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

BackgroundThe 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).DesignForty-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.ResultsCotinine 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.ConclusionsResults 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.

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Concurrent Use of Cigarettes and Smokeless Tobacco in Minnesota

Journal of Environmental and Public Health ◽

10.1155/2012/493109 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 10

Author(s):

Raymond G. Boyle ◽

Ann W. St. Claire ◽

Ann M. Kinney ◽

Joanne D'Silva ◽

Charles Carusi

Keyword(s):

Cigarette Smoking ◽

Smokeless Tobacco ◽

Public Policies ◽

Experimental Phase ◽

Public Places ◽

Cigarette Smokers ◽

Concurrent Use ◽

Changes Over Time ◽

Over Time

Cigarette smokers are being encouraged to use smokeless tobacco (SLT) in locations where smoking is banned. We examined state-wide data from Minnesota to measure changes over time in the use of SLT and concurrent use of cigarettes and SLT. The Minnesota Adult Tobacco Survey was conducted four times between 1999 and 2010 and has provided state-wide estimates of cigarette smoking, SLT use and concurrent use of SLT by smokers. The prevalence of SLT was essentially unchanged through 2007, then increased significantly between 2007 and 2010 (3.1% versus 4.3%,P<0.05). Similarly, the prevalence of cigarette smokers who reported using SLT was stable then increased between 2007 and 2010 (4.4% versus 9.6%,P<0.05). The finding of higher SLT use by smokers could indicate that smokers in Minnesota are in an experimental phase of testing alternative products as they adjust to recent public policies restricting smoking in public places. The findings are suggestive that some Minnesota smokers are switching to concurrent use of cigarettes and SLT. Future surveillance reports will be necessary to confirm the results.

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Heat-not-burn Tobacco Products and the Increased Risk for Poly-tobacco Use

American Journal of Health Behavior ◽

10.5993/ajhb.45.1.16 ◽

2021 ◽

Vol 45 (1) ◽

pp. 195-204

Author(s):

Pallav Pokhrel ◽

Thaddeus A. Herzog ◽

Crissy T. Kawamoto ◽

Pebbles Fagan

Keyword(s):

Smoking Cessation ◽

Young Adults ◽

Tobacco Use ◽

Tobacco Product ◽

Dual Use ◽

Cigarette Smokers ◽

Product Use ◽

Increased Risk ◽

Current Cigarette

Objectives: In this study, we tested the use of ecigarette, cigarette, and dual use of both as predictors of heat-not-burn (HNB) tobacco product use onset among young adults, and examined common predictors of smoking cessation as predictors of HNB product use. Methods: We collected data from 2229 young adults [mean age = 21.1 (SD = 2.1); 55% women] in Hawaii, at 2 time-points 6 months apart. Results: Current cigarette-only use was the strongest concurrent predictor of HNB product use, followed by dual use, and ecigarette-only use. Among HNB product never users at Wave 1, dual and ecigarette-only use at Wave 1 significantly predicted HNB product use onset at Wave 2. Among cigarette smokers who had never used an HNB product at Wave 1, current use of ecigarette for help with smoking cessation predicted increased odds of HNB product use at 6-month follow-up. Conclusions: Although promoted as a safer alternative for exclusive cigarette smokers, HNB products may increase the risk of dual or poly-tobacco product use among young adults, including current exclusive e-cigarette users. Surveillance of HNB product use as a modified risk tobacco product may need to consider the effects of HNB products on poly-tobacco use among young people.

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Transitions to smokeless tobacco use among adult cigarette smokers in the Population Assessment of Tobacco and Health (PATH) Study, Waves 3–5 (2015–2019)

Tobacco Control ◽

10.1136/tobaccocontrol-2021-056907 ◽

2021 ◽

pp. tobaccocontrol-2021-056907

Author(s):

Rebecca A Jackson ◽

Chunfeng Ren ◽

Blair Coleman ◽

Hannah R Day ◽

Cindy M Chang ◽

...

