Recent U.S. trends in smokeless tobacco use and in dual use of smokeless tobacco and cigarettes

Smokeless tobacco products are available in a variety of new forms and flavors. Major cigarette manufacturers, which now dominate the smokeless tobacco market, are promoting these products to smokers as an alternative they can use in smoke-free environments. Some have also suggested that smokers who cannot quit smoking should be encouraged to switch to smokeless tobacco use as part of a harm reduction strategy.

We examined recent trends in youth and adult smokeless tobacco use and dual use of smokeless tobacco and cigarettes using data from four surveys: the National Survey on Drug Use and Health, Monitoring the Future, the Youth Risk Behavior Survey, and the National Youth Tobacco Survey.

The results of this analysis suggest that smokeless tobacco use is increasing among white male adolescent boys and white young adult men. Moreover, the results indicate that many smokeless tobacco users in the demographic groups are concurrently using cigarettes. The results of this analysis suggest that, rather than helping wean smokers off cigarettes, smokeless tobacco is increasingly being used in combination with cigarettes, perhaps in part as a way to sustain nicotine addiction when smokers are in smoke-free environments.

These findings raise significant concerns, especially in light of evidence that duration of smoking is a key factor determining smoking-related health risk. To the extent that concurrent use of smokeless tobacco delays or prevents quitting, it would be expected to increase smoking-related morbidity and mortality, independent of the additional health risks incurred by combined smoking and smokeless tobacco use.