Multiple tobacco product use among adults in the United States: cigarettes, cigars, electronic cigarettes, hookah, smokeless tobacco, and snus

Prev Med. 2014 May:62:14-9. doi: 10.1016/j.ypmed.2014.01.014. Epub 2014 Jan 16.


Objective: Noncigarette tobacco products are increasingly popular. Researchers need to understand multiple tobacco product use to assess the effects of these products on population health. We estimate national prevalence and examine risk factors for multiple product use.

Method: We calculated prevalence estimates of current use patterns involving cigarettes, cigars, electronic cigarettes, hookah, smokeless tobacco, and snus using data from the 2012 RTI National Adult Tobacco Survey (N=3627), a random-digit-dial telephone survey of adults aged 18 and over. Associations between use patterns (exclusive single product and multiple products) and demographic characteristics were examined using Pearson chi-square tests and logistic regression.

Results: 32.1% of adults currently use 1 or more tobacco products; 14.9% use cigarettes exclusively, and 6.6% use one noncigarette product exclusively, 6.9% use cigarettes with another product (dual use), 1.3% use two noncigarette products, and 2.4% use three or more products (polytobacco use). Smokers who are young adult, male, never married, reside in the West, and made prior quit attempts were at risk for multiple product use.

Conclusions: Over 10% of U.S. adults use multiple tobacco products. A better understanding of multiple product use involving combustible products, like cigars and hookah, is needed. Multiple product use may be associated with past quit attempts.

Keywords: Cigar smoking; Cigarette smoking; Hookah smoking; Smokeless tobacco; electronic cigarettes.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Chi-Square Distribution
  • Electronic Nicotine Delivery Systems / psychology
  • Electronic Nicotine Delivery Systems / statistics & numerical data*
  • Female
  • Health Surveys
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Prevalence
  • Risk Factors
  • Smoking / epidemiology*
  • Smoking / psychology
  • Socioeconomic Factors
  • Surveys and Questionnaires
  • Tobacco Products / statistics & numerical data*
  • Tobacco Use Cessation / methods
  • Tobacco Use Cessation / psychology
  • Tobacco Use Cessation / statistics & numerical data
  • Tobacco, Smokeless / statistics & numerical data*
  • United States / epidemiology
  • Young Adult