{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T23:52:50Z","timestamp":1789602770637,"version":"build-2803163510"},"reference-count":42,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000289","name":"Cancer Research UK","doi-asserted-by":"publisher","award":["PRCRPG-Nov21\/100002"],"award-info":[{"award-number":["PRCRPG-Nov21\/100002"]}],"id":[{"id":"10.13039\/501100000289","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000289","name":"Cancer Research UK","doi-asserted-by":"publisher","award":["PICCTR-2024\/100001"],"award-info":[{"award-number":["PICCTR-2024\/100001"]}],"id":[{"id":"10.13039\/501100000289","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Behavioral Research UK Leadership Hub"},{"DOI":"10.13039\/501100000269","name":"Economic and Social Research Council","doi-asserted-by":"publisher","award":["ES\/Y001044\/1"],"award-info":[{"award-number":["ES\/Y001044\/1"]}],"id":[{"id":"10.13039\/501100000269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Non-cigarette tobacco smoking increased in England between 2013 and 2023, but little is known about the prevalence of use of specific types of non-cigarette tobacco, including smokeless products, or whether the increasing trend has continued. This study examined recent trends in exclusive non-cigarette tobacco smoking and estimated the prevalence of different smoked and smokeless product use by sociodemographic characteristics, vaping status, and cigarette smoking status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data came from the Smoking Toolkit Study, a nationally representative monthly cross-sectional survey of adults (\u226518\u00a0years) in England (n\u2009=\u200994\u2009918; April 2020 to February 2025). We used logistic regression to estimate trends in exclusive non-cigarette tobacco smoking. We further examined the prevalence and correlates of (non-exclusive) use of eight specific smoked and smokeless non-cigarette tobacco products among 8129 participants surveyed October 2024 to February 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The prevalence of exclusive non-cigarette tobacco smoking increased from 1.3% [1.1%\u20131.6%] in April 2020 to 2.0% [1.8%\u20132.1%] in August 2022, before declining to 1.2% [1.1%\u20131.5%] by February 2025. Between October 2024 and February 2025, 3.7% [3.2%\u20134.1%] of adults reported any non-cigarette tobacco use (~1.7 million people). Cigars (1.2%) and waterpipes (0.9%) were the most used products. Use patterns varied: cigars, cigarillos, and pipes were more common among men and those who smoked cigarettes, while waterpipes were more common among younger adults, minority ethnic groups, and people who vaped. Smokeless tobacco use was more common among those who smoked (any form of) tobacco.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In England, exclusive non-cigarette tobacco smoking has fluctuated in recent years. Patterns of smoked and smokeless tobacco use vary across products and sociodemographic groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications<\/jats:title>\n                    <jats:p>These findings highlight the importance of tracking non-cigarette tobacco use in detail\u2014clearly distinguishing between products, identifying the groups who use them, and understanding the extent to which they contribute to tobacco-related health inequalities. Some products are disproportionately used by specific groups, such as minority ethnic groups, who are not well served by existing stop-smoking services in England. Tailored interventions may be needed to reduce non-cigarette tobacco use, particularly among younger adults, minority ethnic groups, and those who also smoke cigarettes or use other nicotine products (eg, e-cigarettes).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ntr\/ntag130","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T11:32:37Z","timestamp":1780399957000},"source":"Crossref","is-referenced-by-count":1,"title":["Prevalence and patterns of different types of non-cigarette tobacco use in England: a population study"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5658-6168","authenticated-orcid":false,"given":"Sarah E","family":"Jackson","sequence":"first","affiliation":[{"name":"Department of Behavioural Science and Health, University College London , London WC1E 7HB ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3987-4760","authenticated-orcid":false,"given":"Eve","family":"Taylor","sequence":"additional","affiliation":[{"name":"Department of Behavioural Science and Health, University College London , London WC1E 7HB ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9410-8343","authenticated-orcid":false,"given":"Harry","family":"Tattan-Birch","sequence":"additional","affiliation":[{"name":"Department of Behavioural Science and Health, University College London , London WC1E 7HB ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9083-2131","authenticated-orcid":false,"given":"Katherine","family":"East","sequence":"additional","affiliation":[{"name":"Department of Primary Care and Public Health, Brighton and Sussex Medical School , Brighton, East Sussex BN1 9PX,","place":["United Kingdom"]},{"name":"National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King\u2019s College London , London SE5 8AF,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4033-442X","authenticated-orcid":false,"given":"Lion","family":"Shahab","sequence":"additional","affiliation":[{"name":"Department of Behavioural Science and Health, University College London , London WC1E 7HB ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8494-5105","authenticated-orcid":false,"given":"Sharon","family":"Cox","sequence":"additional","affiliation":[{"name":"Department of Behavioural Science and Health, University College London , London WC1E 7HB ,","place":["United Kingdom"]},{"name":"Behavioural Research UK , London ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masuma Pervin","family":"Mishu","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Public Health, University College London , London WC1E 7HB,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Hammond","sequence":"additional","affiliation":[{"name":"School of Public Health Sciences, University of Waterloo , Waterloo, Ontario, N2L 3G1,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2797-5428","authenticated-orcid":false,"given":"Jamie","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Behavioural Science and Health, University College London , London WC1E 7HB ,","place":["United Kingdom"]},{"name":"Behavioural Research UK , London ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"2026062414345532900_ref1","volume-title":"Tobacco","author":"World Health Organization","year":"2023"},{"key":"2026062414345532900_ref2","article-title":"Trends in exclusive non-cigarette tobacco smoking in England: a population survey 2013\u20132023","volume":"27","author":"Jackson","year":"2024","journal-title":"Nicotine Tob Res"},{"key":"2026062414345532900_ref3","doi-asserted-by":"crossref","first-page":"1509","DOI":"10.1093\/ntr\/ntac099","article-title":"Tobacco-free nicotine pouch use in great Britain: a representative population survey 2020\u20132021","volume":"24","author":"Tattan-Birch","year":"2022","journal-title":"Nicotine Tob Res"},{"key":"2026062414345532900_ref4","doi-asserted-by":"crossref","first-page":"e079016","DOI":"10.1136\/bmj-2023-079016","article-title":"Trends in long term vaping among adults in England, 2013\u201323: population based study","volume":"386","author":"Jackson","year":"2024","journal-title":"BMJ"},{"key":"2026062414345532900_ref5","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1186\/s12954-021-00557-6","article-title":"The health impact of smokeless tobacco products: a systematic review","volume":"18","author":"Hajat","year":"2021","journal-title":"Harm Reduct J"},{"key":"2026062414345532900_ref6","doi-asserted-by":"publisher","first-page":"CD013790","DOI":"10.1002\/14651858.CD013790.pub2","article-title":"Heated tobacco products for smoking cessation and reducing smoking prevalence","volume":"2022","author":"Tattan-Birch","year":"2022","journal-title":"Cochrane Database Syst Rev"},{"key":"2026062414345532900_ref7","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1001\/jama.284.6.735","article-title":"Health risks associated with cigar smoking","volume":"284","author":"Baker","year":"2000","journal-title":"JAMA"},{"key":"2026062414345532900_ref8","first-page":"32","article-title":"The effects of waterpipe tobacco smoking on health outcomes: an updated systematic review and meta-analysis","volume":"46","author":"Waziry","year":"2017","journal-title":"Int J Epidemiol"},{"key":"2026062414345532900_ref9","doi-asserted-by":"crossref","first-page":"1942","DOI":"10.1002\/ijc.34643","article-title":"A systematic review of cancer risk among users of smokeless tobacco (Swedish snus) exclusively, compared with no use of tobacco","volume":"153","author":"Valen","year":"2023","journal-title":"Int J Cancer"},{"key":"2026062414345532900_ref10","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/1477-7517-10-12","article-title":"Motives, beliefs and attitudes towards waterpipe tobacco smoking: a systematic review","volume":"10","author":"Akl","year":"2013","journal-title":"Harm Reduct