Teen Smokeless Tobacco Users Smoke, Too

August 5, 2013

News Review From Harvard Medical School -- Teen Smokeless Tobacco Users Smoke, Too

Teenagers are not using smokeless tobacco to avoid the health hazards of smoking, a new study finds. In fact, almost three-quarters of teen smokeless tobacco users also smoke. The new study was based on a national health survey of 18,866 students in grades 6 through 12. About 5.6% said they used some form of smokeless tobacco. Nearly all of them used tobacco, snuff or dip. Almost 2% used snus, and 0.3% used dissolvable tobacco. Boys were more than 4 times as likely as girls to have the smokeless habit. Among youth who used any smokeless product, 72% smoked as well. The authors said doctors should ask their young patients whether they use any tobacco products, and stress that all are harmful. Smokeless tobacco use was highest, 10.8%, for those ages 18 and up. About 2% of children ages 9 through 11 were users. The journal Pediatrics published the study online. MedPage Today wrote about it August 5.

By Claire McCarthy, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

About 5.6% of U.S. adolescents (grades 6 through 12) are using smokeless tobacco. In theory, that's better than smoking tobacco -- but most of them are smoking, too.

That's the finding of a new study in the journal Pediatrics, the official journal of the American Academy of Pediatrics. Researchers from the Harvard School of Public Health did the study. They looked at data from the 2011 National Youth Tobacco Survey to find out about tobacco use among youth in grades 6 through 12.

In general, while smoking is decreasing among youth, the use of smokeless tobacco is not decreasing. With more bans on smoking in public, companies have been promoting smokeless tobacco.  The conventional types include dry snuff, moist snuff, plug and twist, and loose-leaf chewing tobacco. There are newer kinds as well. They include Swedish-style snus, which is placed under the tongue, and dissolvable products. The newer products don't require spitting and can be used more discreetly.

The fact that 1 youth out of 20 is using smokeless tobacco is alarming enough. After all, any kind of tobacco use carries health risks. But this study also found something even more worrisome. More than three-quarters of the youth who use smokeless tobacco also smoke tobacco. They aren't using smokeless forms instead of smoking; they are using them in addition to smoking.  Even more alarming, those using the smokeless forms weren't even very interested in quitting.

What Changes Can I Make Now?

If you are a parent of an adolescent, or if you know or work with teens or preteens, it's important to talk about the risks of smokeless tobacco. Actually, we need to make sure they understand that all forms of tobacco can cause cancer and other diseases. Researchers found the only factor that really protected against using smokeless tobacco was the belief that all forms of tobacco are harmful. That's the message we need to convey to our youth.

In the study, the health warning labels on the products didn't seem to make any difference. Many teens said they didn't even see them. We need to make those warning labels more visible, and do a better job of restricting advertising about smokeless tobacco.

What Can I Expect Looking to the Future?

This study makes it clear that we need to think more broadly about prevention than just forbidding smoking. We need to think about smokeless tobacco, as well as e-cigarettes and other forms of delivering nicotine. We need to make sure we are talking to our youth about them and restricting their access to them. It's not time to rest on our laurels just yet. Tobacco is still a problem, and there's more work to do.