Dual Use of Combustible and Electronic Cigarettes: Findings From a Multi-State Rapid-Response Survey in the U.S.,...

Dual use of cigarettes and E-cigarettes is common in the U.S. Although some people report using E-cigarettes to quit combustible cigarettes, continued dual use may exacerbate existing health disparities in states with disproportionately high smoking rates.

Respondents (N=4,550) were adults (aged 18-65 years) living in the 13 U.S. states with the highest prevalence of cigarette smoking who completed an online probability-based rapid-response survey in 2023. Weighted logistic regression models, adjusted for sociodemographic characteristics, compared responses on smoking cessation attempts and methods between individuals reporting dual use and those reporting exclusive current cigarette use.

Exclusive cigarette use was reported by 9.4% of respondents, and dual use was reported by 3.8%. Individuals reporting dual use were significantly more likely than those reporting exclusive cigarette use to report at least 1 past-year quit attempt (AOR=1.90; 95% CI=1.11, 3.24, p=0.018), including those lasting 1 day or longer (AOR=2.98, 95% CI=1.76, 5.03, p<0.001), and reducing to less than 1 cigarette per day (AOR=3.38, 95% CI=1.55, 7.39, p=0.002). Individuals reporting dual use were also more likely to report using nonpharmacologic (e.g., telephone counseling) (AOR=2.47, 95% CI=1.01, 6.04, p=0.048) and non-Food and Drug Administration-approved (e.g., switching to E-cigarettes) (AOR=17.38, 95% CI=6.97, 43.36, p<0.001) cessation methods.

Dual use may be associated with greater motivation to quit than exclusive cigarette use. However, given continued combustible cigarette consumption, additional resources are needed to support complete abstinence to reduce tobacco-related disparities in high-tobacco-burden states.