Differential use of other tobacco products among current and former cigarette smokers by income level

• A third of the current and former cigarette smokers used other forms of tobacco.
• Use of other forms of tobacco among current and former smokers varied by income.
• Other tobacco use was more common among lower income current than former smokers.
• Nicotine dependence may be underestimated among lower income current smokers.
• Many higher income former smokers use other tobacco after quitting cigarette smoking.

With the declining sales of cigarettes, the tobacco industry has been promoting other forms of combustible and smokeless tobacco to current and former cigarette smokers. Exposure to the promotion of tobacco products has been shown to vary by income level. We combined the 2006 through 2011 National Surveys on Drug Use and Health to compare the prevalence and patterns of other tobacco use (cigar, snuff, and chewing tobacco) between current and former cigarette smokers by income level. Other tobacco use was minimal among females and among male non-smokers. Approximately a third of both current and former male cigarette smokers reported past-year other tobacco use. Overall, current smokers were more likely than former smokers to have used cigars (adjusted odds ratio (AOR) 1.69, 95% CI 1.50–1.92) or snuff (AOR 1.14, 95% CI 1.01–1.28) in the past year. The association of smoking status with other tobacco use differed by income level (interaction term p-value < 0.001). Among lower income groups, current smokers were more likely to use cigars and snuff compared to former smokers. Among the highest income group, former smokers were just as likely to use smokeless tobacco as current smokers. The differing patterns of use of other tobacco between current and former smokers by income level highlight a need for studies to understand the motivations for the use of these products and their role in smoking cessation.