This study examines the contextual factors influencing polytobacco use behavior, or the concurrent use of two or more forms of tobacco, among young adult South Asians. Fifteen in-depth and qualitative case studies of South Asian college students were conducted in order to illuminate and understand the intrapersonal, social, cultural, and environmental determinants of polytobacco use. Results from the study highlight the dynamic and diverse nature of tobacco use, as patterns of consumption were found to be profoundly influenced and differentially distributed across lines of gender, socioeconomic status, age, nationality, situational context, and ethnic identity. Participants used two to five forms of tobacco, with 60% using more than two. In addition to cigarettes, several alternative tobacco forms, predominantly hookah, spliffs, and dokha, emerged as popular modes of tobacco consumption among this population. South Asian college students use multiple products intermittently in community settings, where use is normalized as a component of a social activity. The current cigarette-centered model for tobacco control must be adjusted to account for the variety of tobacco forms now accessible to and utilized by young adult South Asians, whose choice of product and frequency of usage is guided by the contextual factors identified in the case studies. Tobacco intervention efforts and cessation programs must develop cultural sensitivity that is attuned and responsive to unique patterns of polytobacco use in order to effectively combat the current tobacco epidemic.

This study examines the contextual factors influencing polytobacco use behavior, or the concurrent use of two or more forms of tobacco, among young adult South Asians. Fifteen in-depth and qualitative case studies of South Asian college students were conducted in order to illuminate and understand the intrapersonal, social, cultural, and environmental determinants of polytobacco use. Results from the study highlight the dynamic and diverse nature of tobacco use, as patterns of consumption were found to be profoundly influenced and differentially distributed across lines of gender, socioeconomic status, age, nationality, situational context, and ethnic identity. Participants used two to five forms of tobacco, with 60% using more than two. In addition to cigarettes, several alternative tobacco forms, predominantly hookah, spliffs, and dokha, emerged as popular modes of tobacco consumption among this population. South Asian college students use multiple products intermittently in community settings, where use is normalized as a component of a social activity. The current cigarette-centered model for tobacco control must be adjusted to account for the variety of tobacco forms now accessible to and utilized by young adult South Asians, whose choice of product and frequency of usage is guided by the contextual factors identified in the case studies. Tobacco intervention efforts and cessation programs must develop cultural sensitivity that is attuned and responsive to unique patterns of polytobacco use in order to effectively combat the current tobacco epidemic.