Chewing tobacco use by adolescents: prevalence and relation to cigarette smoking

Tobacco use prevalence and factors associated with tobacco use in new U.S. Army personnel

This study examined the prevalence of tobacco use and factors associated with pre-military service cigarette and smokeless tobacco use. From January 2000 to December 2006, military students arriving for Advanced Individual Training at the U.S. Army Ordnance School completed a questionnaire that asked about their use of tobacco products. The prevalence of smokeless tobacco use from 2000 to 2006 for women generally decreased, as did the number of cigarettes smoked per day by men. For men and women, factors associated with cigarette use included younger age, Caucasian race, and use of smokeless tobacco. Factors associated with smokeless tobacco use among men included younger age, Caucasian race, and cigarette use. For women, cigarette use was the only factor associated with smokeless tobacco use. The identified factors in this study could be used to establish strategies in the future to reduce tobacco use in the military.

Concurrent use of tobacco products by California adolescents

BACKGROUND

To describe patterns and correlates of tobacco product use other than cigarettes in adolescents 12-17 years of age.

METHODS

Adolescent respondents (N = 6090) to the 1999 California Tobacco Survey provided estimates of ever and current use (in last 30 days) of smokeless tobacco, cigars, and bidis, which were examined by cigarette smoking experience, demographics, and known predictors of cigarette use.

RESULTS

Only 3% of adolescents who never smoked cigarettes experimented with other tobacco products. Among ever smokers who were not current smokers, the rate was 35%. Nearly 60% of current cigarette experimenters had tried another tobacco product, but almost 90% of current established smokers had experimented with one. Over 40% of current established smokers used another tobacco product in the last 30 days. Factors predictive of cigarette smoking were also highly associated with other tobacco use. In ever cigarette smokers, having peers who used other tobacco products was most highly associated with other tobacco use. Problem or risky behaviors, beliefs that cigarettes are safe or beneficial, and receptivity to tobacco promotions were also independently associated with other tobacco product use.

CONCLUSIONS

Adolescent smokers who use other tobacco products may be prone to risky behavior and such use may hasten the development of nicotine tolerance.

Curtailing tobacco use among youth: evaluation of project 4-health

This article reports the development and evaluation of Project 4-Health, a theory-driven, research-based program to prevent tobacco use among youth enrolled in 4-H clubs throughout California. Additional goals were to involve youth in discouraging others' tobacco use and to develop youth leadership for tobacco control. To assess program effectiveness, 72 clubs were matched and randomly assigned to the program or control condition. Of 1,853 eligible club members, 88.6% completed the pretest. Of these, 79.5% completed a posttest 4 months after conclusion of program delivery, and 77.6% completed a second posttest 2 years later.Short-term effects were found on 7 of 24 outcome measures, indicating changes in knowledge, attitudes, and behavioral intention, but not in social influence variables or behaviors. No long-term effects were observed. Discussion considers how the challenges of designing, delivering, and evaluating the intervention influenced results and implications for preventing tobacco use through community-based youth groups.

Snuff use and smoking in U.S. men: implications for harm reduction

BACKGROUND

Encouraging smokers to switch to snuff may have unintended public health implications. This study examined the associations between snuff use and smoking in a representative sample of U.S. men.

METHODS

Subjects were males aged >or=18 years in the National Health Interview Survey (N=13,865). The data analysis was conducted between August 2001 and April 2002. Multiple logistic regression modeling was used to examine the association between using snuff and quitting smoking.

RESULTS

In 1998, 26.4% of U.S. men smoked, 3.6% used snuff, and 1.1% used both products. Adjusting for age and race/ethnicity, current smoking was most prevalent among males who used snuff on some days (38.9%) and lowest among those who used snuff every day (19.2%). Daily snuff users were significantly more likely than never-users to have quit smoking in the preceding 12 months (odds ratio [OR]=4.23; 95% confidence interval [CI]=2.16-8.28). However, U.S. men were more likely to be former snuff users who currently smoked (2.5%) than to be former smokers who currently used snuff (1.0%). Occasional snuff users (some day users) were more likely than never users to have tried to quit smoking in the preceding year (OR=1.69; 95% CI=1.04-2.76) but tended to be less likely to succeed (OR=0.50; 95% CI=0.19-1.33).

