141st APHA Annual Meeting and Exposition

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281063
Correlates of dual use of cigarettes and smokeless tobacco products or e-cigarettes


Tuesday, November 5, 2013

Sara Kalkhoran, MD, Department of Medicine, University of California, San Francisco, San Francisco, CA
Rachel A. Grana, PhD, MPH, Center for Tobacco Control Research & Education, University of California, San Francisco, San Francisco, CA
Pamela Ling, MD, MPH, Division of General Internal Medicine, Department of Medicine, Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, CA
Background: Dual use of cigarettes and smokeless tobacco products (particularly snus) and of cigarettes and e-cigarettes is increasing in the U.S. These products are often promoted as safer and for use in smoke-free environments. E-cigarettes are also marketed as beneficial in quitting smoking.

Methods: 1412 current smokers completed online cross-sectional surveys in November 2011. Univariate and multivariate logistic regression models evaluated associations between perceived harm of tobacco products, willingness to try smokeless tobacco, quitting behaviors and (a) dual use of cigarettes and smokeless tobacco products, or (b) dual use of cigarettes and e-cigarettes.

Results: 1210 smokers were cigarette only users, 76 were dual users with smokeless tobacco, and 124 were dual users with e-cigarettes. In multivariate models, dual use with smokeless tobacco was associated with younger age, male gender, and having attempted to quit smoking by switching to smokeless products (OR=15.38 95%CI [7.99, 29.59]). Dual use with e-cigarettes was associated with ever using nicotine replacement therapy (OR=1.99 [1.32,3.01]) and having made an attempt to quit smoking in the past year (OR=1.60 [1.06,2.43]. Willingness to try smokeless tobacco when one is unable to smoke was associated with both smokeless tobacco product dual use (OR=1.29 [1.13,1.47]) and e-cigarette dual use (OR=1.14 [1.04,1.24]).

Conclusions: Compared to cigarette-only smokers, dual users may perceive and use non-cigarette products as they are marketed - for when they cannot smoke and with utility for smoking cessation. E-cigarette use by a cigarette smoker may signal interest in quitting.

Learning Areas:

Epidemiology
Public health or related research
Social and behavioral sciences

Learning Objectives:
Discuss two reasons dual use of cigarettes and other tobacco products have important public health impact. Compare the associations between perceived harm of tobacco products, willingness to try smokeless tobacco, quitting behaviors and (a) dual use of cigarettes and smokeless tobacco products, or (b) dual use of cigarettes and e-cigarettes

Keyword(s): Tobacco, Epidemiology

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an active clinical practice physician with a decade of research experience. Since 2011, I have been conducting tobacco-related research with my co-author on this project Dr. Pam Ling. I have also presented my work at national scientific meetings and co-authored two tobacco-related peer-reviewed papers.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4158.0: Tobacco Use Surveillance, Data, and Evaluation