Multiple products, increased risks: dual and poly use of nicotine products

Using multiple nicotine products, also known as dual or poly use (for two products or more than two, respectively) is associated with greater nicotine dependence and increased likelihood of adverse health effects compared with using one product. 

Today's nicotine product landscape includes a range of addictive products, including traditional combustible products as well as disposable e-cigarettes and oral nicotine pouches containing large amounts of flavored nicotine at affordable prices.

The majority of e-cigarette and pouch products on the market also lack authorization from the U.S. Food and Drug Administration (FDA), making their presence on the market illegal.

Research on the potential risks of combining smoking, vaping, and oral nicotine pouches is still emerging. Here is what we currently know about the risks of using multiple nicotine products at once.

What factors influence dual and poly use?

There are many reasons why people of all ages may start using multiple nicotine products. A study of adults found that some adult dual and poly users may start using multiple products due to flavors, affordability, to reduce secondhand smoke, or to cope with nicotine withdrawals. Age, gender, race, income, education, mental health and disability status, and other social and economic factors may also play a role, and research on how these factors influence dual use is still developing.

What are the risks of dual and poly use?

Dual use of e-cigarettes and cigarettes may lead to greater nicotine dependence and increased adverse health effects for the heart, lungs, and mouth when compared with using one product. This is due to the fact that dual users who smoke and vape are exposed to a wider range of toxins compared to using one product alone.

Dual and poly use has increased among young people

According to a Truth Initiative study, multiple product use has increased significantly among young people. The study found that dual use of e-cigarettes and cigarettes was the most common pattern of nicotine use among study participants, followed by exclusive e-cigarette use. Researchers also found that dual use of e-cigarettes and oral nicotine pouches, like Zyn, increased significantly among young people.

Can using multiple nicotine products help people cut back on cigarette smoking?

A study that analyzed reasons for dual use found that more than half of dual users used e-cigarettes concurrently with cigarettes to try to quit smoking. However, since any amount of cigarette smoking is dangerous, dual use is not a proven path to successfully quitting nicotine and can lead to increased health-related risks.

Tailored quitting resources are needed to help dual and poly users quit

Dual and poly nicotine users may need additional resources and support to quit compared with people who use only one nicotine product. EX Program, a free digital quitting program developed by Truth Initiative with Mayo Clinic, has been proven to help dual users of cigarettes and e-cigarettes quit with tailored content based on relevant tobacco products. 

When people sign up for EX Program, they receive a personalized quit plan, text message support, advice and tips from Mayo Clinic, and 24/7 access to the nation’s largest online quitting community where users can share advice and experiences. EX Program is free, confidential, and can increase the odds of quitting nicotine by up to 40%.