Tobacco and nicotine product use patterns and trends among United States youth and young adults (2021–2024)

Objective: To examine patterns of tobacco and nicotine product use, identify changes in usage trends, and determine the frequency of use across exclusive, dual, and polyuse patterns and the influence of sociodemographic variables among United States youth and young adults. Methods: Data were collected from a repeated, cross-sectional survey of United States young people (aged 15-24 years) from 2021 to 2024. Joinpoint regression was used to determine quarter-year percentage change in usage trends. Chi-square tests and multinomial logistic regression were applied to 2024 data to assess associations with sociodemographic variables. Results: The most common usage pattern was dual use of e-cigarettes and combustible tobacco products. Quarter-year percentage change for dual use of e-cigarettes and oral nicotine pouches increased by 14.75 % from Quarter 3 2023 to Quarter 3 2024. Quarter-year percentage change for polyuse of e-cigarettes, combustible tobacco products, and oral nicotine pouches increased by 6.82 % from Quarter 3 2022 to Quarter 3 2024. Use patterns varied by age, gender identity, race and ethnicity, and perceived financial status. Conclusions: Results indicate significant changes in dual and polyuse of tobacco and nicotine products. These shifts underscore the importance of ongoing surveillance and targeted interventions to mitigate health risks and reduce the burdens of nicotine addiction in this vulnerable population.