Incidence and predictors of smokeless tobacco use among US youth

Objectives. The purpose of this study was to provide estimates of the cumulative incidence of initiation of smokeless tobacco use in a cohort of young persons and to explore sociodemographic, environmental, behavioral, and personal predictors of experimentation with and regular use of snuff or chewing tobacco. Methods. The data for this cohort study were derived from the 1989 Teenage Attitudes and Practices Survey and its 1993 follow-up. The study included 7830 young people 11 through 19 years of age at baseline. Results. During the 4 years, 12.7% of participants (20.9% of male participants) first tried smokeless tobacco, and 4.0% (8.0% of male participants) became self-classified regular users. This suggests that, each year, approximately 824 000 young people in the United States 11 to 9 years of age experiment with smokeless tobacco and about 304 000 become regular users. Cumulative incidence was highest for male non-Hispanic Whites. Predictors of regular use included age, geographic region, cigarette smoking, participation in organized sports, and perceived friends' approval or indifference. Conclusions. Public health approaches to preventing use of smokeless tobacco should include development of skills for responding to pressures to use tobacco.