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Patterns of dual use of cigarettes and smokeless tobacco among US males: findings from national surveys
  1. Scott L Tomar1,
  2. Hillel R Alpert2,
  3. Gregory N Connolly2
  1. 1Department of Community Dentistry and Behavioral Science, University of Florida College of Dentistry, Gainesville, Florida, USA
  2. 2Department of Society, Human Development, and Health, Division of Public Health Practice, Harvard School of Public Health, Boston, Massachusetts, USA
  1. Correspondence to Dr Scott L Tomar, Department of Community Dentistry and Behavioral Science, University of Florida College of Dentistry, 1329 SW 16th Street, Suite 5180, PO Box 103628, Gainesville, FL 32610-3628, USA; stomar{at}


Background In the USA, consumption of moist snuff continues to increase and cigarette manufacturers now control nearly its entire market. Manufacturers have developed new products that represent cigarette brand extension and in test marketing are promoting dual use of cigarettes and snuff. This study examined patterns of concurrent use of smokeless tobacco (ST) and cigarettes among young people and adults in the USA just before cigarette companies' control of the nation's ST market.

Methods Data were drawn from four US nationally representative surveys. Stratified analyses applied sampling weights and accounted for the complex sample designs.

Results Cigarette smoking was substantially more prevalent among young males who used ST than among those who did not. Among adult males, those who smoked daily were less likely than others to have used snuff every day. Men who used moist snuff daily had the lowest prevalence of daily smoking, but the prevalence of daily smoking was relatively high among men who used moist snuff less than daily. Unsuccessful past-year attempts by daily smokers to quit smoking were more prevalent among non-daily snuff users (41.2%) than among those who had never used snuff (29.6%).

Conclusions Although dual daily use of ST and cigarettes is relatively uncommon in the USA, concurrent ST use is more common among adolescent and young adult male smokers than among more mature tobacco users. Among adult males, daily smoking predominates and non-daily ST use is very strongly associated with current smoking. Adult male smokers who also use ST daily tend to have relatively high levels of serum cotinine and high prevalence of a major indicator for tobacco dependence.

  • Co-substance use
  • smokeless tobacco products
  • smoking topography

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  • Funding This study was supported by National Cancer Institute grant R01CA87477 (GNC, principal investigator).

  • Competing interests SLT serves as an expert witness for plaintiffs in product litigation brought against cigarette and smokeless tobacco manufacturers.

  • Ethics approval This study was approved by the institutional review boards of Harvard University and the University of Florida Health Science Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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