Epidemiology
Spit tobacco use has existed in the United States since colonial days.[14] Spit tobacco use originated from religious ceremonies and the product soon became a trade commodity. By the early 1900¹s, spit tobacco accounted for over half of all tobacco consumed. Fear, associated with the spread of tuberculosis via the spit habit, led to the decline of smokeless tobacco use. The mechanization of cigarette production greatly increased the use of cigarettes. This trend did not change until 1964 when the U.S. Surgeon General released a landmark report on smoking which vilified cigarette smoking as a serious health hazard. New public concerns regarding the need to create a smoke-free society and a shift in the focus of tobacco company advertising led to an increase in the use of spit tobacco once again.[15] Between the years 1970 and 1987, spit tobacco use among young men increased at a steady rate[16] with a marked 40% increase in moist snuff specifically.[14] Data from the U.S. Department of Agriculture (Figures 4 and 5) substantiates a decline in the production of cigarettes and a nearly three-fold increase in the production of spit tobacco products over the same time period.
U.S. Consumption of Tobacco as Cigarettes
1981-1991
Source: U.S. Department of Agriculture
U.S. Consumption of Tobacco as Moist Snuff
1981-1991
Source: U.S. Department of Agriculture
Several national surveys have estimated the prevalence of spit tobacco use in the United States. The U.S. Census Bureau's Current Population Survey (CPS) in 1985 estimated the combined use of chewing tobacco and snuff to be 5.5% among males and less than 1% among females.[17] The Adult Use of Tobacco Survey (AUTS) conducted by the U.S. Department of Health and Human Services since 1964 estimated in 1986 that spit tobacco use among 17 year-old males was 5.2% and less than 1% for females of the same age group.[18] Similar results were found in the Centers for Disease Control and Prevention's 1991 National Health Interview Survey (NHIS).[19] These studies showed that spit tobacco use is highest among young white males and declines with age. In fact, the CPS found prevalence of spit tobacco use to be 2.9% for those 16-19 years of age, 2.7% for those aged 20-29 years, 1.8% for those in their thirties, and about 1% for the over-forty age group.[17] Use among Hispanics is on the rise, although studies to date indicate that spit tobacco use is far more prevalent among Whites and Native Americans than among Hispanics and African Americans.
Other studies have focused specifically on the use of spit tobacco use by children and adolescents. Notable among these are the 1989 and 1993 Teenage Attitudes and Practices Surveys (TAPS I and TAPS II) and the Youth Risk Behavior Survey (YRBS) from the Centers for Disease Control and Prevention, the National Household Survey on Drug Abuse (NHSDA) from the Substance Abuse and Mental Health Services Administration, and the Monitoring the Future Project (MTFP) conducted at the University of Michigan. Eighteen percent of the TAPS respondents reported ever having used spit tobacco.[20] In contrast, 29.8% of the 1996 MTFP respondents acknowledged first-time spit tobacco use.[21] The 1994 NHSDA estimated that 36 million Americans over the age of 12 used spit tobacco at least once.[22] In 1995, the NHSDA estimated that 6.9 million Americans (3.3 % of the U.S. population) were current users.[23] Although the 1996 MTFP found that only 3.3% of its twelfth-grade respondents admitted to being current users, nearly one in five males (19.7%) of the 1995 YRBS respondents reported spit tobacco use within the past month.[24-25]
Geographically, the use of spit tobacco in the United States is much higher in the South than in other areas of the United States. The CPS estimated that prevalence rates in the South range from 10% to over 20%, while rates in the Northeast are as low as less than 1%.[17] The higher usage rate in the southern United States may in part be due to the long standing prevalence of spit tobacco use in the textile mills of this region. The flammability of the cotton fibers dictated a smoke-free environment long before it became fashionable policy. In fact, much of the earliest data collected on the association of spit tobacco and oral cancer is based on studies of the textile mill workers in the southeastern United States.
Social factors have been found to be associated with the use of spit tobacco. Among these, peer influence is the most important predictor of use.[26-31] One's own risk-taking behavior, behavior of parents, and relationship with recreational activities correlate with spit tobacco use.[29,32-33] Individuals who plan to serve in the armed forces use spit tobacco more (23%) than those not planning (19%) to enlist.[20] A behavioral study of employees in the energy industry revealed a spit tobacco prevalence of 17%.[34] Similar to other studies, young white male employees reported the highest level of use, with most users proving to be at least high school educated and classified as blue-collar workers.
Spit tobacco use can be attributed to psychological factors as well. The misconception that spit tobacco is a "safe" alternative to smoking contributes significantly to use.[32,35] Likewise, one's self-image and acceptance of controlled substances are associated factors.[29] Approximately 25% of individuals who rate their academic performance as average or below average use spit tobacco, versus 18% of those individuals who rate themselves above average in academic performance.[20]
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