{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T19:20:01Z","timestamp":1782933601996,"version":"3.54.5"},"reference-count":14,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2021,3,8]],"date-time":"2021-03-08T00:00:00Z","timestamp":1615161600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000054","name":"US National Cancer Institute","doi-asserted-by":"crossref","award":["P01 CA200512"],"award-info":[{"award-number":["P01 CA200512"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["FDN-148477"],"award-info":[{"award-number":["FDN-148477"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Health and Medical Research Council of Australia","award":["APP 1106451"],"award-info":[{"award-number":["APP 1106451"]}]},{"DOI":"10.13039\/100012118","name":"Ontario Institute for Cancer Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012118","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000521","name":"Canadian Cancer Society","doi-asserted-by":"publisher","award":["IA-004"],"award-info":[{"award-number":["IA-004"]}],"id":[{"id":"10.13039\/501100000521","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Tobacco Centers of Regulatory Science US National Cancer Institute","award":["U54CA238110"],"award-info":[{"award-number":["U54CA238110"]}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,8,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>This study explores patterns of use of non-cigarette tobacco and nicotine products among adult cigarette smokers and recent ex-smokers. Along with cigarette smoking status we explore differences as a function of countries with different product regulations, gender, and age.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Data came from the ITC Four Country Smoking and Vaping Wave 3 Survey conducted between February\u2013June 2020. The analytic sample consisted of 9112 current cigarette smokers (at least monthly) and 1184 recent ex-smokers (quit cigarettes \u2264 2 years) from Australia, Canada, England, and the United States. Respondents were asked about their cigarette smoking and current use of the following non-cigarette products: combustible tobacco (cigars, cigarillos, pipe, waterpipe); noncombustible tobacco (smokeless tobacco, and heated tobacco products [HTPs]); and non-tobacco nicotine products (nicotine vaping products [NVPs], nicotine replacement therapy [NRT], and nicotine pouches).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Overall, NVPs (13.7%) and NRT (10.9%) were the most reported nicotine products used, followed by cigars (5.3%), cigarillos (4.2%), and HTPs (3.5%). More than 21% current and recent ex-smokers of cigarettes reported using a non-tobacco nicotine product and noncombustible product, with respondents in England reporting the highest levels of use (&amp;gt;26%). Males, younger respondents, and current non-daily cigarette smokers were more likely to use non-cigarette nicotine products. Notably, 11.6% of ex-cigarette smokers were using other combustible tobacco.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Considerable percentages of current cigarette smokers and ex-smokers use non-cigarette nicotine products, and there are unexpectedly high levels of use of other combustible products by those recent ex-smokers of cigarettes which is concerning and has important implications for definitions of smoking cessation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Implications<\/jats:title>\n                  <jats:p>The tobacco product market has evolved to include new products which add to existing non-cigarette tobacco products creating a much more diverse nicotine market. This brief report provides a snapshot of use of various combustible and noncombustible nicotine-containing products among current cigarette smokers and recent ex-smokers in four western countries. Our results indicate that use of non-cigarette tobacco and nicotine products among these cigarette smokers and recent ex-smokers is not low, particularly among males, younger and non-daily cigarette smokers. Use of other combustible tobacco among respondents that recently quit cigarette smoking is concerning and has important implications for definitions of smoking cessation. Increased emphasis on researching non-cigarette nicotine product use is warranted in tobacco control generally and smoking cessation in particular.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ntr\/ntab040","type":"journal-article","created":{"date-parts":[[2021,3,4]],"date-time":"2021-03-04T12:10:36Z","timestamp":1614859836000},"page":"1611-1616","source":"Crossref","is-referenced-by-count":39,"title":["Patterns of Non-Cigarette Tobacco and Nicotine Use Among Current Cigarette Smokers and Recent Quitters: Findings From the 2020 ITC Four Country Smoking and Vaping Survey"],"prefix":"10.1093","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4764-1679","authenticated-orcid":false,"given":"Lin","family":"Li","sequence":"first","affiliation":[{"name":"Melbourne Centre for Behaviour Change, School of Psychological Sciences, University of Melbourne, Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0059-178X","authenticated-orcid":false,"given":"Ron","family":"Borland","sequence":"additional","affiliation":[{"name":"Melbourne Centre for Behaviour Change, School of Psychological Sciences, University of Melbourne, Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K Michael","family":"Cummings","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC"},{"name":"Hollings Cancer Center, Medical University of South Carolina, Charleston, SC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shannon","family":"Gravely","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of Waterloo, Waterloo, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne C K","family":"Quah","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of Waterloo, Waterloo, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey T","family":"Fong","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of Waterloo, Waterloo, ON, Canada"},{"name":"School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada"},{"name":"Ontario Institute for Cancer Research, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Connor R","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6748-3068","authenticated-orcid":false,"given":"Maciej L","family":"Goniewicz","sequence":"additional","affiliation":[{"name":"Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Le Grande","sequence":"additional","affiliation":[{"name":"Melbourne Centre for Behaviour Change, School of Psychological Sciences, University of Melbourne, Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann","family":"McNeill","sequence":"additional","affiliation":[{"name":"Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London, London, UK"},{"name":"Shaping Public hEalth poliCies To Reduce ineqUalities and harm (SPECTRUM), UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,3,8]]},"reference":[{"issue":"4","key":"2021101510243159200_CIT0001","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1056\/NEJMsa1607538","article-title":"Tobacco-product use by adults and youths in the United States in 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