Objectives: There is limited research on combined use of cigarettes, snus and e-cigarettes in the
Nordic countries. This study will investigate whether this pattern of use occurs among adolescents
in Norway. In addition, we will investigate the association between combined use of several
tobacco products, e-cigarettes and socio-demographic and psychosocial factors (SPF). Method: A
school-based cross-sectional survey of adolescents in the 8th to the 12th grade (N ¼ 875) in 2014.
Information on the use of cigarettes, snus, e-cigarettes and SPF was collected using an electronic
questionnaire. Results: Of the adolescents, 31% reported having tried or used one or more
tobacco product and/or e-cigarette. Of these, over half reported having tried or used one product,
1/3 two products and 1/10 three products. There were more boys among poly-users (63%) than
among single-users (44%). Compared to single-users, poly-users also reported weaker school
performance (30% and 11%, respectively), more often reported drinking alcohol to intoxication
(91% and 75%, respectively), and having tried cannabis (28% and 9%, respectively). Poly-users also
scored higher on impulsivity, sensation-seeking and depression. Conclusion: The study shows that combined use of tobacco products and e-cigarettes occurs among young people in Norway.
Such use was associated with psychosocial and socio-demographic risk factors. There is a need to
investigate this phenomenon in more details in representative samples.