Introduction Regulatory imbalances exist in the treatment of cigarettes and non-cigarette tobacco products in the USA. We assessed whether declines in cigarette consumption during 2002–2012 were offset by increased use of non-cigarette tobacco products—cigars, pipes, roll-your-own (RYO) and smokeless tobacco.

Methods Industry-reported taxable removals (actual sales) were converted into packs for cigarettes and cigarette pack equivalents (CPEs) for loose tobacco (RYO plus pipe tobacco) and moist snuff. Cigars were not converted to CPEs because of their heterogeneity in size/tobacco content. Per capita sales were calculated for the US adult population aged ≥18 years based on the US Census Bureau data. Self-reported data on current (past 30-day) tobacco use among US adults aged ≥18 years were from the National Survey on Drug Use and Health (NSDUH). Joinpoint and logistic regression were used to assess linear trends during 2002–2012.

Results During 2002–2012, cigarette sales declined from 96.91 to 59.85 cigarette packs per capita; increases occurred for sale of cigars (30.51–57.42 cigars per capita), loose tobacco (2.50–5.63 CPEs per capita) and moist snuff (10.64–14.58 CPEs per capita; all p<0.05 for trend). Self-reported current cigarette smoking declined during 2002–2012 (27.4–23.6%); increases were noted for current RYO (2.6–3.6%) and smokeless tobacco use (3.5–3.7%; all p<0.05 for trend).

Conclusions The increase in non-cigarette tobacco consumption is a public health concern because all tobacco products are harmful. Eliminating imbalances in tax structure and regulations between cigarettes and non-cigarette tobacco products may help reduce aggregate tobacco consumption.