Polytobacco Use of Cigarettes, Cigars, Chewing Tobacco, and Snuff Among US Adults

Abstract

Introduction: Tobacco use prevalence has been commonly estimated on a product by product basis and the extent of polytobacco use among current users of each tobacco product is not well understood. This study aimed to examine the prevalence, trends, and correlates of polytobacco use among current users of cigarettes, cigars, chewing tobacco, and snuff in US adults aged ≥18. Methods: We used pooled data from the 1998, 2000, 2005, and 2010 Cancer Control Supplements of the National Health Interview Survey (N = 123 399 adults). Multivariate logistic regression models were estimated to determine significant factors associated with polytobacco use. Results: In 2010, the prevalence of polytobacco use was 8.6% among current cigarette smokers, 50.3% among current cigar users, 54.8% among current chewing tobacco users, and 42.5% among current snuff users. After controlling for other covariates, gender and race/ethnicity did not show consistent associations with poly-use across these four groups of current tobacco users; however, a positive association of young adulthood, less than high school education, and binge drinking with poly-use was consistently found among all these groups. Conclusions: Polytobacco use is extremely popular among current users of non-cigarette tobacco products. Polytobacco use patterns differ across sociodemographic subpopulations, and the gender and racial/ethnic profiles in poly-users vary across different groups of current tobacco users. Tobacco control strategies need to consider the interrelationships in the use of different tobacco products and the diverse profiles of poly-users in order to develop tailored tobacco prevention and intervention policies to further reduce the burden of tobacco use. 818Nicotine & Tobacco Research, 2016, Vol. 18, No. 5 use has been linked to oral and pharyngeal cancers, bladder and pancreatic cancer, oral leukoplakia, periodontal disease, and hypercholesterolemia.9-12 Because different tobacco products have potentially different levels of addiction and toxicity, 3 polytobacco use may be associated with increased risks of nicotine dependence, 13 adverse health effects, 14 and healthcare utilization compared with exclusive use of a single tobacco product. To evaluate the potential effects of polytobacco use on population health and health-related economic burden, it is crucial to understand the pattern of poly-use and the demographic profile of poly-users.The prevalence of tobacco use has been commonly estimated on a product by product basis in population-level surveillance studies, [15][16][17][18] and the extent of polytobacco use among current users of each tobacco product, especially non-cigarette product, is not well understood. In the literature of polytobacco use among US adults, except few recent studies which examined lifetime polytobacco use, , and relatively few studies estimated the prevalence of current polytobacco use among current users of all tobacco products combined (9.9%−12.1% of those aged ≥26 and 21.4%−24.6% of those aged 18−25), 39 ...

Other tobacco product and electronic cigarette use among homeless cigarette smokers

“…Little and large cigar use was very common, with over half of participants using a cigar product in the past month. This figure is about 10-fold higher than the prevalence of cigar use among cigarette smokers in the general population (Backinger, et al, 2008; Sung, Wang, Yao, Lightwood, & Max, 2015) and nearly 3-fold higher than the past-month prevalence of cigar use by impoverished, non-homeless male smokers in the U.S. (Vijayaraghavan, Pierce, White, & Messer, 2014). The popularity of little cigar use in this sample, especially among individuals with more frequent subsistence difficulties, may point toward the affordability of these products relative to conventional cigarettes, due in part to historical differences in their regulation and taxation (Delnevo & Hrywna, 2007).…”

Tobacco Product Use Patterns, and Nicotine and Tobacco-Specific Nitrosamine Exposure: NHANES 1999–2012

“…For example, among U.S. adult tobacco users in 2010, 8.6% of cigarette smokers, 50.3% of cigar users, 54.8% of chewing tobacco users, and 42.5% of snuff users reported using at least one additional tobacco product every day or some days. (2)…”

“…First, researchers have defined dual and/or poly-tobacco use as consumption of any two or more tobacco products. (2, 3) This definition neglects the relative difference in health risks associated with nicotine delivery mechanisms that fall on a risk continuum with non-combustible products being the relatively less harmful and cigarettes being the most harmful tobacco products. Non-cigarette combustible generally are also less harmful than cigarette largely due to the lower frequency of product use compared to cigarettes.…”

Prevalence and Factors Associated with Smokeless Tobacco Use, 2014-2016

“…15,25,61 Previous studies have linked use of flavored tobacco products at initiation with increased odds of current polytobacco use, and a study by Oliver et al noted that around 60% of STP users started using STP with a flavored product. 62–64 Moreover, STPs often are marketed for use in smoke-free settings and STP advertising suggests that STPs are less harmful than cigarettes; thus, it is unsurprising that STP users report using STPs in smoke-free settings or as a cigarette cessation method.…”