Tobacco control policies and the concurrent use of smokeless tobacco and cigarettes among men, 1992–2002

Abstract

Accelerating the decline in smoking prevalence requires an understanding of changes in the concurrent use of and the substitution between different tobacco products, such as smokeless tobacco (SLT) and cigarettes. SLT could play an important role in reducing the toll of smoking-related illness and premature mortality. Research examining the role of tobacco control policies in explaining concurrent use of SLT and cigarettes has been minimal. Using the Current Population Survey Tobacco Use Supplements (CPS-TUS), we examined tobacco control policies in relationship with adult males' SLT use concurrent with smoking over the period 1992-2002. Consistent with the decline in smokeless-only and cigarette-only rates, concurrent use of SLT and cigarettes declined during the period. SLT users, faced with home or workplace smoking bans, are less likely to report smoking. Smokers with a home ban appear more likely to use SLT, but in more recent years, smokers with a workplace ban are less likely to use SLT. Tobacco excise taxes do not signal substitution between cigarettes and SLT products. Understanding current use patterns of the range of tobacco products, including their interaction with available policy levers, is vital in assessing whether changes that might promote substitution of arguably less toxic SLT products for highly toxic cigarettes are likely to lead to net public health gains or losses. Findings of the present study, in concert with other research about transitional probabilities between behavioral states, will inform the design of an effective policy framework that supports the objective of reducing tobacco-related death and disease.

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

“…To compare our results with the literature of poly-use among current tobacco users, 13,16,[29][30][31][32][34][35][36][37][38][39] it is worth pointing out that previous poly-use prevalence estimates varied widely depending on types of tobacco products examined, frequency of tobacco use (daily vs. nondaily), and gender. In the literature, dual use of cigarettes with SLT (chewing tobacco and snuff) 16,30,31,35,36 and dual use of cigarettes with snuff 13,37 were the most commonly examined poly-use combinations.…”

“…To compare our results with the literature of poly-use among current tobacco users, 13,16,[29][30][31][32][34][35][36][37][38][39] it is worth pointing out that previous poly-use prevalence estimates varied widely depending on types of tobacco products examined, frequency of tobacco use (daily vs. nondaily), and gender. In the literature, dual use of cigarettes with SLT (chewing tobacco and snuff) 16,30,31,35,36 and dual use of cigarettes with snuff 13,37 were the most commonly examined poly-use combinations. These dual-use studies showed that 15.0%−19.2% of male daily snuff users and 38.9%−44.7% of male nondaily snuff users concurrently used cigarettes, 13,37 that dual-use prevalence among current SLT users was 25.0%−33.0% for men, 30,35,36 42.4% for women, 36 and 41.3% for both genders, 31 and that dual-use prevalence among current cigarette smokers was 4.4%−8.5%% for men, 35,36 2.3% for women, 36 and 6.1% for both genders.…”

“…In the literature, dual use of cigarettes with SLT (chewing tobacco and snuff) 16,30,31,35,36 and dual use of cigarettes with snuff 13,37 were the most commonly examined poly-use combinations. These dual-use studies showed that 15.0%−19.2% of male daily snuff users and 38.9%−44.7% of male nondaily snuff users concurrently used cigarettes, 13,37 that dual-use prevalence among current SLT users was 25.0%−33.0% for men, 30,35,36 42.4% for women, 36 and 41.3% for both genders, 31 and that dual-use prevalence among current cigarette smokers was 4.4%−8.5%% for men, 35,36 2.3% for women, 36 and 6.1% for both genders. 31 We examined four types of tobacco products and our poly-use prevalence estimates are generally greater than those from the above-mentioned dual-use studies.…”

“…In the literature of polytobacco use among US adults, except few recent studies which examined lifetime polytobacco use, 4,[19][20][21] most studies examined current polytobacco use at either the population level or tobacco users' level. At the population level, some studies estimated the prevalence of current polytobacco use among special populations such as the Lumbee American Indians in North Carolina (4.8%), 22 Air Force recruits (1.3%−3.3%), 5,23 active duty military personnel (11.5%), 24 college students (7.4%), 25 young adults aged 18−34 (7.0%), 26 and cancer prevention trial participants (3.7%), 27 while others estimated the prevalence of current polytobacco use among the general population of all adults (ranging from 0.3%−1.6% [28][29][30][31] to 2.5%−3.4% 32,33 and up to 10.6% 34 ), of all men (0.6%−1.6%), 28,[35][36][37] and of all women (0.3%). 36 At the tobacco users' level, the vast majority of studies estimated the prevalence of current polytobacco use among current cigarette smokers (ranging from 2.3%−8.5% 13 , 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 among male current snuff users (15.0%−19.2% of daily snuff users and 38.9%−44.7% of nondaily snuff users), 13,37 and among current SLT users (25.0%−42.4%).…”

“…36 At the tobacco users' level, the vast majority of studies estimated the prevalence of current polytobacco use among current cigarette smokers (ranging from 2.3%−8.5% 13 , 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 among male current snuff users (15.0%−19.2% of daily snuff users and 38.9%−44.7% of nondaily snuff users), 13,37 and among current SLT users (25.0%−42.4%). 30,31,35,36 There is a lack of studies that examine polytobacco use among current cigar users, even though it has been shown that cigars were the most prevalent product concurrently used among current cigarette smokers, 29 and one-half of all polytobacco users consumed both cigarettes and cigars. 3 Given the increasing use of non-cigarette tobacco products, the popularity of polytobacco use, and the limited research examining polytobacco use among non-cigarette tobacco users, this study aims to assess the prevalence, trends, and correlates of polytobacco use separately among current cigarette smokers as well as three groups of non-cigarette tobacco users-current cigar users, current chewing tobacco users, and current snuff users-using a large-scale nationally representative survey of the US adult population.…”