Keyword(s):

Tobacco Use ◽

Smokeless Tobacco ◽

Health Study ◽

Dual Use ◽

Cigarette Smokers ◽

Population Assessment ◽

Current Cigarette ◽

Smokeless Tobacco Use ◽

Using Data

ObjectiveExamine patterns of dual use of cigarettes and smokeless tobacco and complete switching over time among adult current cigarette smokers using data from the Population Assessment of Tobacco and Health Study Wave 3 (2015–2016), Wave 4 (2016–2018) and Wave 5 (2018–2019).MethodsWe examined four tobacco use states among 6834 exclusive smokers and 372 dual users at Wave 3 with two waves of follow-up data: exclusive cigarette use, exclusive smokeless tobacco use, dual use and use of neither product.ResultsAmong exclusive smokers at Wave 3, only 1.6% (95% CI: 1.3% to 2.1%) transitioned to dual use at Wave 4, and 0.1% (95% CI: 0.07% to 0.2%) switched to exclusive smokeless tobacco use. Among exclusive smokers who switched to dual use, 53.1% (95% CI: 40.9% to 64.9%) returned to exclusive cigarette smoking, 34.3% (95% CI: 23.8% to 46.6%) maintained dual use and 12.6% (95% CI: 7.0% to 21.7%) did not smoke cigarettes after an additional wave of follow-up. Dual users at Wave 3 were likely to maintain their dual use status at Wave 4, 51.2% (95% CI: 46.1% to 56.3%) and Wave 5, 47.9% (95% CI: 40.1% to 55.8%).ConclusionsVery few cigarette smokers transition to smokeless tobacco use, and among those who do, dual use is more common than exclusive smokeless tobacco use. Further, the majority of exclusive cigarette smokers who transition to dual use at Wave 4 continue smoking cigarettes at Wave 5, either as dual users or as exclusive smokers.

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Biomarkers of Exposure Among “Dual Users” of Tobacco Cigarettes and Electronic Cigarettes in Canada

Nicotine & Tobacco Research ◽

10.1093/ntr/nty174 ◽

2018 ◽

Vol 21 (9) ◽

pp. 1259-1266 ◽

Cited By ~ 10

Author(s):

Christine D Czoli ◽

Geoffrey T Fong ◽

Maciej L Goniewicz ◽

David Hammond

Keyword(s):

Repeated Measures ◽

Electronic Cigarettes ◽

Cigarette Use ◽

Dual Use ◽

Potential Health ◽

Product Use ◽

Biomarkers Of Exposure ◽

Health Authorities ◽

Concurrent Use ◽

Public Health Authorities

Abstract Introduction “Dual use” refers to the concurrent use of tobacco cigarettes (smoking) and electronic cigarettes (e-cigarettes; vaping). Although dual use is common among e-cigarette users, there is little evidence regarding biomarkers of exposure among dual users and how these change under different conditions of product use. Methods A nonblinded within-subjects crossover experiment was conducted with adult daily dual users (n = 48) in Ontario, Canada. Participants completed three consecutive 7-day periods in which the use of tobacco cigarettes and e-cigarettes was experimentally manipulated, resulting in four study conditions: Dual use, Tobacco cigarette use, E-cigarette use, and No product use. Repeated measures models were used to examine changes in product use and biomarkers of exposure. Results Compared to dual use, cotinine remained stable when participants exclusively smoked (p = .524), but significantly decreased when they exclusively vaped (p = .027), despite significant increases in e-cigarette consumption (p = .001). Levels of biomarkers of exposure to toxicants, including carbon monoxide (CO), 1-hydroxypyrene (1-HOP), and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), were significantly lower when participants exclusively vaped than when they engaged in dual use (CO = −41%, p < .001; 1-HOP = −31%, p = .025; NNAL = −30%, p = .017). Similar findings were observed among participants abstaining from both products as compared to dual use (CO: −26%, p < .001; 1-HOP = −14% [ns]; NNAL = −35%, p = .016). In contrast, levels of biomarkers of exposure increased when participants exclusively smoked as compared to dual use (CO = +21%, p = .029; 1-HOP = +23%, p = .048; NNAL = +8% [ns]). Conclusions Although dual use may reduce exposure to tobacco smoke constituents to some extent, abstaining from smoking is the most effective way to reduce such exposure. Implications Public health authorities should clearly communicate the relative risk of e-cigarettes and tobacco cigarettes to the general public, focusing on two salient points: (1) e-cigarettes are not harmless, but they are less harmful than tobacco cigarettes; and (2) using e-cigarettes while smoking may not necessarily reduce health risks; therefore, consumers should stop smoking completely to maximize potential health benefits.

