Poly-tobacco use among adults in 44 countries during 2008-2012: Evidence for an integrative and comprehensive approach in tobacco control

Introduction: The concurrent use of multiple tobacco products (i.e., poly-tobacco use) might hinder efforts to reduce overall tobacco use, particularly considering that use of some non-cigarette tobacco products may be popular in some regions due to social, cultural, or economic reasons. This study assessed poly-tobacco use patterns among persons aged >= 15 years old from 44 countries. Methods: Data from 44 countries in all six World Health Organization regions were obtained from the 2008 to 2012 Global Adult Tobacco Surveys (n = 19 countries), and the Special Eurobarometer 385 (77.1) survey, 2012 (n = 25 countries). Correlates of poly-tobacco use were assessed using multivariate logistic regression analyses (p < 0.05). Results: Overall prevalence of poly-tobacco use ranged from 0.8% (Mexico) to 11.9% (Denmark). In 28 countries, 20% or more of current smokers of manufactured cigarettes concurrently used at least one other tobacco product and this proportion was highest in India (66.2%) and lowest in Argentina (4.4%). After adjusting for other factors, the likelihood of being a poly-tobacco user among all respondents was lower among females (aOR = 0.09; 95% CI: 0.08-0.11), and among respondents from upper-middle-income (aOR = 0.53, 95% CI: 0.43-0.66), and lower-middle-income countries (aOR = 0.64; 95% CI: 0.51-0.81) compared to high-income countries. Increased likelihood of poly-tobacco use was observed among respondents from the South-East Asian region compared to those from the European region (aOR = 1.58, 95% CI: 1.35-1.85), as well as among respondents aged >= 65 years (aOR = 2.10; 95% CI: 1.73-2.54), compared to those aged <25 years. Conclusions: The pattern of tobacco use varied widely, underscoring the need for intensified efforts towards implementing policies that address all tobacco products, not only manufactured cigarettes. (C) 2014 Elsevier Ireland Ltd. All rights reserved.