Abstract
Background
There has been an increase in the use of smokeless tobacco recently. Whether smokeless
tobacco use may predispose individuals to use other addictive substances is unknown.
The use of multiple addictive substances may compound an individual's adverse health
effects.
Methods
In a cross-sectional analysis, we used the 2016-2017 Behavioral Risk Factor Surveillance
System (BRFSS) survey database to identify all individuals who reported the use of
smokeless tobacco and extracted data regarding baseline and demographic patterns,
as well as information regarding the use of other addictive substances. Weighted multivariable
logistic regression models adjusting for age, gender, race/ethnicity, poverty level,
education, employment status, and marital status were used to determine the odds ratios
(ORs) for use of alcohol, cigarettes, e-cigarettes, and marijuana among smokeless
tobacco users.
Results
We identified 30,395 (3.38%) individuals in our study population who reported smokeless
tobacco use. Compared with non-users, smokeless tobacco users were more likely to
be unmarried, male, Caucasian, belonging to the lower socioeconomic strata, and did
not have a formal college education (P <0.01). In multivariable analyses, smokeless tobacco use was associated with a higher
likelihood of cigarettes use (OR: 1.76 [95% confidence interval {CI}: 1.66-1.86, P <0.01]), e-cigarette use (OR: 1.61 [95% CI: 1.52-1.71, P <0.01]), and heavy alcohol consumption (OR:2.36 [95% CI: 2.17-2.56, P <0.01]) but not marijuana use (OR: 1.11 [95% CI: 0.90-1.38, P = 0.33]).
Conclusion
In a large, nationally representative sample, smokeless tobacco use was associated
with the increased use of cigarettes, e-cigarettes, and alcohol. Simultaneous use
of these substances may compound the adverse health effects of smokeless tobacco use.
Public health interventions addressing this concerning trend are warranted.
Keywords
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Article Info
Publication History
Published online: July 01, 2020
Footnotes
Funding: None.
Conflicts of Interest: MT reports being employed with Bayer Healthcare Pharmaceuticals, Inc. in the Oncology division. PBM serves as a consultant (ad board participation) for Esperion and Novo Nordisk; and Local PI: Esperion CLEAR Outcomes Trials. SSV reports Honorarium for American College of Cardiology (Associate Editor for Innovations, aacc.org); serves on Steering Committee, Patient and Provider Assessment of Lipid Management (PALM registry) at the Duke Clinical Research Institute (no financial remuneration). VJ, MAR, SN, RB, SI, XJ, ATM, WSA report none.
Authorship: All authors had access to the data and a role in writing this manuscript.
Identification
Copyright
Published by Elsevier Inc.
