Trends in exclusive, dual and polytobacco use among U.S. adults, 2014–2019: Results from two nationally representative surveys

Delvon T. Mattingly, Luis Zavala-Arciniega, Jana L. Hirschtick, Rafael Meza, David T. Levy, Nancy L. Fleischer

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Although increases in the variety of tobacco products available to consumers have led to investigations of dual/polytobacco use patterns, few studies have documented trends in these patterns over time. We used data from the 2014/2015 and 2018/2019 Tobacco Use Supplement to the Current Population Survey (TUS-CPS) and the 2015–2019 National Health Interview Survey (NHIS) to estimate trends in the following use patterns: exclusive use of cigarettes, electronic nicotine delivery systems (ENDS), other combustibles (cigars/cigarillos/little filtered cigars and traditional pipes/hookah), and smokeless tobacco (four categories); dual use (two product groups) of each product group with cigarettes (three categories); polyuse with cigarettes (all four product groups; one category); and dual/polyuse without cigarettes (one category). We estimated trends in product use patterns overall and by age, sex, and race/ethnicity using two-sample tests for differences in linear proportions. From 2014/2015 to 2018/2019, exclusive ENDS use increased, whereas cigarettes and ENDS dual use decreased. Furthermore, polyuse with cigarettes decreased, whereas dual/polyuse without cigarettes increased, with trends varying by age, sex, and race/ethnicity. Our findings suggest that patterns of dual/polyuse with and without cigarettes have changed in recent years, indicating the need for further surveillance of concurrent tobacco product use patterns.

Original languageEnglish
Article number13092
JournalInternational Journal of Environmental Research and Public Health
Issue number24
StatePublished - Dec 1 2021

Bibliographical note

Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.


  • Cigarettes
  • Cigars
  • Dual use
  • Electronic nicotine delivery systems
  • Pipes
  • Polyuse
  • Prevalence
  • Smokeless tobacco
  • Tobacco products

ASJC Scopus subject areas

  • Pollution
  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis


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