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

Background: The concurrent use of cigarettes withother tobacco products, such as smokeless tobacco(SLT), is increasingly common. Extant work withcigarette smokers who also use SLT is based heavily onretrospective reports and between-group comparisons.The purpose of this study was to assess prospectively thepatterns of dual users’ product use and nicotine exposureon days when cigarettes were smoked exclusively (singleuse) versus concurrently with SLT (dual use).Design: Forty-six dual cigarette-SLT users recordedtheir product use in real time via ecological momentaryassessment for a 2-week longitudinal design. Theyresponded to questions about situational factors (eg,location, mood) using this same diary, and collectedsaliva samples each night for later cotinine measurement.At the end of this 2-week period, users reported on theirreasons for and beliefs about SLT use.Results: levels were significantly higher on dualversus single use days (mean±SEM=374.48±41.08 ng/mL vs 300.17±28.13 ng/mL, respectively; pConclusions: Results support the idea of productsupplementation rather than replacement among thisconvenience sample of dual users. For smokers whoseprimary motivation for SLT use involves situations wherethey would otherwise be tobacco free, the potentialbenefits of clean indoor air laws may be diminished