Concurrent Use of Cigarettes and Smokeless Tobacco in Minnesota

Abstract

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.

High tobacco use prevalence with significant regional and sex differences in smokeless tobacco use among Western Alaska Native people: the WATCH study

“…Nationally, there is increasing concern over concurrent dual- and multi-product tobacco use. Research using Minnesota statewide data found the proportion of cigarettes smokers reporting ST use increased between 2007 and 2010 [18]. It has been suggested that the increase in ST use among smokers may be due to wide implementation of in-home and public smoking bans nationwide and the tobacco industry marketing of ST as a substitute for cigarettes when smoking is not permitted [48].…”

“…This is explained by the lower likelihood of women being dual cigarette and ST users than exclusive ST users and the higher likelihood of women being dual cigarette and ST users when compared to exclusive smokers. Research has demonstrated that dual- and multi-product tobacco users experience lower cessation rates [17,18], possibly due to greater cotinine and dependence levels [50]. On average, AN smokers living in Bristol Bay smoke about half as many cigarettes (7.8) per day [42] as US smokers (14.2) [51], but demonstrate similar plasma cotinine levels (170 ng/mL and 200 ng/mL, respectively), suggesting altered nicotine metabolism [49,52].…”

“…Concurrent use has been variably defined as the use of more than one product within a given day, week or month. Surveillance reports indicate prevalence of multiple tobacco product use is on the rise, especially among young adults [17], while tobacco users who use more than one product report lower tobacco cessation rates [17,18]. Studies with other cohorts, such as adolescents, in which multiple forms of tobacco use are reported, indicate that tobacco cessation interventions and tobacco control policies must address dual and multiple tobacco product use in order to impact tobacco use on a population level [18–20].…”

“…Surveillance reports indicate prevalence of multiple tobacco product use is on the rise, especially among young adults [17], while tobacco users who use more than one product report lower tobacco cessation rates [17,18]. Studies with other cohorts, such as adolescents, in which multiple forms of tobacco use are reported, indicate that tobacco cessation interventions and tobacco control policies must address dual and multiple tobacco product use in order to impact tobacco use on a population level [18–20]. Epidemiological studies of tobacco initiation in the US have typically reported product use initiation separately and, among ever users, have not considered initiation of multiple tobacco products sequentially or simultaneously or the type of product used first.…”

Association of smokeless tobacco use and smoking in adolescents in the United States

“…Smokeless tobacco is being marketed as a way to use tobacco in smoke-free environments such as on airplanes, in restaurants, and at work places. 3, 4 Smokeless tobacco is a risk factor of cancer of the oral tissues and pharynx, oral soft tissue lesions (such as leukoplakia), periodontal disease, gingivitis, caries, halitosis, tooth loss, tooth stains, and nicotine addiction. 5 Smokeless tobacco has also been associated with low birth weight babies 5 and pancreatic cancer.…”