Image: PD 

1. 5.6% of adolescents in this study used smokeless tobacco with 72.1% of smokeless tobacco users concurrently smoking tobacco. 

2. Perception of harm of all tobacco products was protective and was significantly correlated with reduced use of smokeless tobacco. 

Evidence Rating Level: 2 (Good) 

Study Rundown: Tobacco use among adolescents is evolving. As tobacco smoking is more heavily legislated, novel smokeless products such as snus, dissolvable tobacco, and electronic cigarettes continue to be used as a more socially acceptable alternative. Some studies have suggested that smokeless tobacco may be less harmful than combustible tobacco, with this claim based on the assumption that users are choosing smokeless products exclusively over combustible tobacco. This study examined the patterns of both conventional and novel smokeless tobacco product use in adolescents through the 2011 National Youth Tobacco Survey. This study showed that adolescents who use smokeless tobacco are also likely to use combustible forms of tobacco. Researchers also found that smokeless tobacco use was associated with a reduced perception of the harm of all tobacco products. The study was limited by recall bias. In light of these findings, the study authors support pediatrician’s efforts in counseling on the risks of smokeless tobacco and the American Academy of Pediatrics’ stance on increased regulation of smokeless tobacco products.

Click to read the study in Pediatrics

Relevant Reading: Smokeless tobacco: harm reduction or induction?

In-Depth [cross-sectional study]: This study included 18,866 middle and high students surveyed via the biennial National Youth Tobacco Survey (response rate 72.7%). Smokeless tobacco use was defined as self-reported use greater than 0 days in the past 30 days, and likewise for combustible tobacco product use. Perception of harm of tobacco products was defined as an affirmative response to the statement “All tobacco products are dangerous.” Potential covariates including cigarette smoking by peers or household members were not significantly associated with current smokeless tobacco use. The prevalence of any smokeless tobacco use was 5.6% among those surveyed. Dual use of combustible tobacco amongst smokeless tobacco users was 72.1%. Agreeing that all tobacco products are harmful was positively correlated with not using smokeless tobacco (aOR 0.55; 95% CI: 0.38-0.79).

By Laurel Wickberg and Leah H. Carr

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