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Reasons for individual and concurrent use of vaped nicotine and cannabis: their similarities, differences, and association with product use

Journal of Cannabis Research ◽

10.1186/s42238-021-00097-7 ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

Danielle M. Smith ◽

Lynn Kozlowski ◽

Richard J. O’Connor ◽

Andrew Hyland ◽

R. Lorraine Collins

Keyword(s):

Harm Reduction ◽

Amazon Mechanical Turk ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Convenience Sample ◽

Product Use ◽

Paired Samples ◽

Concurrent Use ◽

Cannabis Smoking ◽

Reasons For Use

Abstract Background Understanding similarities, differences, and associations between reasons people vape nicotine and cannabis may be important for identifying underlying contributors to their co-use. Methods A cross-sectional survey of 112 co-users of vaped nicotine and cannabis was conducted in 2020. A convenience sample of participants was recruited for the survey using Amazon Mechanical Turk. Participants responded to questions about their reasons for individual nicotine and cannabis product use and co-use and rated their level of agreement using numerical scales. Mean ratings for each reason for use subscale were examined across all participants and compared using paired samples t tests. Associations between reasons for use ratings and product consumption behaviors were examined using linear and logistic regression analyses. Results Cannabis vaping and smoking exhibited similar mean ratings for user experience and product/substance-related reasons for use. Mean ratings for reasons related to product utility were similar for cannabis vaping and nicotine vaping. Mean ratings for utility-related reasons for use were higher for cannabis vaping than cannabis smoking (mean (SD), 3.6 (± 1.0) vs. 2.6 (± 1.2), p < 0.0001). On average, harm reduction-related reasons for use were rated higher for nicotine vaping than cannabis vaping (2.4 (± 1.6) vs. 1.8 (± 1.4), p < 0.0001). Regression models showed higher average ratings for utility-related (b = 0.32; 95% CI, 0.03-0.60) and harm reduction-related (b = 0.21; 95% CI, 0.04-0.37) reasons for nicotine vaping were associated with more frequent nicotine vaping (both p < 0.05). Higher average ratings for instrumentality-related reasons for co-use corresponded with more frequent monthly nicotine vaping (b = 0.26; 95% CI, 0.08-0.44) and higher odds of ever chasing cannabis with nicotine (aOR, 3.06; 95% CI, 1.29-7.30). Conclusions Vaping serves purposes that differ by substance; nicotine vaping was more closely related to reducing tobacco smoking-related harms, and cannabis vaping was more closely related to circumventing social problems posed by cannabis smoking. Lifetime sequential co-use practices and more frequent nicotine vaping were associated with enhancing the intoxicating effects of cannabis. While replication of these findings using non convenience-based sampling approaches is warranted, results underscore the need to consider shared and unique aspects of nicotine and cannabis vaping, as well as cross-substance interactions between nicotine and cannabis.

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Polytobacco product use among current cigarette smokers in Hong Kong, China: results from population surveys (2015–17)

BMC Public Health ◽

10.1186/s12889-021-10341-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

S. L. Chau ◽

M. P. Wang ◽

Y. Wu ◽

D. Y. T. Cheung ◽

A. Kong ◽

...