CONCLUSIONS

Some men may use snuff to quit smoking, but U.S. men more commonly switch from snuff use to smoking. Some smokers may use snuff to supplement their nicotine intake, and smokers who also use snuff are more likely than nonusers to try to quit smoking but tend to have less success.

Oral spit tobacco: addiction, prevention and treatment

The prevalence of smokeless tobacco is significant and reaches as high as 17% past month use in white males aged 18-25. Smokeless tobacco use is of concern because of the potential for addiction and the associated negative health consequences. This article reviews the basis for addiction to smokeless tobacco, examining the nicotine content in smokeless tobacco products, pharmacokinetics, psychoactive effects, tolerance, and withdrawal. It also explores the negative health consequences which include a number of oral pathologies and increased cardiovascular risk factors. Furthermore, it examines the factors associated with the initiation of smokeless tobacco use, and the current prevention programs that address these factors. Current smokeless tobacco treatment approaches are also discussed as well as predictors for abstinence. Finally, the future directions are discussed in light of the limited amount of research that has been conducted in the smokeless tobacco area, particularly related to prevention and treatment.

Adult smokeless tobacco use and age of onset

To determine if an earlier age of onset is associated with greater levels of adult smokeless tobacco (SLT) use and to evaluate if this relationship differs by SLT type, 345 current adult SLT users were interviewed to obtain the age at first onset and current frequency of SLT use. The results indicated that more than twice as many SLT users began during adulthood than during preadolescence. Although preadolescent onset was associated with greater chewing tobacco use than adolescent onset, the greatest levels of both chewing tobacco and snuff use were associated with adult onset, suggesting an increased need for SLT prevention programs for young adults.

Use of smokeless tobacco by Mexican-American high school students

A survey of 208 girls and 191 boys attending a public high school in southwestern New Mexico was conducted to examine students' use of smokeless tobacco products. One Mexican-American girl identified herself as a user of chewing tobacco. Of the boys 8% (17) indicated that they used chewing tobacco and 7% (15) reported that they dipped snuff. 6% (12) indicated use of both snuff and chewing tobacco. The boys included 153 Mexican-Americans of whom 7% used smokeless tobacco and 26 Anglo-Americans of whom 34% were users.

Correlates of exclusive or combined use of cigarettes and smokeless tobacco among male adolescents

Past studies which examined correlates of smokeless tobacco or cigarette use have investigated use of one tobacco product regardless of use of the other product. Thus, the etiology of exclusive use of the two tobacco products is not clear. The present study investigated the relationship of problem-prone-related variables to exclusive versus overlapping use of smokeless tobacco and cigarettes. Two samples of southern California male students (eighth-grade and high school) were divided into groups according to their tobacco use status: neither product, cigarettes only, smokeless tobacco only, or both tobacco products. Generally, triers and monthly users of both tobacco products reported a higher risk-taking preference, greater susceptibility to peer social influence to use tobacco products, and greater likelihood to have tried marijuana and alcohol than did subjects who were not users of either tobacco product. Adolescents who used either product, but not both, reported similar scores on most of the variables examined, which fell in between combined or nonuse categories. These results suggest that the number of tobacco products used, not the specific product, is associated with problem-prone attributes.

Smokeless tobacco habits and oral mucosal lesions in dental patients

As part of a smokeless tobacco (ST) intervention study, we collected data on tobacco use habits and oral health for 245 male ST users aged 15 to 77. The study sample was identified during routine dental office visits and represents a relatively diverse population of patients. Oral health data collection included grading the clinical appearance of oral mucosal lesions using Greer and Poulson's classification system, as well as identifying and recording the primary anatomic location of ST placement. Results show that 78.6 percent of ST users had observable oral lesions, 23.6 percent of which were in the most clinically advanced category (degree III). Of the lesions noted, 85 percent were in the same location the patient identified as his primary area of smokeless tobacco placement. In a comparison sample of 223 non-ST-users with the same age distribution, only 6.3 percent had observable lesions. A multiple logistic regression model for ST users showed that lesion presence and severity were most significantly related to current frequency of ST use.

