In a recent study conducted with Airmen regarding their e-cigarette use prior to enlistment, individuals who reported using e-cigarettes were over 4 times more likely to be dual and poly-tobacco users compared with the participants who did not use e-cigarettes ( 8). Military personnel have high rates of the tobacco-use risk factors mentioned above: They are predominantly young, male, sensation-seeking, and unmarried ( 18).
While there is increasing attention to the prevalence of dual and poly-tobacco use in the civilian population, little is known about patterns of use of these products in the military. The use of multiple tobacco products is more common among young adults who are male, low in income, low in education, high in sensation-seeking, never married, and originally from the Western region of the United States ( 13, 15– 17). Recent findings from the National Adult Tobacco Survey show that 21.3% of US adults report current use of a tobacco product, with 73.4% of these reporting the use of more than 1 product daily ( 9). Reflecting the growing popularity of new and emerging tobacco products, the prevalence of dual and poly-tobacco use is increasing ( 13, 14). As such, it is important to evaluate tobacco-product use in the military and identify opportunities for intervention. Of these, approximately 250,000 military personnel reenter the civilian sector each year. The Department of Defense is the world's largest employer, with 3.2 million employees, half of whom are active-duty personnel ( 12). The prevalence of past-30-day hookah use among US Air Force technical trainees prior to enlistment was 10 times higher than the national average and 4 times higher than the average in young adults aged 18–24 years, and the prevalence of e-cigarette use was 4 times higher than the national average ( 8, 11). 2.8% for smokeless tobacco use) ( 9, 10). Although the US Air Force has the lowest rates of cigarette smoking among service branches ( 10), the prevalences of current cigarette smoking and smokeless tobacco use are much higher among Air Force members than among civilian populations (24% vs. Tobacco-product use prior to enlistment among US Air Force technical trainees has been reported to be twice that of the general population ( 8, 9). However, other tobacco products, such as electronic cigarettes (e-cigarettes), hookahs, and cigars, have grown in popularity ( 3– 7). The prevalence of cigarette smoking has steadily declined over the past decade, from 20.9% in 2005 to 17.8% in 2013 ( 2). Tobacco use in the United States kills approximately half a million people annually ( 1).
Rates of dual and poly-tobacco use are high among trainees, and while these groups are similar to mono users in some ways, there are a number of differences that need to be considered when developing targeted interventions to address use of multiple tobacco products.
mono-tobacco) use included lower confidence to remain tobacco-free, low harm perceptions, and receiving tobacco products free at bars or social events. Factors associated with poly-tobacco (vs. Latent class analysis indicated 5 classes of poly-tobacco use. Tobacco-product use was reported by 27.1% of participants, and of those, over half reported using more than 1 tobacco product. Latent class analysis was carried out to determine types of poly-tobacco users.
The assessment included prevalence of the use of 10 different tobacco products and demographic and environmental factors, such as risk perceptions of tobacco use, peer use, and tobacco-company influences. We conducted a cross-sectional assessment of tobacco-product use among 13,873 Air Force trainees from 2013 to 2014. The present investigation was designed to determine the prevalence and types of dual and poly-use of tobacco products in the US Air Force, as well as characteristics and factors associated with these types.