J"},{"key":"2026062414345532900_ref11","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1093\/ntr\/ntu015","article-title":"Prevalence of waterpipe (shisha, narghille, hookah) use among adults in great Britain and factors associated with waterpipe use: data from cross-sectional online surveys in 2012 and 2013","volume":"16","author":"Grant","year":"2014","journal-title":"Nicotine Tob Res"},{"key":"2026062414345532900_ref12","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1186\/1471-2458-8-174","article-title":"Waterpipe smoking in students: prevalence, risk factors, symptoms of addiction, and smoke intake. Evidence from one British university","volume":"8","author":"Jackson","year":"2008","journal-title":"BMC Public Health"},{"key":"2026062414345532900_ref13","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1136\/tc.12.4.349","article-title":"Effect of smokeless tobacco (snus) on smoking and public health in Sweden","volume":"12","author":"Foulds","year":"2003","journal-title":"Tob Control"},{"key":"2026062414345532900_ref14","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1038\/sj.bdj.4811286","article-title":"Smokeless tobacco cessation guidelines for health professionals in England","volume":"196","author":"West","year":"2004","journal-title":"Br Dent J"},{"key":"2026062414345532900_ref15","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1093\/pubmed\/fdq035","article-title":"Accessibility of chewing tobacco products in England","volume":"32","author":"Longman","year":"2010","journal-title":"J Public Health"},{"key":"2026062414345532900_ref16","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1038\/sj.bjc.6604191","article-title":"Oral and pharyngeal cancer in South Asians and non-South Asians in relation to socioeconomic deprivation in South East England","volume":"98","author":"Moles","year":"2008","journal-title":"Br J Cancer"},{"key":"2026062414345532900_ref17","volume-title":"Cancer Research UK\u2019s February 2023 Cancer Awareness Measure (CAM)","author":"Rennie","year":"2023"},{"key":"2026062414345532900_ref18","doi-asserted-by":"crossref","first-page":"1611","DOI":"10.1093\/ntr\/ntab040","article-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","volume":"23","author":"Li","year":"2021","journal-title":"Nicotine Tob Res"},{"key":"2026062414345532900_ref19","volume-title":"Trends in Smoking and Vaping among Young People: Findings from the ITC Youth & Young Adult Tobacco and Vaping Survey","author":"Hammond"},{"key":"2026062414345532900_ref20","volume-title":"Tobacco Statistics Commentary January 2025. GOV.UK","author":"HM Revenue & Customs","year":"2025"},{"key":"2026062414345532900_ref21","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1186\/1471-2458-11-479","article-title":"\u2018The smoking toolkit study\u2019: a national study of smoking and smoking cessation in England","volume":"11","author":"Fidler","year":"2011","journal-title":"BMC Public Health"},{"key":"2026062414345532900_ref22","doi-asserted-by":"crossref","first-page":"67","DOI":"10.12688\/wellcomeopenres.16700.1","article-title":"Protocol for expansion of an existing national monthly survey of smoking behaviour and alcohol use in England to Scotland and Wales: The Smoking and Alcohol Toolkit Study","volume":"6","author":"Kock","year":"2021","journal-title":"Wellcome Open Res"},{"key":"2026062414345532900_ref23","doi-asserted-by":"crossref","first-page":"e1910161","DOI":"10.1001\/jamanetworkopen.2019.10161","article-title":"Comparison of trends in self-reported cigarette consumption and sales in England, 2011 to 2018","volume":"2","author":"Jackson","year":"2019","journal-title":"JAMA Netw Open"},{"key":"2026062414345532900_ref24","doi-asserted-by":"crossref","first-page":"e26","DOI":"10.1016\/S2468-2667(25)00296-8","article-title":"Oral nicotine pouch use in great Britain: a repeat cross-sectional study, 2020\u201325","volume":"11","author":"Tattan-Birch","year":"2026","journal-title":"Lancet Public Health"},{"key":"2026062414345532900_ref25","volume-title":"Social Grade","author":"National Readership Survey"},{"key":"2026062414345532900_ref26","volume-title":"Ethnic Group Classifications: Census 2021","author":"Office for National Statistics","year":"2023"},{"key":"2026062414345532900_ref27","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1136\/tobaccocontrol-2020-055700","article-title":"Cigarette-like cigarillo introduced to bypass taxation, standardised packaging, minimum pack sizes, and menthol ban in the UK","volume":"30","author":"Branston","year":"2021","journal-title":"Tob