Smokeless tobacco abstinence effects and nicotine gum dose

There were two experiments on abstinence from smokeless tobacco. The purpose of the first experiment was to determine abstinence effects from smokeless tobacco. The purpose of the second experiment was to examine the effects of different doses of nicotine gum on smokeless tobacco abstinence effects. The subjects were male Copenhagen smokeless tobacco users who underwent 3 days of baseline measurement while continuing to use smokeless tobacco ad libitum, and 5 days of the experimental condition. In the first experiment, the subjects were assigned randomly to one of two groups and compared: continuous smokeless tobacco users (n = 10), and deprivation plus no nicotine gum (n = 10). In the second experiment, subjects were assigned randomly and in a double-blind fashion to one of three groups and compared: (1) deprivation plus 0 mg nicotine gum (n = 20); (2) deprivation plus 2 mg nicotine gum (n = 20); and (3) deprivation plus 4 mg nicotine gum (n = 20). The first experiment showed significant increases upon abstinence for the following variables: (1) craving; (2) difficulty concentrating; (3) restlessness; (4) excessive hunger; (5) eating; (6) reaction time; (7) variability of reaction time and (8) total withdrawal scores for both the self-rated and the observer-rated forms. The second experiment showed that nicotine gum failed to significantly reduce smokeless tobacco abstinence effects, although those with high cotinine levels may receive some benefit from nicotine gum.

The role of race and ethnic status on the psychosocial correlates of smokeless tobacco use in adolescent males

From a stratified, random sampling of non-urban high schools in the Southeast, survey data were obtained from 5374 adolescent males. Over half reported trying smokeless tobacco, and approximately one third of these reported a regular, substantial level of use. The average age at initial use was 12.2 yr. and was negatively correlated with the level of use. Factor analysis of the psychosocial items resulted in four factors: substance use/deviant style, modeling, perceived negative consequences, and health behavior. Discriminant analysis of initial use indicated that substance use and modeling influences were the strongest predictors of trying smokeless tobacco. Regression analysis of level of smokeless tobacco use indicated that substance use, modeling, and perceived negative consequences were equivalent in their contribution. Separate analyses were performed for American Indian, Black, and White males. Although predictors of initial use were similar, level of smokeless tobacco use was most associated with the use of other substances in Blacks and with modeling influences in Whites.

A comparison of smokeless tobacco and smoking practices of university varsity and intramural baseball players

To examine the smokeless tobacco (ST) and smoking practices of collegiate varsity and intramural baseball players, 284 undergraduate athletes at two major Southwestern universities were surveyed using a questionnaire previously developed to measure use among this population. About one-fourth of all athletes were current ST users and 4% smokers. Over half of varsity players (53%) compared to 25.9% of intramural players used one or both forms of ST. Varsity players were about 20 times more likely to use ST as to smoke, while intramural players were about five times as likely to use ST than to smoke. On both teams, use of chewing tobacco was associated with use of snuff. Smoking was not associated with ST use in either group. Mean ages for initiation for all products was 15, and for quitting, 18. There was no evidence that one form of tobacco served as a gateway for the other among these young adult athletes. Over a fourth of all users started after age 17, suggesting that college is an appropriate locus for both ST prevention and cessation programming. Such programs for this population must address the unique characteristics of the social environment in collegiate baseball.

Use of smokeless tobacco among conscripts: a cross-sectional study of Norwegian army conscripts

In a cross-sectional study of 2,112 Norwegian army conscripts ages 18 to 25 years, 10% reported daily use of wet snuff, while 23% were occasional users. Nearly half of the snuff users had started or increased their consumption during the military service. Cigarette smoking, alcohol consumption, and having a best friend using snuff were positively correlated with starting to use snuff. Daily use was associated with high physical activity. Use of snuff did not vary significantly with length of education when adjusting for other variables. Nearly all subjects believed prolonged snuff use to be a hazard to health. Forty percent of the snuff users believed they would give up snuff after the military service. Giving up during the service was statistically associated with having a steady relationship with a girlfriend and with length of time served. The relatively high percentage of occasional users and the high rate of stopping and starting reflect the novelty of snuff use among Norwegian youth. The widespread intention to give up seems to indicate that a large proportion of snuff users have ambivalent attitudes toward their own behavior. Therefore, future intervention measures in the armed forces could have a substantial impact on young males' use of smokeless tobacco.

Prevalence of smokeless tobacco consumption at a southwestern university

265 students attending a southwestern university were surveyed about their use of smokeless tobacco products. 27% of 84 male respondents indicated they consumed smokeless tobacco. The women did not report routine use of smokeless tobacco.

