Impact of survey item wording on reported tobacco use among youth: effect of adding ‘even one or two puffs’ to use questions

Having ever used tobacco is a key surveillance metric. Existing tobacco use survey items differ in their inclusion of minimal use language, such as 'even one or two puffs.' This study aimed to quantify how minimal use language affects tobacco ever use prevalence estimated from adolescent surveys. Participants (N = 5127) in the 2022 Teens, Nicotine, and Tobacco Project online panel survey of California adolescents (ages 12–17) were randomized to one of two differently worded ever use survey items (i.e. with or without minimal use language) for eight different tobacco products independently. For seven of the eight products (except hookah), minimal use language resulted in numerically higher ever use prevalence estimates. Averaged across all products, ever use prevalence was 0.7-percentage points higher when items included minimal use language (95% CI: 0.1, 1.4). Findings suggest that minimal use language yields modestly higher tobacco use prevalence, with implications for comparing and interpretating surveillance data.