It seems the average American smoker isn't content with puffing away on just a cigarette, not when he's got e-cigarettes, cigars and hookahs to choose from.

Initial results from the Population Assessment of Tobacco and Health (PATH) Study released today show 40 percent of American tobacco smokers use many tobacco products such as cigarettes, cigarillos, hookah and cigars. PATH is the largest U.S. survey of tobacco consumption.

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Surprisingly, half of all combinations involved e-cigarettes, a result certain to arouse more heated debate on the safety of this product.

Begun in 2011, the PATH study 46,000 people and is expected to provide a wealth of information about tobacco use, smoking behavior and attitudes. It will also give the U.S. Food and Drug Administration data to reshape industry regulations.

The data, however, didn't give definitive insights as to why Americans are using different forms of tobacco. It also showed an increase in what the survey termed as "polyuse", or the use of multiple tobacco products.

The most common combination of products among youth and adults was cigarettes and e-cigarettes, according to the data.

"We were struck by the proportion of users that engaged in polyuse," said Mitch Zeller, head of the Food and Drug Administration's tobacco division.

Andrew Hyland, scientific principal investigator on the study and chair of the department of health behavior at Roswell Park Cancer Institute, said the rise in polyuse might mean smokers could be transitioning away from cigarettes, or they might be becoming more entrenched.

Health experts said more time is needed to identify the reasons for polyuse.

Over the coming years, the results of PATH are expected to provide the type of information about tobacco products that the Framingham Heart Study in the 1960s provided about heart disease and its impact on public health.