The tobacco use research program at Oregon Research Institute

The research program at ORI deals with both adolescent and adult tobacco use and is guided by a behavioral framework which emphasizes the role of the social context in tobacco use onset, maintenance and cessation. Growing appreciation of the importance of social context variables, combined with an emerging recognition of the need for a public health rather than clinical perspective on tobacco use, have led to a focus on interventions in larger social systems such as schools, worksites, health care plans, and communities. This research requires attention to the science of behavior change at both the individual and organizational levels.

Smokeless tobacco use in adolescent females: prevalence and psychosocial factors among racial/ethnic groups

From a stratified, random sampling of Southeastern, nonurban high schools, survey data on smokeless tobacco use and potential psychosocial risk factors were obtained from 5683 adolescent females. Of the 15.3% who reported trying smokeless tobacco, most (75%) reported only experimental use. Factor analysis of the psychosocial items resulted in four factors: perceived negative consequences, substance use, modeling, and active lifestyle. Discriminant analysis on use indicated that modeling influences and use of other substances were the strongest predictors of initial smokeless tobacco use. Level of use, however, was most strongly associated with lower perceived negative consequences for use and the use of other substances. Separate analyses on American Indian, Black, and White subgroups suggested that factors associated with initial use were similar but that substantial differences exist between subgroups on risk factors for level of smokeless tobacco use.

Psychosocial factors in the use of smokeless tobacco and their implications for P.L. 99-252

This article briefly reviews the prevalence of smokeless tobacco use by males in the United States, the relationship of smokeless tobacco use to cigarette use, and patterns of use that include dosage, topography, products, and function of use. The primary focus of the article is to describe the concurrent and predictive factors associated with onset, use, and cessation of smokeless tobacco. The implications of P.L. 99-252, the Comprehensive Smokeless Tobacco Act of 1986, are discussed in the context of what is known about the psychosocial variables associated with the use of smokeless tobacco.

An in-depth analysis of male adolescent smokeless tobacco users: interviews with users and their fathers

Male adolescent smokeless tobacco (ST) users (N = 191) were extensively interviewed, then followed over a 6-month period with monthly telephone interviews. In addition, their fathers (N = 137) were interviewed by telephone. Based on these data, ST use appears similar to cigarette smoking with respect to onset, patterns of use, social influences, attempts to quit, and indications of addiction. Onset and continued use of ST largely occur in a social context. Parents are reportedly aware (73%) of their sons' ST use but appear tolerant. The great majority of S's (92%) believe that there is some health risk associated with ST use. Over half report noticing ST-related changes in their oral cavities, although their dentists generally had not discussed ST use with them. Over one-third of the current users report unsuccessful quit attempts. ST use appears to be part of a more general pattern of substance use, including marijuana and alcohol.

Typology and correlates of smokeless tobacco use

The incidence, use patterns, and correlates of smokeless tobacco have become increasingly important as usage rates rise and harmful health effects become established. The present study assessed the incidence of smokeless tobacco use in a Southeastern U.S. sample and selected correlates of use. From the responses of 3725 high school students, 19.9% reported trying smokeless tobacco products (35.5% for males, 5.8% for females). Most agreed that tobacco use has harmful health consequences. Those disagreeing with these health beliefs were more likely to use smokeless tobacco. Cigarette smoking was strongly associated with initial use. Of those reporting any use of smokeless tobacco, most used it for less than an hour per day, but 18% reported 3 or more hours of use per day. Forty-four percent reported a first use of smokeless tobacco before 13 years of age. Early initial use was associated with greater frequency and duration of use. Early initial users also reported greater influence from family and advertisements. Encouragement from friends, however, appeared to be the major factor regardless of age at initial use. Of particular concern is that 8.4% of those having any experience with smokeless tobacco felt they were addicted to the substance. Finally, 27.9% reported swallowing the substance or spittle, suggesting the need for further research on the potential health implications of this behavior.

Smokeless tobacco use by youth in the U.S

Oral snuff and chewing tobacco, commonly referred to as smokeless tobacco, are being used by many adolescent and young adult males, and no indication exists that use by this group is declining. Users are at risk for oral cancer, noncancerous oral pathology such as leukoplakias, and addiction. Information about patterns of smokeless tobacco use and motivations of users may help planners develop and implement interventions. Variables include the importance of peer and family influences, social image, knowledge of harmful effects, regional differences, use of other substances, and addiction. Due to the addictive nature of smokeless tobacco, older youth may need cessation programs. Health educators are encouraged to include smokeless tobacco in their tobacco use prevention programs and to develop and implement comprehensive tobacco interventions appropriate for their youth population.

