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

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.