title: The role of smokeless tobacco use in smoking persistence among male college students.
abstract: BACKGROUND
  Significant changes in the tobacco industry have led to heightened concern about co-use of cigarettes and smokeless tobacco (SLT) products.
  
  
  OBJECTIVE
  The aim of this study was to assess whether male cigarette smokers who also used SLT products, in the first semester of their first year of college, were more or less likely than male cigarette smokers who did not use SLT products to still be smoking by the first semester of their senior year.
  
  
  METHODS
  Using a longitudinal, observational study, we followed a cohort of undergraduate students from 11 four-year universities in North Carolina and Virginia through their college career. Mixed-effects logistic regression analysis was conducted to estimate the likelihood of being a current smoker fall of senior year for male students who used both cigarettes and SLT at baseline, compared to those who only smoked cigarettes, after adjustment for potential confounders (n = 274).
  
  
  RESULTS
  At baseline, 67.2% of participants were smoking cigarettes only (no SLT use) and 32.8% were dual users (cigarettes and SLT). A total of 62% were still smoking at senior year. Dual users were 30% more likely to be current smokers senior year compared to cigarette only users, although this difference was not statistically significant. Having at least one friend who smoked cigarettes and heavier cigarette smoking at baseline were significantly related to senior year smoking.
  
  
  CONCLUSIONS
  Our findings do not support the argument that SLT use may help male college smokers discontinue their smoking habit. In fact, it may contribute to smoking persistence.
authors.affiliation: a Department of Social Sciences and Health Policy .
authors.forename: Mark
authors.initials: M
authors.lastname: Wolfson
authors.affiliation: b Department of Biostatistical Sciences , and.
authors.forename: Cynthia K
authors.initials: CK
authors.lastname: Suerken
authors.affiliation: a Department of Social Sciences and Health Policy .
authors.forename: Kathleen L
authors.initials: KL
authors.lastname: Egan
authors.affiliation: a Department of Social Sciences and Health Policy .
authors.forename: Erin L
authors.initials: EL
authors.lastname: Sutfin
authors.affiliation: b Department of Biostatistical Sciences , and.
authors.forename: Beth A
authors.initials: BA
authors.lastname: Reboussin
authors.affiliation: a Department of Social Sciences and Health Policy .
authors.forename: Kimberly G
authors.initials: KG
authors.lastname: Wagoner
authors.affiliation: c Department of Family and Community Medicine , Wake Forest School of Medicine , Winston-Salem, North Carolina , USA.
authors.forename: John
authors.initials: J
authors.lastname: Spangler
mesh_terms: D016022:Case-Control Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009657:North Carolina / Q000453:epidemiology; D012907:Smoking / Q000453:epidemiology*; D013334:Students / Q000523:psychology*; D014030:Tobacco, Smokeless / Q000706:statistics & numerical data*; D014495:Universities; D014768:Virginia / Q000453:epidemiology
keywords: Cigarette smoking; United States; co-use; college student; smokeless tobacco; substitution