Doubling down: Analysis of interviews with dual tobacco users

Introduction: The growth of smoking bans (governmental and voluntary) and a recognition of secondhand smoke hazards by most of the public have led many adults to quit smoking. However, some smokers are opting to substitute smokeless tobacco when they cannot—or choose not to smoke. The purpose of this study was to learn from dual tobacco users why they are doing so. Methods: We conducted in-depth interviews with adult West Virginians who are regular smokers and users of smokeless tobacco. All interviews were recorded and transcribed. The two investigators independently coded the interviews using NVivo 9 software. Results: We developed 5 profiles of dual tobacco users, found the circumstances under which dual users opt for cigarettes or smokeless tobacco, and examined their disparate opinions about differences (if any) in the nicotine effects and health risks of these two types of tobacco. Discussion: An unintended consequence of smoking bans is the adoption of smokeless tobacco by some smokers. The tobacco industry has exploited smokers' concerns by marketing tobacco products (e.g., snus and dissolvables) as cigarette substitutes. What we have learned in this study will inform tobacco control practitioners and researchers who need to be more proactive in addressing dual tobacco users, who will find it harder to quit tobacco.