Differences between Dual Users of Cigarettes and Snus and Other Tobacco Users in the United States: An Examination of Adolescent Males

Although dual use of tobacco products is increasingly prevalent among youths, no studies in the United States have examined dual use of cigarettes and snus, a new spitless form of tobacco. This study compared adolescent dual users with snus users, cigarette users, and non-users of these tobacco products, on various intrapersonal (e.g., other tobacco use) and interpersonal (e.g., friend use of tobacco) factors. Participants were 5,574 sixth- through twelfth-grade students who voluntarily completed the 2011 Texas Youth Tobacco Survey. Because snus users were predominately male, mixed-effects regression analyses were conducted for males only (N = 2,790). Compared with cigarette users and nonusers of either cigarettes or snus, male dual users scored significantly higher on the study variables; there were few differences between dual users and snus users. Limitations and implications are discussed.