Young users of smokeless tobacco lack awareness of its dangers

December 17, 2000

Smokeless tobacco users have less awareness of the dangers of their habit than non-users, according to a survey of West Virginia public school students.

West Virginia has the highest prevalence of adult smokeless tobacco use in the United States. "Many West Virginia users see smokeless tobacco as a safe alternative to cigarettes," said lead author Lynne J. Goebel, MD, FACP, of the Marshall University School of Medicine in Huntington, WV. "Education programs emphasizing that all tobacco products are dangerous and highly addictive are needed."

Every day approximately 2,200 U.S. youths, ages 11 to 19, try smokeless tobacco for the first time, and approximately 830 become regular users, according to a national study cited by the researchers.

Goebel and colleagues compared 648 non-users with 160 users of smokeless tobacco. Study participants were all male youths in the fifth, eighth and eleventh grades in West Virginia public schools during the 1996-1997 school year. The researchers excluded females from the study since so few use smokeless tobacco.

The researchers found that 7 percent of fifth graders, 22 percent of eighth graders, and 32 percent of eleventh graders used smokeless tobacco monthly or daily. The most frequent grade for initiation was the seventh grade, and 10 percent of the study participant users tried snuff or chewing tobacco as early as first or second grade.

Only 74 percent of users knew that smokeless tobacco is harmful to health, compared to 91 percent of non-users. In addition, users were four times more likely to believe that smokeless tobacco was safer than cigarettes, Goebel and colleagues found.

Smokeless tobacco is not a safe alternative to smoking, according to the American Cancer Society. Use of smokeless tobacco can lead to cancer of the mouth and pharynx; leukoplakia, or mouth sores that lead to cancer; gum recession, or peeling back of gums; and abrasion of teeth.

Smokeless tobacco users were more likely than non-users to have a family member not living in the home who also used smokeless tobacco, to have a close friend who used smokeless tobacco, to play school football, to have tried cigarettes and to have parents who let them use smokeless tobacco at home.

The study results are published in the current issue of the journal Nicotine and Tobacco Research.

The researchers were initially surprised to find relatives not living in the home influenced the use of smokeless tobacco more than immediate family members did. "One hypothesis to explain this fact is that uncles and cousins living nearby may act as both peers and family members, and thus exert a stronger influence than brothers and fathers," said Goebel.

The researchers noted that because smokeless tobacco occupies a unique role in the Appalachian culture, the study results can't be generalized to the United States as a whole. "Among some West Virginians, family and friends see the ability to tolerate tobacco without becoming nauseated as a sign of manhood," said Goebel. "Our study showed that family permitting use in the home was strongly correlated with use of smokeless tobacco."

West Virginia tobacco use prevention programs should begin early, in elementary school, said Goebel and colleagues, who also suggested targeting young athletes, especially school football players.

"The tobacco industry's multi-billion dollar advertising campaign portrays smokeless tobacco users as 'cool, macho, and attractive.' Although children will not admit that advertising influences them, underage smokers use the most heavily advertised brands," said Goebel. "Our study showed that users more often described themselves as 'cool, macho and attractive,' consistent with the image portrayed in the ads."
The research was supported by a grant from the West Virginia Prevention Research Center.

Nicotine & Tobacco Research is the official peer-reviewed quarterly journal of the Society for Research on Nicotine and Tobacco. For information about the journal, contact Gary E. Swan, PhD, at (650) 859-5322.

Posted by the Center for the Advancement of Health For more research news and information, go to our special section devoted to health and behavior in the "Peer-Reviewed Journals" area of Eurekalert!, For information about the Center, call Petrina Chong, (202) 387-2829.

Center for Advancing Health

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