Smokeless Tobacco and Dual Use among Firefighters in the Central United States

Little is known about smokeless tobacco (SLT) use in the fire service, whose personnel need to maintain high levels of health and fitness given the rigorous physical and mental job requirements. We examined the relationships among variables associated with SLT use and dual tobacco use (SLT and smoking) among 353 male career firefighters. Around 13% of male career firefighters reported being current exclusive SLT users, and 2.6% used both cigarettes and SLT. Age-adjusted models revealed that race, binge drinking, and dietary fat consumption were positively associated with exclusive SLT use when compared to nontobacco users. SLT users were much more likely to binge drink (OR = 3.98, ) and consume high fat foods (OR = 1.94, ). Only high dietary fat consumption was a strong correlate (OR = 8.41, ) of dual use when compared to nontobacco users. SLT and dual tobacco use are associated with significant health risks. Detailed information on the predictors of SLT use among firefighters will aid in developing more effective tobacco prevention and cessation intervention in fire service. 1. Introduction Smoking is the leading preventable cause of morbidity and mortality in the USA. In the last decades however, rates of cigarette smoking have decreased. In contrast, the use of the other forms such as smokeless tobacco (SLT) has increased [1, 2]. This suggests that smokers might use SLT as a substitute for cigarettes due to restrictions on smoking (e.g., indoor smoking laws), participation in smoking cessation programs, and/or the perception that SLT products confer lower morbidity and mortality risks [3]. In addition, various SLT products have been suggested as alternatives to smoking and/or as a harm reduction strategy [4], but there is limited evidence establishing the effectiveness of such an approach [5]. In contrast, some data suggest that SLT use significantly increases the subsequent use of cigarettes and dual use of cigarettes and SLT [6, 7]. Furthermore, a number of studies concluded that SLT use is related to several types of cancer (i.e., oral cancer, pancreatic cancer) [8]. Rates of SLT use are high among US military personnel relative to the general US population [9, 10]. However, little is known about SLT use in the fire service, which shares some cultural characteristics with the military and whose personnel also need to maintain high levels of health and fitness given the rigorous physical and mental job requirements [11]. Only two studies to date have reported tobacco use prevalence among firefighters. Lee and colleagues [12] estimated that the