Gustatory function and dietary habits in users and nonusers of smokeless tobacco

Nicotine and smoking may modify gustatory function or preferences and are associated with altered energy balance; however, there is no information on whether smokeless tobacco (ST) has similar effects. Evaluations of gustatory function (threshold sensitivity, perceived intensity of suprathreshold stimuli, preferences) were conducted on 28 chronic ST users and 30 nonusers after both abstaining and using ST. Subjects also maintained 7-d dietary records that included descriptions of the predominant taste qualities of foods. There were few user vs nonuser differences in gustatory measures. Among nonusers, use of ST reduced perceived intensity of salty, sour, and bitter stimuli. Users reported greater alcohol intakes and lower consumption of carbohydrates, sweet foods, fruits, and grains. Chronic use of ST does not appear to have substantial effects on gustatory function but may be associated with decreased carbohydrate intakes, perhaps related to increased alcohol use and possibly because of reduced consumption of sweet-tasting foods.

Media manipulation of adolescents' personal level judgements regarding consequences of smokeless tobacco use

Videotapes were developed to try to impact on personal level judgements of concern and risk in the context of smokeless tobacco use, a growing substance use problem in adolescents. In a within-and-between-subjects design, convincingness (i.e., dramatic portrayal) of the videotaped message (high and low) and perceived probability of consequences portrayed in the message (high and low) were manipulated.

Correlates of adolescents' use of smokeless tobacco

Data are presented on the prevalence and correlates of smokeless tobacco use among a group of 568 adolescents from five public schools located in western New York State. Two of the five schools were located in rural communities, two were located in suburbs of Buffalo, and one school was located in the city of Buffalo. Nineteen percent of males reported current use of smokeless tobacco. There was very little regular use among girls, although 18% reported having tried it. Sharp regional differences in the use of smokeless tobacco were observed with the highest percentage of users among students from rural communities. Experimentation with cigarette smoking was associated with use of smokeless tobacco, however, few regular users of smokeless tobacco were current smokers. As is the case with cigarette smoking, social influences, especially those of peers and family members, were important factors associated with use of smokeless tobacco. Study findings suggest that programs that attempt to prepare students to cope with social pressures for using and stress the immediate negative consequences of use (i.e., stained teeth, bad breath) are more likely to be successful in discouraging adolescents from using smokeless tobacco than programs that only educate about the detrimental health effects of chewing and/or dipping tobacco.

Patterns and prevalence of smokeless tobacco use by high school seniors in New York

Patterns and prevalence of smokeless tobacco use by high school seniors in New York state were identified in this study. A questionnaire was administered to a sample of 10% of each senior class in 96 randomly selected public and nonpublic secondary schools in New York; 1,830 students participated. Data analysis included descriptive statistics, t-tests, and chi-square tests. Comparisons were made by gender, hometown status, concurrent use of smokeless tobacco and cigarettes, and smokeless tobacco use versus cigarette smoking. Results revealed a significant difference existed between males and females and between urban and rural smokeless tobacco use (p = .05). Use of chewing tobacco related significantly to use of cigarettes (p = .05). A significant difference existed between prevalence of cigarette smoking and smokeless tobacco use (p = .05). Smokeless tobacco use by high school seniors in New York is predominantly a habit of rural males. Use of chewing tobacco is related to cigarette smoking, and smokeless tobacco was less prevalent than cigarette smoking in the sample (p = .05). Further research on the relationship between smokeless tobacco and cigarette smoking should be conducted. Use of chemical assays or the bogus pipeline to validate self-reported data is recommended. Identified high-risk groups such as rural males should receive particular attention in future research efforts.

Smokeless tobacco on campus

Self-reports on smokeless tobacco consumption were obtained from 438 students attending a small Midwestern liberal arts college. While use among 249 female students was negligible, 9% of 189 male respondents reported routine use of smokeless tobacco products.

Personality and smokeless tobacco use

Smokeless tobacco use and personality factors associated with smokeless tobacco use were examined in a broad, representative sample of 8th and 10th graders from central and south-central Florida (n = 1413). Current, occasional, or ex-users of smokeless tobacco accounted for 51% of the males and 9% of the females. Smokeless tobacco users, as compared to non-users, had significantly higher Trait Anger, and Angry Temperament and Angry Reaction subscale scores on the State-Trait Personality Inventory, suggesting a possible role in the initiation of smokeless tobacco use. There were no differences in Trait Anger, Anxiety, or Curiosity scores between the three user groups, suggesting that trait personality does not play a role in the maintenance of smokeless tobacco use.

