Investigating the use of new tobacco products among cigarette smokers in the U.S.: The dual use phenomenon

Objective: A number of new tobacco products have recently been introduced into the U.S. market. Advertisements for many of these products target cigarette smokers; some of these products are advertised to be used in smokefree places. There is increasing concern that smokers may engage in “dual use,” meaning using cigarettes in combination with these new products. We sought to assess this “dual use” as a mean to describe this as a potential emerging public health problem.

Methods: Porter Novelli's® Healthstyles is a nationally representative consumer mail-in survey of U.S. adults. In 2009, 4,556 adults were asked about whether they had used electronic-cigarettes (e-cigarettes); cigars, cigarillos, little cigars, or flavored little cigars (cigars); waterpipes; dissolvable tobacco products (dissolvables); nicotine water; snus; and/or chewing tobacco (smokeless) at least once in the past 30 days. The weighted percentage of adults who currently smoke and used any of these products in the past 30 days was computed.

Results: Overall, 19.9% of the U.S. adult population is classified as current smokers. Of these, 22.7% engaged in “dual use” in the past 30 days. The most commonly used products in combination with cigarettes were cigars (13.6%), chewing tobacco (7.4%), snus (6.7%), and waterpipes (5.2%), e-cigarettes (1.7%), dissolvables (0.9%), and nicotine water (0.4%).

Conclusions: Some products that are not new such as cigars and chewing tobacco are more commonly used in combination with cigarettes than new emerging tobacco products. It's essential to monitor usage of these products, especially non-combustibles, as they may be used dually with cigarettes.