摘要：Objectives. Smokeless tobacco has many adverse health effects. We analyzed long-term national trends in smokeless tobacco use. Methods. We used 1987 to 2000 National Health Interview Survey data for adults aged 18 years and older, 1986 to 2003 data from Monitoring the Future surveys of adolescents, and 1991 to 2003 data from the Youth Risk Behavior Survey for 9th- to 12th-grade students to examine overall and demographic-specific trends. Results. Smokeless tobacco use among adult and adolescent females was low and showed little change. Smokeless tobacco use among men declined slowly (relative decline=26%), with the largest declines among those aged 18 to 24 years or 65 years and older, Blacks, residents of the South, and persons in more rural areas. Overall and demographic-specific data for adolescent boys indicate that smokeless tobacco use increased for 12th-grade students from 1986 until the early 1990s, but has subsequently declined rapidly in all grades since then (range of relative overall declines=43% to 48%). Conclusions. Smokeless tobacco use has declined sharply, especially among adolescent boys. Ongoing prevention and cessation efforts are needed to continue this trend. Smokeless tobacco products, which consist of chewing tobacco, moist snuff, and dry snuff, cause many adverse health effects, including cancers of the oral cavity and pharynx, oral soft tissue lesions, gum recession, and nicotine addiction. 1 – 9 One large cohort study also reported an association between smokeless tobacco use and cardiovascular disease, 10 although this has not been a consistent finding. 11 , 12 More recent studies suggest that smokeless tobacco use may be associated with adverse pregnancy outcomes 13 and pancreatic cancer. 14 Studies of US adults have shown that smokeless tobacco use is much higher among certain adult demographic groups, including men, young adults, rural residents, residents of southern or western states, Whites, American Indians/Alaska Natives, and persons with lower levels of education. 15 – 19 For adolescents, smokeless tobacco use is higher among those of older age, boys, Whites, American Indians/Alaska Natives, and residents in some parts of the South, Midwest, and West. 20 – 22 Smokeless tobacco use was widely recognized as a major public health problem beginning in the mid-1980s after the smokeless tobacco industry began a wide-scale advertising and marketing campaign earlier in the decade that succeeded in substantially boosting sales. 1 , 5 , 7 , 9 , 20 , 23 , 24 In 1986, Congress enacted legislation banning smokeless tobacco television and radio advertising, and requiring warning labels on such products. 20 Since the early 1990s, less attention has been focused on smokeless tobacco issues. Some health scientists in recent years have even suggested smokeless tobacco be actively promoted to cigarette smokers as a safer alternative (i.e., a harm-reduction product) for those having difficulty quitting smoking, 25 , 26 although others have noted that considerably more research and product regulation is necessary before considering such a strategy. 4 , 27 There have been some studies of adult smokeless tobacco use on the basis of selected national, state, and other data sets. 16 , 19 , 28 , 29 Descriptive reports suggest that smokeless tobacco use, which increased between 1970 and 1991 among adults, 30 may have declined in more recent years. 31 There are several studies on the prevalence and correlates of adolescent smokeless tobacco use. 32 – 34 Overall national data from Monitoring the Future (MTF) surveys show that smokeless tobacco prevalence among adolescents declined, beginning in the mid-1990s, among students in grades 8, 10, and 12. 35 The Centers for Disease Control and Prevention’s (CDC) national Youth Risk Behavior Survey (YRBS) also reports an overall decline in smokeless tobacco use among 9th- through 12th-grade students since 1991. 36 To date, however, formal trend analyses of smokeless tobacco use are rare. 18 Overall findings on smokeless tobacco use, although important, may mask differing smokeless tobacco trends among demographic subgroups such as age, gender, race/ethnicity, and place of residence. To better describe and understand national adult and adolescent trends in smokeless tobacco use over the past 2 decades, we used several nationally representative data sets to conduct overall and subgroup trend analyses.