The interaction of alcohol and tobacco use in adolescents and young adults: Bogalusa Heart Study

Alcohol and tobacco usage patterns were assessed in 1,811 children and young adults, 12-24 years of age. The prevalence of cigarette smoking and alcohol consumption increased with age in all race and sex groups. Smokeless tobacco use (chewing tobacco and snuff) was primarily seen in white males with the highest prevalence rates in 12-15 year olds. Among white males who reported smokeless tobacco usage, 44% of the 12-17 year olds and 80% of the 18-24 year olds reported concurrent alcohol use. There was a significant interaction between alcohol consumption and cigarette smoking in all four race-sex groups (p less than 0.001). Given the potential synergistic relationship between ethanol and tobacco products on oral and upper gastrointestinal tract cancer, as well as between smoking and cardiovascular disease, the long term effects from these behaviors could be troublesome. Since healthy lifestyles are established in youth, early intervention on alcohol and tobacco use is needed to prevent the future morbidity and mortality from cancer and cardiovascular disease.

An interpretative review of smokeless tobacco research in the United States: Part I

The first part of a two-part series reviewing the published literature of smokeless tobacco in the United States and concomitant health effects associated with its use. This article delineates the current status of its prevalence, behavioral psychosocial factors associated with use, and review of the negative health effects associated with regular use.

The social image of smokeless tobacco use in three different types of teenagers

The current study used an unobtrusive methodology to describe the social image associated with smokeless tobacco use and with cigarette smoking in three "types" of teenage models--an athlete, a cowboy, and an average teenager. As in previous research, the social image associated with smokeless tobacco use was more positive than that associated with cigarette smoking, suggesting that adopting smokeless tobacco use may have perceived social image benefits for adolescent males. The image conveyed by smokeless tobacco use was similar across the three different types of adolescent. Relations between social image factors and tobacco use behavior were examined, and implications for tobacco use prevention are discussed.

Use of smokeless tobacco among children and adolescents in the United States

Data collected by National Cancer Institute grantees on the use of smokeless tobacco by youth are reported. Self-reports were collected from over 43,000 students from grades 4 through 11 in 16 locations in the United States and 1 location in Canada. Lifetime and recent use of smokeless tobacco are reported by location, sex, grade level, and ethnic group. Use of smokeless tobacco increased with grade level. Typically, 40 to 60% of males had tried smokeless tobacco, and in most locations, 10 to 20% of older male youths reported recent use. With the exception of Native Americans, rates of use among females were lower than those among males. Use was highest among Native Americans and lowest among blacks and Asians. Smokeless tobacco use by Hispanics was comparable to that by whites. Collectively, the data indicate that large numbers of male youths in many areas of the United States are using smokeless tobacco. In light of recent research on the health consequences of using smokeless tobacco, the health of these youth may be endangered.

Adolescent smokeless tobacco incidence: relations with other drugs and psychosocial variables

This article presents data regarding the prevalence of trying smokeless tobacco in a longitudinal sample of 2,714 urban, ethnically diverse adolescent males and females. A predominance of trial use was found in white males in 8th and 9th grades. Also presented is the relation of smokeless tobacco onset to experimentation with other drugs (cigarettes, alcohol, marijuana), cigarette smoking in significant others, self-image as a smoker, risk taking, and smoking refusal self-efficacy. Smokeless tobacco onset was related to higher levels of cigarette smoking and lower quit rates, and was positively associated with use of cigarettes by significant others, one's self-image as a smoker, and with a disinclination to refuse cigarette offers. Finally, onset was more probable in individuals who had previously tried alcoholic beverages and marijuana, and who reported enjoying taking risks. A multivariate logistic regression analysis retained sex, smoking level, beer and wine use, and risk taking as predictors of smokeless tobacco onset. Apparently, smokeless tobacco is an additional activity in which drug-experimenting male adolescents are likely to participate.

