Background:
Cigarettes, bidis, and smokeless tobacco (SLT) are popular in Bangladesh and many tobacco users may transition between products or/and use them concurrently.

Objective:
The aim of the study is to longitudinally track transitions of tobacco use within different subgroups of users (i.e. cigarettes, bidis, and SLTs) and explore factors related to transitions between them and to cessation.

Methods:
Four waves (2009–2015) of the International Tobacco Control (ITC) Bangladesh Survey with a sample of 3245 tobacco users were utilized to examine changes in tobacco product use and transitional patterns among Bangladeshi adults over time. Generalized estimating equation (GEE) models were utilized to evaluate socioeconomic correlates of transitions from exclusive use of cigarettes, bidis, or SLT, to the use of other tobacco products or quitting, from the first to the last wave.

Results:
Exclusive cigarette users in rural areas were more likely to transition than urban respondents to bidi use (OR=3.02; 95% CI: 1.45–6.29), to SLT use (OR=2.68; 95% CI: 1.79–4.02), or to quitting (OR=1.57; 95% CI: 1.06–2.33). Transitions for exclusive bidi users seemed to be more frequent. Higher SES was related to quitting (OR=4.16; 95% CI: 1.08–13.12) and less likely to transition to cigarette use (OR=0.49; 95% CI: 0.24–0.99). As for exclusive SLT users, quitting was more likely among younger respondents (OR=2.94; 95% CI: 1.23–6.9), and less likely for those in rural areas (OR=0.52; 95% CI: 0.3–0.86) compared to urban residents.

Conclusions:
Complex transitional patterns were found among different types of tobacco product users over time. These findings can inform more comprehensive and multi-faceted approaches to tackle diversified tobacco use in Bangladesh.