Background:
Concurrent use of smoking and smokeless tobacco products is common, but little is known regarding the association of smokeless tobacco use with smoking cessation. The present study aims to compare intention to quit and quit attempts among current smokers who also use smokeless tobacco (dual users) and exclusive smokers

Methods:
A cross-sectional study was conducted among 1360 respondents (542 smokers and dual users; 818 smokeless tobacco users) visiting 22 primary care facilities in two high tobacco burden states of India in 2016. The health facilities and patients were chosen using systematic random sampling. We compared intention to quit between dual users and exclusive smokers, using multivariate regression model

Results:
Out of 542 tobacco users, about 70% (378) were smokers and 30% (164) were dual tobacco users. Exclusive Smokers (62%) were more likely than dual users (38%) to have an intention to quit tobacco even after adjusting for demographic differences and tobacco dependence levels (OR:1.75; 95% CI 1.19-2.57). About 27% of smokers made an attempt to quit as compared to 23% of dual users. The quitting attempt last for less than 6 months for about 20% of smokers (19%) and smokeless tobacco users (17%). Less than 10% of smokers and smokeless tobacco users used counseling technique for tobacco cessation.

Conclusions:
Smokers are more likely to intend to quit smoking and have recently made quit attempts as compared to dual users. Findings document a high level of interest in quitting among smokers than dual users suggesting the need to develop targeted interventions for dual users and smokeless tobacco users to enhance cessation attempts. Further population prospective studies are needed to understand the issues faced by dual users as they make an attempt in quitting tobacco.