Patterns of dual use of cigarettes and smokeless tobacco among US males: findings from national surveys

Tob Control. 2010 Apr;19(2):104-9. doi: 10.1136/tc.2009.031070. Epub 2009 Dec 11.


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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Cotinine / blood
  • Data Collection
  • Data Interpretation, Statistical
  • Humans
  • Male
  • Nicotine / blood
  • Smoking / epidemiology*
  • Smoking Cessation
  • Socioeconomic Factors
  • Substance-Related Disorders / psychology
  • Tobacco Use Disorder / complications
  • Tobacco Use Disorder / epidemiology*
  • Tobacco Use Disorder / psychology
  • Tobacco, Smokeless*
  • United States / epidemiology
  • Young Adult


  • Nicotine
  • Cotinine