Smokeless Tobacco Rates on the Rise
Study Shows Many Smokers Are Also Using Smokeless Tobacco
By Bill Hendrick
WebMD Health News
Reviewed by Laura J. Martin, MD


Nov. 4, 2010 -- Even after a generation of warnings from public health officials about the dangers of tobacco use, about 20% of Americans still smoke cigarettes, a CDC report says. The report also shows the rate of smokers who also use smokeless tobacco, such as chewing tobacco and snuff, is rising.

Using smokeless tobacco can keep the nicotine habit alive, making it even harder to quit than going cold turkey, Terry Pechacek, PhD, of the CDC, tells WebMD.

More Americans are turning to smokeless tobacco because of laws that prohibit smoking in public places such as bars, restaurants, and airplanes -- and also because smokeless forms can be used in offices and on the job, Pechacek says.

The CDC report is published in the Nov. 5 edition of the Morbidity and Mortality Weekly Report.

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Immediate Benefits of Smoking Cessation

The tobacco companies market smokeless tobacco as a substitute for smokers, but they don’t help people quit smoking, Pechacek tells WebMD.

“We are making no progress in getting people to quit smoking,” he says. “This is a tragedy. Over 400,000 people are dying prematurely and won’t be able to walk their children down the aisle or see their grandchildren.”

Contrary to common beliefs of smokers, the benefits of quitting start immediately, Pechacek tells WebMD.

“We see lower rates for heart attacks within months of quitting,” he says. “And lower rates for lung cancer, too. Stopping a decline in lung function is one of the biggest benefits of quitting smoking.”

The national smoking prevalence rate was 20.6% in 2008 and 2009. About 23% of males smoke, compared to 18.3% of females.

“We are not making progress and we are going to have this burden for tobacco-related diseases for decades to come,” Pechacek tells WebMD.
Who’s Using Smokeless Tobacco

The CDC report says the use of smokeless tobacco is “predominantly a problem among men, young adults, those with a high school education or less and in some states with higher smoking rates.”

Smoking prevalence varies widely among states and territories, from 25.6% in Kentucky and West Virginia and 25.5% in Oklahoma to 9.8% in Utah, 12.9% in California and 14.9% in Washington.

Smoking prevalence was 6.4% in the U.S. Virgin Islands, 10.6% in Puerto Rico, and 24.1% in Guam.

Smoking prevalence for men was significantly higher than for women in 15 states, plus Guam and Puerto Rico. Smokeless tobacco use was highest in Wyoming at 9.1%, West Virginia at 8.5%, and Mississippi at 7.5%. It was lowest in California at 1.3% and Massachusetts and Rhode Island at 1.5%.

Among findings and conclusions in the report:

    * Smokeless tobacco use was most common among those aged 18 to 24.
    * Smokeless tobacco use decreased with higher educational attainment.
    * Among the 25% of states in which smoking prevalence was greatest, seven also had the highest numbers for smokeless tobacco use, Alabama, Alaska, Arkansas, Kentucky, Mississippi, Oklahoma, and West Virginia.
    * Doctors, dentists, and others in their offices should encourage patients to quit smoking and help them find ways to do so.


CDC Director Tom Frieden, MD, MPH, says it’s unfortunate that so many smokers also are using smokeless tobacco products, which “may keep some people from quitting tobacco altogether.” He says in a news release that anti-tobacco efforts need to be beefed up against all forms of use.

Tim McAfee, MD, MPH, director of the CDC’s Office on Smoking and Health, says in the news release that the new numbers showing smokeless tobacco use “are concerning” and that officials “need to fully put into practice effective strategies, such as strong state laws that protect nonsmokers from secondhand smoke, higher tobacco prices, aggressive ad campaigns that show the human impact of tobacco use and well-funded tobacco control programs, while stepping up our work to help people quit using all forms of tobacco.”
Tobacco Use State by State

Here’s a list of percentages of smokers who also use smokeless tobacco, by state, from lowest to highest.

State                   Percentage

Delaware                   2.9

Washington, D.C.     3.0

Rhode Island            3.0

California                  3.2

Maryland                  3.6

Massachusetts        4.1

New Jersey              4.4

Maine                        4.7

Louisiana                  4.8

Illinois                        5.2

Nevada                     5.2

New York                  5.2

Arizona                      5.7

Hawaii                       5.7

Connecticut              5.8

Colorado                  6.1

Wisconsin                6.1

Georgia                    6.4

Ohio                          6.5

Tennessee              6.5

North Carolina        6.6

Florida                     6.7

New Mexico           6.8

Nebraska               6.9

Missouri                 7.0

South Carolina      7.0

Pennsylvania        7.1

Kansas                  7.5

Kentucky               7.7

Washington          7.8

Indiana                  8.0

Vermont                8.1

Iowa                      8.3

West Virginia       8.3

Texas                   8.4

Mississippi           8.5

Oregon                 8.7

South Dakota       8.7

Alaska                   8.8

New Hampshire   9.2

Oklahoma             9.2

Idaho                      9.6

Alabama                9.8

Michigan               9.9

Minnesota           10.5

Virginia                10.5

Utah                    10.9

Arkansas            11.7

North Dakota     11.8

Montana             12.1

Wyoming            13.7

Puerto Rico          0.9

Guam                    3.2

Virgin Islands      4.2