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Objectives. We investigated the frequency of alternative tobacco product use (loose leaf, moist snuff, snus, dissolvables, electronic cigarettes [e-cigarettes]) among smokers and the association with quit attempts and intentions.
Methods. A nationally representative probability-based cross-sectional survey of 1836 current or recently former adult smokers was completed in November 2011. Multivariate logistic regressions evaluated associations between alternative tobacco product use and smoking cessation behaviors.
Results. Of the smokers, 38% had tried an alternative tobacco product, most frequently e-cigarettes. Alternative tobacco product use was associated with having made a quit attempt, and those intending to quit were significantly more likely to have tried and to currently use the products than were smokers with no intentions to quit. Use was not associated with successful quit attempts. Interest in future use of alternative tobacco products was low, except for e-cigarettes.
Conclusions. Alternative tobacco products are attractive to smokers who want to quit smoking, but these data did not indicate that alternative tobacco products promote cessation. Unsubstantiated overt and implied claims that alternative tobacco products aid smoking cessation should be prohibited. (Am J Public Health. 2013;103:923-930. doi:10.2105/AJPH.2012.301070)
Smoking rates in the United States have been driven down by health concerns, increasing regulations, higher prices, and changing social norms. Cigarette companies have recognized that smokeless tobacco may be a way to retain profits and customers,1 and since 2006, the promotion of novel and alternative tobacco products has escalated. However, traditional smokeless tobacco products, such as loose leaf chewing tobacco and moist snuff(Figure 1), continue to dominate the smokeless market.8 Although the market share of loose leaf chewing tobacco is decreasing,8 moist snuffhas the largest share of the US market (75% in 2009),9 and its use has steadily increased since the 1980s.8
In addition, since about 2006, various alternative tobacco products, such as snus, dissolvables, and electronic cigarettes (e-cigarettes), have been promoted in the United States (Figure 1). Although snus has been used in Sweden since the early 19th century,10 in 2006, the major US cigarette manufacturers acquired smokeless tobacco companies and began selling snus bearing cigarette brand names (e.g., Marlboro Snus, Camel Snus).11 E-cigarettes were first marketed in China in 200412 but have been aggressively promoted on the Internet in the United States since 2007.13 In addition, between 2009 and...