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Cigarette smokers’ concurrent use of smokeless tobacco: dual use patterns and nicotine exposure


Felicione, NJ and Ozga-Hess, JE and Ferguson, SG and Dino, G and Kuhn, S and Haliwa, L and Blank, MD, Cigarette smokers' concurrent use of smokeless tobacco: dual use patterns and nicotine exposure, Tobacco Control, 30, (1) pp. 24-29. ISSN 0964-4563 (2020) [Refereed Article]

Copyright Statement

© Author(s) (or their employer(s)) 2020.

DOI: doi:10.1136/tobaccocontrol-2019-055345


Background: The concurrent use of cigarettes with other tobacco products, such as smokeless tobacco (SLT), is increasingly common. Extant work with cigarette smokers who also use SLT is based heavily on retrospective reports and between-group comparisons. The purpose of this study was to assess prospectively the patterns of dual users’ product use and nicotine exposure on days when cigarettes were smoked exclusively (single use) versus concurrently with SLT (dual use).

Design: Forty-six dual cigarette-SLT users recorded their product use in real time via ecological momentary assessment for a 2-week longitudinal design. They responded to questions about situational factors (eg, location, mood) using this same diary, and collected saliva samples each night for later cotinine measurement. At the end of this 2-week period, users reported on their reasons for and beliefs about SLT use.

Results: Cotinine levels were significantly higher on dual versus single use days (mean±SEM=374.48±41.08 ng/ mL vs 300.17±28.13 ng/mL, respectively; p<0.01), and the number of cigarettes logged was higher on dual versus single use days (11.13±0.98 vs 9.13±1.11, respectively; p<0.01). Product use was distinguished by situational factors, with the strongest predictor being location of use. Moreover, the most common reason for initiating (56.52%) and continuing (67.39%) SLT use was to circumvent indoor smoking restrictions.

Conclusions: Results support the idea of product supplementation rather than replacement among this convenience sample of dual users. For smokers whose primary motivation for SLT use involves situations where they would otherwise be tobacco free, the potential benefits of clean indoor air laws may be diminished.

Item Details

Item Type:Refereed Article
Keywords:nicotine, tobacco control, dual use
Research Division:Psychology
Research Group:Clinical and health psychology
Research Field:Health psychology
Objective Division:Health
Objective Group:Public health (excl. specific population health)
Objective Field:Behaviour and health
UTAS Author:Ferguson, SG (Professor Stuart Ferguson)
ID Code:138770
Year Published:2020
Web of Science® Times Cited:5
Deposited By:Medicine
Deposited On:2020-04-28
Last Modified:2021-05-27

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