Primary and dual users of cigars and cigarettes: Profiles, tobacco use patterns and relevance to policy

Introduction: The Family Smoking Prevention and Tobacco Control Act provides an unprecedented opportunity to regulate tobacco in the United States. However, restrictions on little cigars, cigarillos, and large cigars are notably absent from the Act, which may create a favorable environment for increased dual usage of cigars. The purpose of this study is to examine demographic profiles and tobacco use behaviors of dual, as opposed to primary, users of cigarettes and cigars. Methods: This study used data from a cross-sectional nationally representative survey of 2,649 adult smokers and nonsmokers. Multivariable regression analysis was used to compare the demographic characteristics and tobacco use behaviors of dual users versus cigarette-only smokers. Results: Data indicate that 12.5% of cigarette smokers are dual users of cigars. Dual users are more likely to be male, 18-29 years of age, non-Hispanic Black, of lower educational attainment, and either unemployed or out of the work force. Dual users were less likely than cigarette-only smokers to be daily cigarette smokers (odds ratio [OR] = 0.57, 95% CI: 0.32, 1.02), more likely to have made a recent quit attempt (OR = 2.39, 95% CI: 1.44, 3.97), and more likely to have used at least one other alternative product (OR = 2.26, 95% CI: 1.26, 4.05), including snus, e-cigarettes, dissolvables, and chewing tobacco. Conclusions: As greater restrictions on cigarettes become implemented in the United States, it will be critical to monitor increased dual use of cigars, in order to inform prevention and treatment strategies and guide more comprehensive policy efforts.