Control"},{"key":"2026062414345532900_ref28","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1007\/s00038-018-1166-7","article-title":"E-cigarette use is associated with other tobacco use among US adolescents","volume":"64","author":"Auf","year":"2019","journal-title":"Int J Public Health"},{"key":"2026062414345532900_ref29","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1001\/jama.2015.8950","article-title":"Association of electronic cigarette use with initiation of combustible tobacco product smoking in early adolescence","volume":"314","author":"Leventhal","year":"2015","journal-title":"JAMA"},{"key":"2026062414345532900_ref30","doi-asserted-by":"publisher","first-page":"tc-2025-059469","DOI":"10.1136\/tc-2025-059469","article-title":"The end of smoking in England? The importance of considering different metrics of success","author":"Jackson","year":"2025","journal-title":"Tob Control"},{"key":"2026062414345532900_ref31","doi-asserted-by":"publisher","first-page":"1876","DOI":"10.1111\/add.70057","article-title":"Changes in vaping trends since the announcement of an impending ban on disposable vapes: a population study in Great Britain","volume":"120","author":"Jackson","year":"2025","journal-title":"Addiction"},{"key":"2026062414345532900_ref32","volume-title":"Population Estimates for the UK, England, Wales, Scotland, and Northern Ireland: Mid-2022","author":"Office for National Statistics","year":"2024"},{"key":"2026062414345532900_ref33","doi-asserted-by":"crossref","first-page":"e005663","DOI":"10.1136\/bmjopen-2014-005663","article-title":"Do smoking habits differ between women and men in contemporary western populations? Evidence from half a million people in the UK biobank study","volume":"4","author":"Peters","year":"2014","journal-title":"BMJ Open"},{"key":"2026062414345532900_ref34","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1186\/s12889-019-6680-x","article-title":"Knowledge, attitudes, and perceptions towards waterpipe tobacco smoking amongst college or university students: a systematic review","volume":"19","author":"Arshad","year":"2019","journal-title":"BMC Public Health"},{"key":"2026062414345532900_ref35","doi-asserted-by":"crossref","first-page":"2010","DOI":"10.1016\/S0140-6736(07)60677-1","article-title":"Assessment of Swedish snus for tobacco harm reduction: an epidemiological modelling study","volume":"369","author":"Gartner","year":"2007","journal-title":"Lancet"},{"key":"2026062414345532900_ref36","volume-title":"The Times","author":"Roberts","year":"2025"},{"key":"2026062414345532900_ref37","volume-title":"Have you Heard of White Snus? A Swedish Tobacco Control Activist Rings the Alarm","author":"World Health Organisation","year":"2024"},{"key":"2026062414345532900_ref38","doi-asserted-by":"publisher","first-page":"213","DOI":"10.2188\/jea.JE20240189","article-title":"Patterns of use of heated tobacco products: a comprehensive systematic review","volume":"35","author":"Scala","year":"2025","journal-title":"J Epidemiol"},{"key":"2026062414345532900_ref39","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1111\/add.70243","article-title":"The changing face of nicotine use in England: age-specific annual trends, 2014 to 2024","volume":"121","author":"Jackson","journal-title":"Addiction"},{"key":"2026062414345532900_ref40","doi-asserted-by":"publisher","first-page":"tc-2024-059207","DOI":"10.1136\/tc-2024-059207","article-title":"The UK tobacco and vapes bill (2023\/4): framing strategies used by tobacco and nicotine industry actors faced with an endgame policy (a generational sales ban of tobacco products) and nicotine product restrictions","author":"Matthes","year":"2025","journal-title":"Tob Control"},{"key":"2026062414345532900_ref41","author":"English language skills. GOV.UK","year":"2018"},{"key":"2026062414345532900_ref42","volume-title":"Adult Smoking Habits in the UK: 2023","author":"Office for National Statistics","year":"2024"}],"container-title":["Nicotine &amp; Tobacco Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ntr\/advance-article-pdf\/doi\/10.1093\/ntr\/ntag130\/68479348\/ntag130.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ntr\/advance-article-pdf\/doi\/10.1093\/ntr\/ntag130\/68479348\/ntag130.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T18:35:06Z","timestamp":1782326106000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ntr\/advance-article\/doi\/10.1093\/ntr\/ntag130\/8702846"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,5]]},"references-count":42,"URL":"https:\/\/doi.org\/10.1093\/ntr\/ntag130","relation":{},"ISSN":["1469-994X"],"issn-type":[{"value":"1469-994X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,5]]},"article-number":"ntag130"}}