Smokeless tobacco use among male adolescents: patterns, correlates, predictors, and the use of other drugs

Questionnaire data from a sample of 3,023 adolescents indicated that over 60% of boys have tried smokeless tobacco, and 7% use it daily. Daily users reported an average of 5.3 uses per day. Among boys the prevalence of smokeless tobacco use in the past 6 months (18.8%) was higher than that for cigarette use (10.4%). For 86% of boys, the initial use of smokeless tobacco occurred in a social setting with other boys. Split-sample discriminant analyses identified peer use of smokeless tobacco as a discriminator between users and nonusers. Male triers of smokeless tobacco were discriminated from those who had never tried it by whether they had also tried smoking, intended to smoke, or had peers who used smokeless tobacco. Nine-month longitudinal data indicated that onset of smokeless tobacco use was not well predicted. Among daily users, the initial rate of use was the best prospective predictor of rate of use at follow-up (r = 0.576). Smokeless tobacco use was related to the use of other drugs, with 83% of male daily users indicating concurrent use of alcohol, marijuana, and/or cigarettes (tau = 0.354, 0.210, and 0.284, respectively). The use of smokeless tobacco was a prospective risk factor for the onset or increased use of cigarettes, alcohol, or marijuana.

Learner characteristics associated with responses to film and interactive video lessons on smokeless tobacco

To determine college students' cognitive and affective responses to alternative technologies for presenting a lesson on smokeless tobacco, and to learn if responses to experimental conditions were associated with gender, ethnicity, tobacco-use practices, and the practices of significant others, 162 undergraduate students were randomly assigned to either a control group (questionnaire only) or one of two experimental groups. Experimental subjects viewed a videotape or an interactive video version of the lesson and then completed a questionnaire to ascertain knowledge and attitude. Each main effect was significant for knowledge about smokeless tobacco [experimental condition (P less than 0.001); gender (P less than 0.024); and ethnicity (P less than 0.003)]. The interactive video group demonstrated the most accurate and comprehensive recall. Neither gender nor ethnicity interacted significantly with experimental condition, indicating that the effect of experimental condition is constant across gender and ethnicity. Attitudes to instructional formats did not vary significantly as a function of experimental condition or gender, but were associated with ethnicity (P less than 0.034). Again, neither gender nor ethnicity interacted significantly with experimental condition, suggesting that attitudes reflect a generalized view toward content irrespective of presentation mode. Responses to both experimental conditions were quite favorable. Items about present and past experiences with tobacco, with the exception of the "Do you smoke?" item, were not associated with total cognitive score or attitude.

Implications of Smokeless Tobacco Use Among Athletes

In brief: This literature review delineates the current status of smokeless tobacco. It discusses the prevalence and terminology as well as periodontal effects, buccal mucosal and soft-tissue alterations, leukoplakia, cancer, carcinogenic components, hemodynamic alterations, and potential addiction. It is clear that physicians and dentists should discourage their patients from using smokeless tobacco. Young people particularly may be influenced by popular sports figures and celebrities who convey the erroneous impression that smokeless tobacco is harmless.

Smokeless tobacco use among adolescents: demographic differences, other substance use, and psychological correlates

Survey data on smokeless tobacco and other substance use were obtained from 2,926 seventh, ninth, and eleventh graders in Ventura County, California public schools. Patterns of smokeless tobacco use were examined relative to other drug use, particularly cigarette smoking. Few females used smokeless tobacco regularly, as compared to 4.7 percent of the males. The data supported the view that the recent increases in smokeless tobacco use were related to male tobacco users' belief that smokeless tobacco was less harmful to physical health than cigarette smoking. A Guttman scalogram analysis showed that tobacco use, either cigarette smoking or smokeless tobacco use, occurred after marijuana use rather than before. Perceived parental attitudes toward marijuana use predicted both cigarette smoking and use of smokeless tobacco, whereas perceived parental attitudes toward alcohol use was only related to use of cigarettes. Quality of life measures were inversely related to both cigarette smoking and smokeless tobacco use, but mood state measures predicted only cigarette smoking. Implications of the results for a historical hydraulic model of aggregate drug use are discussed with recommendations for improved approaches to the prevention of drug abuse.

Psychosocial correlates of adolescent smokeless tobacco use

The current study investigated psychosocial correlates of adolescent smokeless tobacco use. Subjects viewed smokeless tobacco use as less of a health danger than smoking and as more socially acceptable. The social image associated with smokeless tobacco use was an ambivalent one that in some ways matched the masculine, athletic image features in advertising. Subjects' beliefs about the health consequences of smokeless tobacco use, its social acceptability, and its associated social image related to current tobacco use and (among nonusers) to intentions to use tobacco in the future.