Bimodal initiation of smokeless tobacco usage: Implications for cancer education

Abstract

One hundred fifty (150) randomly chosen adult male subjects (average age 37) drawn from a university general dental clinic were classified by self-report into three equal categories of fifty smokeless tobacco users, fifty cigarette smokers (non-smokeless tobacco users), and fifty non-tobacco users. According to questionnaire results, a bimodal curve was exhibited among smokeless tobacco users with the two peaks of initiation at ages 12 and 18 compared to a unimodal age of initiation for cigarette smokers at age 16. Two different cohorts of smokeless tobacco users based on age of initiation were observed with differences reported in level of education, urban versus rural origin, average length of time in using smokeless tobacco, and the type of smokeless tobacco product used. Young initiators appeared to be primarily from rural communities having a strong parental or familial influence when initiating smokeless tobacco usage, whereas older initiators appeared to be primarily from more urbanized regions with peer influences as the most significant for initiating smokeless tobacco usage. Other characteristics associated with one or the other cohort were also reported, pointing to different educational measures that may be necessary for prevention and intervention, based on the age of initiating smokeless tobacco usage, as well as place of residence.

An Interpretative Review of Smokeless Tobacco Research in the United States: Part II

“…For older initiators, particularly high school and college students, educational efforts should be aimed at understanding the role of peer influence and enlisting peers, coaches, and community role models in prevention programs [47]. Five recent studies appear to corroborate these findings, indicating differences between urban versus rural localities and age of initiation [48,50-531. Thus, with the re-emergence of smokeless tobacco in the 1970s, the nature of the males initiating this habit appear to have changed [54].…”

“…The educational strategy for prior to twelve years of age for primarily rural boys, should be directed toward family, parents and siblings to provide a supportive environment. The educational strategy for the high risk cohort peaking at eighteen, of primarily nonrural boys, should be directed to the boys' friends to provide a supportive environment [47]. Just as in anti-smoking attempts, current health education efforts may be starting too late.…”

P.L. 99‐252–Implications for Dentists and Their Clinical Practice

“…Passive advertising still has an impact, even though smokeless tobacco has been banned from commercials (54). One study (49) not only indicated the influence that peers and family members could have with regard to the use of smokeless tobacco, bu t also indicated varying influences depending on urban or rural dwelling. This is probably related in part to social history and varying levels of acceptability.…”

“…Although smokeless tobacco users have been known to begin their habit as early as age 5, a bimodal curve has been observed showing two high-risk groups, peaking around ages 12 and 18 (49). The younger initiators are primarily from rural communities, having a strong parental or familial influence for initiating smokeless tobacco use.…”

“…Older initiators (high school teenagers and young adults) appear to be from more urbanized regions, and tend to use snuff rather than chewing tobacco. Peer influences appear to be the most significant for initiating smokeless tobacco use by this group (49). These demographic characteristics need to be considered by the dentist who wants to be sensitive to the early detection of lesions and prevention of smokeless tobacco use.…”