Differentiating Factors Affecting the Initiation of Multiple Tobacco Product Use Among U.S. Adolescents and Young Adults: A Systematic Scoping Review

The U.S. tobacco landscape has evolved significantly over the past decade, with a decrease in combustible cigarette use but a rise in multiple tobacco product (MTP) use among adolescents and young adults (AYAs). MTP use, defined as the concurrent use of two or more tobacco products, increases nicotine exposure and the risk of dependence, particularly during adolescence when substance use can impact brain development. This shift underscores the need for targeted prevention efforts addressing the factors influencing the initiation and progression to regular tobacco use, especially among those most susceptible. This systematic scoping review employed the Joanna Briggs Institute (JBI) method and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist to explore factors associated with MTP susceptibility, uptake, and use among U.S. AYAs. A comprehensive search in the PsycINFO and PubMed databases yielded 52 eligible articles published from 2013 onward. Findings reveal overlapping factors across stages, including peer and parental tobacco use, tobacco marketing exposure, mental health challenges, and sensation-seeking tendencies, as well as stage-specific factors such as tobacco use intentions, e-cigarette use, and substance use history. By situating these factors within a stage-based continuum, the review provides a framework for multilevel, developmentally informed prevention strategies targeting individual behaviors, family and peer contexts, and broader policy environments. These insights highlight opportunities for phase-specific interventions and underscore the importance of regulatory measures—including flavor bans, age restrictions, and retail enforcement—to reduce initiation, progression, and long-term harms associated with MTP use among AYAs.