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Purpose: To understand changes in purchasing behaviors and use of tobacco products such as e-cigarettes and cigarettes among different tobacco user groups during the COVID-19 pandemic using a mixed methods approach. Methods: A quantitative online survey was conducted in October-November 2020 using a national probability sample of US adults (N = 1,460) comprising exclusive cigarette smokers (n = 1,080), dual users of both cigarettes and e-cigarettes (n = 143), and exclusive e-cigarette users (n = 237). Simultaneously, ten online focus groups were conducted with 61 adults in the Atlanta, GA area including exclusive smokers (n = 16), current E-cigarette users (n = 22), and transitioning (recently quit or currently quitting) smokers and/or E-cigarette users (n = 23). Results: From the survey, dual users vs. exclusive smokers had higher odds of buying cheaper cigarette brands (adjusted odds ratio (aOR) 2.50, 95% confidence interval (CI) = 1.49, 4.20), buying cigarettes online (aOR = 2.79; 95% CI = 1.02, 7.69), buying from Indian Reservations (aOR = 3.99; 95% CI = 2.07, 7.69), buying fewer cigarettes than normal (aOR = 4.01; 95% CI = 2.42, 6.65) and buying other tobacco products (aOR = 4.44; 95% CI = 2.24, 8.79). From the focus groups, participants perceived reduced accessibility, fear of contracting COVID-19, rising prices, and convenience to influence their purchasing behaviors and tobacco use. Conclusions: Exclusive and dual users differed in their tobacco purchasing behaviors during the COVID-19 pandemic, such that dual users were more likely to change their purchasing behaviors (e.g., buying other tobacco products) than exclusive users. Educational campaigns and public health workers may promote interventions targeting dual users either to switch to reduced-risk products or quit smoking, particularly during stressful societal situations such as the COVID-19 pandemic. Implications: The findings inform public health educators and policymakers to develop policies and interventions carefully tailored for tobacco user groups targeting the perceived factors influencing purchasing behaviors during challenging situations affecting tobacco product availability. [ABSTRACT FROM AUTHOR]

Objective: To track trends in cigar smoking and assess perceptions of cigar related health risks among Massachusetts adults., Design: A random digit dial telephone survey conducted in 1993 and a subsequent monthly random digit dial survey conducted March 1995 to June 2000., Participants: 4733 adults who completed the 1993 survey and 14 868 adults who completed the monthly survey between 1995 and 2000., Main Outcome Measures: Trends in current and experimental cigar use and perceptions of health risks., Results: Current cigar usage increased significantly among men aged 18-34 years between 1993 (5.8%) and 1997-98 (18.2%), but began to decrease in 1999-2000 (13.5%). Young men were much more likely than older men or women of any age to have experimented with cigars in the year before interview, but this trend appears to have decreased slightly since 1998. Young male cigar smokers were increasingly those who never smoked cigarettes. Former cigarette smokers were not smoking cigars in greater numbers. Cigar smokers were roughly three times as likely as those who do not smoke cigars to believe cigars are a safer alternative to cigarettes, and that perception did not appear to change much over time., Conclusion: Cigar usage increased dramatically among young men in Massachusetts in conjunction with national increases in sales and marketing of cigars, but now appears to be decreasing.