Keyword(s):

Control Policy ◽

Tobacco Product ◽

Cigarette Use ◽

Related Factors ◽

Cigarette Smokers ◽

Tobacco Products ◽

Product Use ◽

Younger Age ◽

Current Cigarette ◽

Age And Sex

Abstract Background Polytobacco product use is increasingly popular, but little is known about the prevalence, trend, and factors of such use particularly in non-western countries. Method A representative sample of 1139 current cigarette smokers aged 15+ (84.1% male) were telephone interviewed in Tobacco Control Policy-related Surveys in 2015–2017. Information collected included poly-tobacco use (PTU), smoking and socio-demographic characteristics. Associations of current PTU with related factors were analyzed using logistic regression with adjustment for confounders. Prevalence was weighted by age and sex of current cigarette users in the general population. Results Eighty-four point one percent (95% CI 81.4–86.6%) were exclusive cigarette smokers. Fifteen point nine percent (13.4–18.6%) were current polytobacco product users, 12.3% (10.2–14.8%) used one tobacco product and 2.52% (1.59–3.97%) used two tobacco products in addition to cigarette. Cigarette use with cigar was more common (6.28%, 4.75–8.27%), and the least used product with cigarette was e-cigarette (1.05%, 0.44–2.50%). The changes in overall prevalence of PTU by number of products use varied in 3 years. Current PTU was associated with being male (AOR 2.01, 95% CI 1.12–3.61), younger age (AORs range from 1.34–4.65, P for trend < .001) and less ready to quit (2.08, 1.09–3.97). Conclusions Prevalence of PTU increased slowly by year, one tobacco product use with cigarette was more common. The most used tobacco product with cigarette was cigar. Being male, younger and less ready to quit were associated with current PTU.

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A Comparison of Tobacco Product Prevalence by Different Frequency of Use Thresholds Across Three US Surveys

10.21203/rs.3.rs-333579/v1 ◽

2021 ◽

Author(s):

Luz María Sánchez-Romero ◽

Christopher J. Cadham ◽

Jana L. Hirschtick ◽

Delvon T. Mattingly ◽

Beomyoung Cho ◽

...

Keyword(s):

Tobacco Use ◽

Smokeless Tobacco ◽

Tobacco Product ◽

Adult Age ◽

Product Group ◽

Use Patterns ◽

Product Use ◽

Frequency Of Use ◽

Smokeless Tobacco Use ◽

Frequency Threshold

Abstract Background: With the increasing changes in tobacco use patterns, “current use” definition and the survey used may have important implications for monitoring population use trends. Methods: Using three US surveys (2014/15 TUS-CPS, NHIS and PATH), we compared the adult (age 18+) prevalence of four product groups (cigarettes, other combustibles, smokeless tobacco, and e-cigarettes) based on three past 30-day frequency of use thresholds: 1+, 10+, and 25+ days. We also examined mutually exclusive single, dual, and polytobacco users as a percentage of total users for each product group. Results: Regardless of threshold or product, the prevalence was higher in PATH followed by NHIS and TUS-CPS, in some cases by large percentages. The differences in cigarette and smokeless tobacco use prevalence in going from the 1+ to 10+ days and to the 25+ days threshold were minimal. Applying different frequency thresholds had the largest impact on other combustibles prevalence, with a 60% reduction with the 10+ days threshold and a 80% reduction with the 25+ days threshold, compared to the 1+ days threshold, followed by e-cigarettes with 40% and 60% reductions, respectively. The proportion of dual and polytobacco users decreased considerably when using the 10+ vs. the 1+ days threshold and polytobacco use was almost non-existent with the 25+ days threshold. Conclusion: The estimated prevalence of each tobacco product use depends largely on the survey and frequency of use threshold adopted. The choice of survey and frequency threshold merits serious consideration when monitoring patterns of tobacco use.

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Effect of a hypothetical modified risk tobacco product claim on heated tobacco product use intention and perceptions in young adults

Tobacco Control ◽

10.1136/tobaccocontrol-2021-056479 ◽

2021 ◽

pp. tobaccocontrol-2021-056479

Author(s):

Julia C Chen-Sankey ◽

Afton Kechter ◽

Jessica Barrington-Trimis ◽

Rob McConnell ◽

Evan A Krueger ◽

...

