Smokeless tobacco use in children has not changed

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1. Between 2000-2011, there was no significant variation in smokeless tobacco use among US middle and high school students. 

2. Demographics such as race/ethnicity and gender were not predictors of the rate of smokeless tobacco use. 

Evidence Rating Level: 2 (Good) 

Study Rundown: The study determined that, between 2000-2011, the overall rate of smokeless tobacco use among US middle and high school students was low, but unchanged. Some variation was noted by age group: decreased use in age groups of 9-11 year olds and 12-14 year olds, but increased use in 15-17 year olds. Demographic information such as race/ethnicity and gender did not affect the rate of smokeless tobacco use.

The strengths of this study include its large sample base, which ranged from 18,000-35,000 students yearly. The data came from a reputable survey, the National Youth Tobacco Survey (NYTS). With this tool, the study could be repeated in future years, and it may allow for evaluation of any public health interventions that are made. However, the fact that the entirety of the study is based on a volunteer, anonymous survey is subject to recall and selection bias, which its biggest limitation. In addition, the authors do not disclose variation based upon geography or subtype (e.g. public versus private), which is important given the heterogeneity of the US school system.

Click to read the study, published today in JAMA

Relevant Reading: Trends in smokeless tobacco use among adults and adolescents in the United States

Dr. Israel Agaku, DMD, MPH speaks to 2 Minute Medicine: Harvard School of Public Health 

“As you may know, smokeless tobacco has been shown to be a starter product for initiating tobacco use among youths since they may be milder, sweeter or cheaper than smoked tobacco products. Our findings showed a stable trend in smokeless tobacco use among U.S. middle and high school students during 2000-2011.  Leveling regulatory and taxation policies for smoked and smokeless tobacco products, coupled with evidence-based population measures that denormalize tobacco use as well as clinical cessation programs may help reduce the prevalence of smokeless tobacco use among youths.”

In-Depth [prospective observational study]: The study was conducted between 2000-2011 using the National Youth Tobacco Survey (NYTS). The number of respondents varied from year to year, ranging from approximately 18,000 to 35,000 middle school and high school students in the US. To monitor changes in use over time, the researchers used average annual percentage changes (AAPC).

Between 2000 and 2011, the overall rate of smokeless tobacco use among US middle and high school students was low but unchanged (5.3% and 5.2%, respectively). Some variation was noted by age group: decreased AAPC in age groups of 9-11 year olds (-4.6, p=0.007) and 12-14 year olds (-3.4, p=0.02), but increased AAPC in 15-17 year olds (0.9, p=0.01). Demographics such as race/ethnicity and gender did not affect the rate of smokeless tobacco use (p>0.05).  

By Anne Marie Walters and Rif Rahman

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