Disparities in Poly-Tobacco Use Among United States Adults in the All of Us Research Program

Although overall tobacco use has declined in the United States (U.S.), poly-tobacco use remains a concern due to increased risk of toxicant exposure and addiction potential, with disparities across sociodemographic groups. This study examined the prevalence of tobacco use patterns among different sociodemographic groups in U.S. adults.

We analyzed data from 480,608 U.S. adults (aged ≥18) in the All of Us Research Program. Tobacco use was classified as single-tobacco product (any 1 product), dual-tobacco (any 2 products), or poly-tobacco (any 3+ products) use. Sociodemographic characteristics included age, gender, sexual orientation, race and ethnicity, nativity, educational attainment, homeownership, and employment status. Prevalence estimates and multinomial logistic regression were used to identify associations.

Overall, 14.1%, 3.9% and 1.2% of participants reported single-tobacco product, dual-tobacco, and poly-tobacco use, respectively. Among participants reporting current use, the corresponding proportions were 73.4%, 20.5% and 6.1%. Younger adults, males, non-Hispanic Middle Eastern or North African adults, bisexual adults, adults with low education, non-homeowners, and unemployed adults had higher odds of dual- and poly-tobacco use vs. current non-use and compared to their respective reference groups. Specifically, participants with less than a 12th grade education (vs. advanced degrees) had more than ten times the odds (95% CI: 8.78, 11.95) of poly-tobacco use vs. current non-use. Homemaker individuals had higher odds of dual-tobacco use vs. current non-use.

Sociodemographic correlates of multiple tobacco product use patterns highlight persistent disparities, particularly among underrepresented groups. Findings underscore the need for more inclusive surveillance and targeted interventions to reduce dual and poly-tobacco use.