Keyword(s):

Young Adults ◽

Tobacco Product ◽

Cigarette Use ◽

Dual Use ◽

Cigarette Smokers ◽

Web Based ◽

Experimental Effect ◽

Current Cigarette ◽

Product Claim ◽

Related Harm

IntroductionModified risk tobacco product (MRTP) claims for heated tobacco products (HTPs) that convey reduced exposure compared with conventional cigarettes may promote product initiation and transition among young people. We assessed the effects of a hypothetical MRTP claim for HTPs on young adults’ intention and perceptions of using HTPs and whether these effects differed by their current cigarette and e-cigarette use.MethodsWe embedded a randomised between-subjects experiment into a web-based survey administered among a cohort of 2354 Southern California young adults (aged 20–23) in 2020. Participants viewed depictions of HTPs with an MRTP claim (n=1190) or no claim (n=1164). HTP use intention and HTP-related harm and use perceptions relative to cigarettes and e-cigarettes were assessed.ResultsOverall, participants who viewed versus did not view the claim did not differ in HTP use intention (28.5% vs 28.7%) but were more likely to perceive HTPs as less harmful than cigarettes (11.4% vs 7.0%; p<0.001). The experimental effect on HTP use intention did not differ among past 30-day cigarette smokers versus non-smokers (interaction adjusted OR (AOR)=0.78, 95% CI 0.36 to 1.76) but differed among past 30-day e-cigarette users versus non-users (interaction AOR=1.67, 95% CI 1.02 to 2.68).DiscussionThe hypothetical MRTP claim may lower young adults’ HTP harm perceptions compared with cigarettes but may not change HTP use intention overall or differentially for cigarette smokers. The larger effect on HTP use intention among e-cigarette users than non-users raises the question of whether MRTP claims may promote HTP use or HTP and e-cigarette dual use among young e-cigarette users.

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Evaluation of Chemical Dot Thermometers for Measuring Body Temperature of Orally Intubated Patients

American Journal of Critical Care ◽

10.4037/ajcc2003.12.5.403 ◽

2003 ◽

Vol 12 (5) ◽

pp. 403-408 ◽

Cited By ~ 10

Author(s):

Patricia Potter ◽

Marilyn Schallom ◽

Susan Davis ◽

Carrie Sona ◽

Maryellen McSweeney

Keyword(s):

Intensive Care ◽

Body Temperature ◽

Adult Patients ◽

Surgical Trauma ◽

Convenience Sample ◽

Acceptable Alternative ◽

Single Use ◽

Electronic Thermometer ◽

The Difference ◽

Subsequent Patient

• Background Recent research indicates that oral measurement of body temperature is a reliable option in orally intubated patients. In situations such as protective isolation, where dedicated electronic thermometers are not available, are single-use chemical dot thermometers an acceptable alternative?• Objective To determine the accuracy of single-use chemical dot thermometers in orally intubated adult patients.• Methods Subjects included a convenience sample of 85 adult patients admitted to 1 of 2 intensive care units (surgical trauma and neuroscience). For each patient, oral temperatures were measured concurrently (within 5 minutes) with a chemical dot thermometer and an electronic thermometer. The sequence of temperature measurements was alternated with each subsequent patient. Both thermometers were placed in the same posterior sublingual pocket opposite the side of the endotracheal tube.• Results Measurements obtained with electronic and single-use chemical dot thermometers correlated strongly (r = 0.937). With the chemical dot thermometer, body temperature was overestimated in 11.8% of the measurements and underestimated in 10.8% of the measurements by 0.4°C or more. The difference between oral temperatures measured with the 2 different thermometers was not related to the patient’s age, sex, or sublingual pocket location or to the order of thermometer use.• Conclusion The chemical dot thermometer is useful and reliable for measuring body temperature of orally intubated patients. When measurements of body temperature have important consequences for decisions about treatment, clinicians should use an electronic thermometer to confirm measurements made with a chemical dot thermometer.

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