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Cigarette smokers’ concurrent use of smokeless tobacco: dual use patterns and nicotine exposure
Open accessAbstract
Background: The concurrent use of cigarettes with other tobacco products, such as smokeless tobacco (SLT), is increasingly common. Extant work with cigarette smokers who also use SLT is based heavily on retrospective reports and between-group comparisons. The purpose of this study was to assess prospectively the patterns of dual users’ product use and nicotine exposure on days when cigarettes were smoked exclusively (single use) versus concurrently with SLT (dual use). Design: Forty-six dual cigarette-SLT users recorded their product use in real time via ecological momentary assessment for a 2-week longitudinal design. They responded to questions about situational factors (eg, location, mood) using this same diary, and collected saliva samples each night for later cotinine measurement. At the end of this 2-week period, users reported on their reasons for and beliefs about SLT use. Results: Cotinine levels were significantly higher on dual versus single use days (mean±SEM=374.48±41.08 ng/mL vs 300.17±28.13 ng/mL, respectively; p<0.01), and the number of cigarettes logged was higher on dual versus single use days (11.13±0.98 vs 9.13±1.11, respectively; p<0.01). Product use was distinguished by situational factors, with the strongest predictor being location of use. Moreover, the most common reason for initiating (56.52%) and continuing (67.39%) SLT use was to circumvent indoor smoking restrictions. Conclusions: Results support the idea of product supplementation rather than replacement among this convenience sample of dual users. For smokers whose primary motivation for SLT use involves situations where they would otherwise be tobacco free, the potential benefits of clean indoor air laws may be diminished.
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“There is some evidence of differential product use behavior; for example, Felicione et al. (2020) observed significantly lower cotinine levels among dual users on days when they only smoked cigarettes as opposed to when they dual used both cigarettes and MST.”
From Nicotine pharmacokinetics and subjective responses after using nicotine pouches with different nicotine levels compared to combustible cigarettes and moist smokeless tobacco in adult tobacco users (2022) · cites this paper as Felicione et al. (2020)
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Liu, J., Rensch, J., Wang, J., Jin, X., Vansickel, A., Edmiston, J., & Sarkar, M. (2022) · Psychopharmacology · doi:10.1007/s00213-022-06172-y · Cited by 37
Metadata
- Authors
- Felicione, N. J., Ozga-Hess, J. E., Ferguson, S. G., Dino, G., Kuhn, S., Haliwa, I., & Blank, M. D.
- Affiliations
- West Virginia University (US)
- University of Tasmania (AU)
- Corresponding author
- Blank, Melissa D
- Venue
- Tobacco Control
- Publisher
- BMJ
- Published
- 2020-02-12
- Volume
- 30
- Issue
- 1
- Pages
- 24-29
- ISSN
- 0964-4563 (ISSN-L)
- 1468-3318
- PMC
- PMC7423753
- OpenAlex
- W3006105694
- Cited by
- 19
- References
- 1
- Citations by year
- 2025: 1 · 2024: 6 · 2023: 3 · 2022: 3 · 2021: 5 · 2020: 1
- FWCI
- 2.19
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Tobacco Control (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- UTAS Research Repository (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Funders
- National Institute of General Medical Sciences (T32GM081741)
- Centers for Disease Control and Prevention (U481006466AR)
- National Institute on Drug Abuse and the Center for Tobacco Products of the U.S. Food and Drug Administration (R03DA037583)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
- Keywords
- dual tobacco use, cigarette smoking, smokeless tobacco, nicotine exposure, cotinine, ecological momentary assessment, situational factors, clean indoor air laws, salivary biomarkers
- MeSH terms
- Smokers, Humans, Nicotine, Retrospective Studies, Tobacco, Smokeless, Tobacco Products, Tobacco Use
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