use patterns by generation.

Generation X had the highest cigarette-exclusive use (32.1%), whereas Generation Z led in ENDS-exclusive use (13.5%). Millennials showed the highest dual use of cigarettes and ENDS (6.4%). Except for Baby Boomers, there were decreased odds of ENDS and dual use when ENDS were perceived as about the same or more harmful compared with cigarettes. Social media demonstrated a protective effect against cigarette use for Generation Z (adjusted odds ratio = 0.51, 95% CI [0.35, 0.74]) and Generation X (adjusted odds ratio = 0.80, 95% CI [0.64, 0.99]). Social influences had strong effects on use across all generations. Specifically, when important people in the participants' lives used a product, the odds of them using the same product increased.

Tobacco use patterns differed by generation. These findings highlight the need for targeted public health interventions to address generational-specific tobacco use behaviors.