Alternative flavored and unflavored tobacco product use and cigarette quit attempts among current smokers experiencing homelessness

•Almost two-thirds of participants used alternative tobacco products.•Cigars, blunts, and e-cigarettes most commonly used alternative tobacco products.•Most cigar and e-cigarette users used fruit-flavored tobacco products.•Discordance found between perceptions of addiction/harm and alternative tobacco use.•Alternative tobacco product use was not associated with a past-year quit attempt. Alternative tobacco product (ATP) use is common in the general population; however, few studies have explored ATP among individuals experiencing homelessness. We recruited individuals experiencing homelessness who were current cigarette smokers to explore flavored and unflavored ATP use and its association with past-year cigarette quit attempts. Using time-location sampling, we recruited participants from eight service sites in San Francisco, CA between December 2017 and July 2018. We explored type of ATP use and perceptions of product addiction, harm and risk between cigarette-only smokers and those who used cigarettes and ATPs (‘ATP users’). We used logistic regression to examine the association between ATP and past-year quit attempts, adjusting for demographics, substance use disorders, depressive symptoms, and cigarette use characteristics. Among the 470 participants, 34.5% were cigarette-only users and 65.5% were ATP users. Among ATP users, 74.0% used cigars and 29.8% used e-cigarettes in the past month, with fruit-flavored products being the most common. ATP users were more likely to perceive cigars, blunts, and smokeless tobacco to be quite to extremely harmful or addictive compared to cigarette-only users. ATP use was not associated with past-year quit attempts, whereas hazardous alcohol use (OR = 2.07; CI 1.07–4.02) was associated with higher odds and and amphetamine use (OR = 0.50; CI 0.26–0.98) was associated with lower odds of past-year attempts. High rates of ATP use highlight a need for studies that explore motivations for use, beyond use as a smoking cessation aid, among people experiencing homelessness.