Mortality Risks of Dual- and Poly-Tobacco Product Users in the United States.

Increasing numbers of adults in the United States use more than one tobacco product. Most use cigarettes in combination with other tobacco products. However, little is known about the all-cause and cancer-specific mortality risks of dual- and poly-tobacco use. We examined these associations by pooling nationally-representative data from the 1991, 1992, 1998, 2000, 2005, and 2010 National Health Interview Surveys (n=118,144). Mortality information was obtained by linkage to the National Death Index. Cigarette smokers who additionally used other tobacco products smoked as many if not more cigarettes per day than exclusive cigarette smokers. Furthermore, cigarette smokers who additionally used other tobacco products had mortality risks that were as high and sometimes higher than exclusive cigarette smokers. As tobacco use patterns continue to change and diversify, future studies need to carefully assess the impact of non-cigarette tobacco products on cigarette use and determine disease risks. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2019.