Trends in smokeless tobacco use in the us workforce: 1987-2005

Smokeless tobacco exposure increases the risk of oral cavity, esophageal, lung, and pancreatic cancers,[1-3] and stroke [4]. A number of carcinogens are present in smokeless tobacco products and users have higher urinary levels of known carcinogens, including 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) and N'-nitrosonornicotine (NNN), than non-users [3,5]. Further, research shows comparable NNK exposures in smokeless tobacco users and smokers [5]. Smokeless tobacco use is higher in men, young adults, individuals living in non-metropolitan areas, whites, individuals with lower education levels, and people living in the Southern or Western United States [6,7]. Overall, the prevalence of smokeless tobacco use decreased from 1987-2000, except among men 25-44 [6,7]. Further, from 2002-2007, the prevalence of smokeless tobacco use, in general, among individuals 12 or older remained fairly stable [8]. While smokeless tobacco use declined and then stabilized in the general population, it may be that the prevalence of smokeless tobacco use has increased among workers due to workplace smoking restrictions, which have been shown to have increased over the years [9]. In 1999, approximately 70% of US workplaces had a workplace smoking restriction [10]. This figure increased to 77% by 2003, with some variation by occupation category [11]. There may be increases in smokeless tobacco use among workers as tobacco companies increase their advertising promoting smokeless tobacco products as an alternative to quitting smoking or as a way to cope with smoking restrictions [12-15]. In the present study, we examined the relationship between occupational status, the presence of workplace smoking restrictions, and smokeless tobacco use among a nationally representative sample of US adults.The most current data specifically asking respondents about their smokeless tobacco use from the 1987-2005 National Health Interview Survey (NHIS), an annual population-based survey of the entire