Alternative tobacco product use and smoking cessation: a national study

Am J Public Health. 2013 May;103(5):923-30. doi: 10.2105/AJPH.2012.301070. Epub 2013 Mar 14.


Objectives: We investigated the frequency of alternative tobacco product use (loose leaf, moist snuff, snus, dissolvables, electronic cigarettes [e-cigarettes]) among smokers and the association with quit attempts and intentions.

Methods: A nationally representative probability-based cross-sectional survey of 1836 current or recently former adult smokers was completed in November 2011. Multivariate logistic regressions evaluated associations between alternative tobacco product use and smoking cessation behaviors.

Results: Of the smokers, 38% had tried an alternative tobacco product, most frequently e-cigarettes. Alternative tobacco product use was associated with having made a quit attempt, and those intending to quit were significantly more likely to have tried and to currently use the products than were smokers with no intentions to quit. Use was not associated with successful quit attempts. Interest in future use of alternative tobacco products was low, except for e-cigarettes.

Conclusions: Alternative tobacco products are attractive to smokers who want to quit smoking, but these data did not indicate that alternative tobacco products promote cessation. Unsubstantiated overt and implied claims that alternative tobacco products aid smoking cessation should be prohibited.

Publication types

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

MeSH terms

  • Adolescent
  • Adult
  • Cross-Sectional Studies
  • Electronics
  • Female
  • Harm Reduction
  • Humans
  • Intention
  • Logistic Models
  • Male
  • Middle Aged
  • Nicotine / administration & dosage
  • Nicotine / adverse effects
  • Nicotinic Agonists / administration & dosage
  • Nicotinic Agonists / adverse effects
  • Smoking Cessation / methods*
  • Smoking Cessation / statistics & numerical data
  • Tobacco Use Cessation Devices / adverse effects
  • Tobacco Use Cessation Devices / statistics & numerical data*
  • Tobacco Use Cessation Devices / trends
  • Tobacco Use Disorder / rehabilitation*
  • Tobacco, Smokeless / adverse effects
  • Tobacco, Smokeless / statistics & numerical data*
  • United States
  • Young Adult


  • Nicotinic Agonists
  • Nicotine