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.