Smokeless tobacco usage: a growing and menacing addiction among Hoosier children and young adults.

During the past 25 years, the consumption of chewing tobacco and moist snuff has been increasing in frequency, especially among the youth. Smokeless tobacco (ST) use among Indiana youngsters is higher than its use among youngsters nationally. More than 10% of current Indiana high school junior and senior female students report some ST usage. ST ingestion causes addiction and serious health consequences, including various forms of cancer and significant dental diseases. It is not a safe alternative to cigarette smoking. Nicotine levels in ST are very high, and ST intake is rapidly addicting. Tobacco companies have been accused of "graduating" youthful customers from flavored lower-nicotine "starter" products to forms that contain a more highly concentrated nicotine content. Clinicians should routinely ask children, teens and adults about ST use. Early intervention in youth who are experimenting with ST or using "starter" products may prevent addiction and disease. Physicians should be alert to the intraoral physical signs of ST use. To strengthen their tobacco intervention skills, physicians should require continuing education training regarding ST.