Dual use of cigarettes and smokeless tobacco among active duty service members in the US military

The high prevalence of dual use of cigarettes and smokeless tobacco is a unique tobacco use behavior in the US military population. However, dual tobacco use has rarely been addressed in active duty populations. We aimed to identify factors contributing to dual tobacco use among active duty service members from Army and Air Force. We also compared age at initiation, duration of use, and amount of use between dual users and exclusive users. The study included 168 exclusive cigarette smokers, 171 exclusive smokeless tobacco users, and 110 dual users. In stepwise logistic regression, smokeless tobacco use among family members (OR = 4.78, 95% CI = 2.05–11.13 for father use vs. no use, OR = 3.39, 95% CI = 1.56–7.37 for other relatives use vs. no use), and deployment history (serving combat unit vs. combat support unit: OR = 4.12, 95% CI = 1.59–10.66; never deployed vs. combat support unit: OR = 3.32, 95% CI = 1.45–7.61) were factors identified to be associated with dual use relative to exclusive cigarette smoking. Cigarette smoking among family members (OR = 1.96, 95% CI = 1.07–3.60 for sibling smoking), high perception of harm using smokeless tobacco (OR = 2.34, 95% CI = 1.29–4.26), secondhand smoke exposure (OR = 4.83, 95% CI = 2.73–8.55), and lower education (associated degree or some college: OR = 2.76, 95% CI = 1.01–7.51; high school of lower: OR = 4.10, 95% CI = 1.45–11.61) were factors associated with dual use relative to exclusive smokeless tobacco use. Compared to exclusive cigarette smokers, dual users started smoking at younger age, smoked cigarettes for longer period, and smoked more cigarettes per day. Our study addressed dual tobacco use behavior in military population and has implications to tobacco control programs in the military.

卷烟与无烟烟草双重使用的高流行率，是美国军人群体中特有的烟草使用行为。然而，现役军人群体中的烟草双重使用问题却极少被研究关注。本研究旨在明确美陆军与空军现役军人发生烟草双重使用的影响因素，并对比双重使用者与单一使用者的初次使用年龄、使用时长及每日使用量。本研究共纳入168名单一卷烟使用者、171名单一无烟烟草使用者及110名双重使用者。经逐步逻辑回归（stepwise logistic regression）分析，与单一卷烟使用者相比，以下因素与烟草双重使用显著相关：家庭成员无烟烟草使用（父亲使用无烟烟草相较于未使用者的比值比（Odds Ratio，OR）=4.78，95%置信区间（Confidence Interval，CI）=2.05~11.13；其他亲属使用相较于未使用者的OR=3.39，95%CI=1.56~7.37），以及部署经历（在作战单位服役相较于作战支援单位：OR=4.12，95%CI=1.59~10.66；从未部署相较于作战支援单位：OR=3.32，95%CI=1.45~7.61）。与单一无烟烟草使用者相比，以下因素与烟草双重使用相关：家庭成员卷烟使用（兄弟姐妹吸烟相较于未吸烟的OR=1.96，95%CI=1.07~3.60）、对无烟烟草危害的高认知水平（OR=2.34，95%CI=1.29~4.26）、二手烟暴露（OR=4.83，95%CI=2.73~8.55），以及较低的受教育程度（副学士学位或大学在读：OR=2.76，95%CI=1.01~7.51；高中及以下学历：OR=4.10，95%CI=1.45~11.61）。相较于单一卷烟使用者，双重使用者初次吸烟年龄更早、卷烟使用时长更长且每日卷烟消费量更高。本研究聚焦军人群体的烟草双重使用行为，对军队烟草管控项目具有重要参考价值。