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.
- non-cigarette tobacco products
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Contributors MDB conceptualised and supervised all aspects of the project, including manuscript preparation and review. SGF developed and oversaw use of the EMA software, and also assisted with manuscript preparation and review. NJF and JEOH collected the data, conducted statistical analyses and assisted with manuscript preparation and review. SK assisted with data collection, and reviewed and edited the drafts of the manuscript. GD and IH reviewed and edited the drafts of the manuscript.
Funding Financial support was provided by the National Institute on Drug Abuse of the National Institutes of Health and the Center for Tobacco Products of the US Food and Drug Administration (R03DA037583; PI MDB, consultant SGF). Additional support was provided by the National Institute of General Medical Sciences (T32GM081741; NJF and JEOH), and the US Centers for Disease Control and Prevention (U481006466AR; PI GD, Co-I MDB) to the West Virginia Prevention Research Center.
Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the views of the NIH, the FDA or the CDC.
Competing interests SGF has consulted for various pharmaceutical companies on matters relating to smoking cessation. All other authors declare no conflicts of interest.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request.
Author note All work was performed at West Virginia University.
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