Typology and correlates of smokeless tobacco use.

The incidence, use patterns, and correlates of smokeless tobacco have become increasingly important as usage rates rise and harmful health effects become established. The present study assessed the incidence of smokeless tobacco use in a Southeastern U.S. sample and selected correlates of use. From the responses of 3725 high school students, 19.9% reported trying smokeless tobacco products (35.5% for males, 5.8% for females). Most agreed that tobacco use has harmful health consequences. Those disagreeing with these health beliefs were more likely to use smokeless tobacco. Cigarette smoking was strongly associated with initial use. Of those reporting any use of smokeless tobacco, most used it for less than an hour per day, but 18% reported 3 or more hours of use per day. Forty-four percent reported a first use of smokeless tobacco before 13 years of age. Early initial use was associated with greater frequency and duration of use. Early initial users also reported greater influence from family and advertisements. Encouragement from friends, however, appeared to be the major factor regardless of age at initial use. Of particular concern is that 8.4% of those having any experience with smokeless tobacco felt they were addicted to the substance. Finally, 27.9% reported swallowing the substance or spittle, suggesting the need for further research on the potential health implications of this behavior.