Trends in Smokeless Tobacco Use and Initiation: 2002 to 2012

In Brief
  • In 2012, 3.5 percent of persons aged 12 or older (an estimated 9.0 million persons) used smokeless tobacco in the past month. Rates of past month smokeless tobacco use remained relatively stable between 2002 and 2012.
  • The generally stable trend in past month smokeless tobacco use was consistent among adolescents and adults aged 26 or older. The 2012 rate of past month smokeless tobacco use among young adults aged 18 to 25 was higher than the rates in 2002 through 2004 but lower than the rate in 2010.
  • In 2012, an estimated 1.0 million persons aged 12 or older used smokeless tobacco for the first time; this represents 0.5 percent of persons who had not previously used smokeless tobacco.
  • Rates of past year initiation of smokeless tobacco use among persons who had not previously used smokeless tobacco was lower in 2012 than in the years between 2005 and 2011 but matched the levels between 2002 and 2004.

Smokeless tobacco products may be chewed, placed in the oral cavity outside the gums, or inhaled or snorted through the nose rather than smoked. Many people who use smokeless tobacco may think it is safer than smoking, but all tobacco products contain toxicants, and use of smokeless tobacco poses its own significant health risks. People who use smokeless tobacco products have an increased risk of oral cavity, esophageal, and pancreatic cancers.1 Although all tobacco use is addictive, the amount of nicotine absorbed from smokeless tobacco is 3 to 4 times greater than that delivered by a cigarette.2 In addition, nicotine stays in the blood longer for smokeless tobacco users than for smokers.2 Monitoring trends in smokeless tobacco and the shifting demographics of users can help to further refine prevention efforts.

The National Survey on Drug Use and Health (NSDUH) asks persons aged 12 or older about their substance use in the past 30 days, including their use of tobacco products (e.g., cigarettes, cigars, pipe tobacco, chewing tobacco, and snuff). For this report, data for chewing tobacco and snuff are combined and termed "smokeless tobacco." Respondents who used these substances are asked how old they were when they first used them; responses to these questions were used to identify persons at risk for initiation (i.e., persons who had never used the substance as of 12 months prior to the interview date) and to identify past year initiates (i.e., persons who used the substance for the first time in the 12 months prior to the survey). This issue of The NSDUH Report examines smokeless tobacco use and initiation among persons aged 12 or older in 2012, as well as trends between 2002 and 2012.

Smokeless Tobacco Use

In 2012, 3.5 percent of persons aged 12 or older (an estimated 9.0 million persons) used smokeless tobacco in the past month. Males were more likely than females to have used smokeless tobacco in the past month. In 2012, 6.7 percent of males compared with 0.4 percent of females used smokeless tobacco in the past month (8.5 million vs. 540,000) (Figure 1). Young adults aged 18 to 25 were more likely to have used smokeless tobacco in the past month than were adolescents aged 12 to 17 or adults aged 26 or older (5.5 vs. 2.1 and 3.3 percent, respectively). These percentages translate to 515,000 persons aged 12 to 17, 1.9 million persons aged 18 to 25, and 6.6 million persons aged 26 or older being current smokeless tobacco users.

Figure 1. Past month smokeless tobacco use among persons aged 12 or older, by gender and age group: 2012
This is a bar graph comparing past month smokeless tobacco use among persons aged 12 or older, by gender and age group: 2012. Accessible table located below this figure.

Figure 1 Table. Past month smokeless tobacco use among persons aged 12 or older, by gender and age group: 2012
  Number of Adults (millions) Percent
Gender
Male 8,500,000 6.7%
Female    540,000 0.4%
Age
Aged 12 to 17    515,000 2.1%
Aged 18 to 25 1,900,000 5.5%
Aged 26 or Older 6,600,000 3.3%
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2012.

Rates of past month smokeless tobacco use among persons aged 12 or older remained relatively stable between 2002 and 2012 (Figure 2). Among females, rates of past month smokeless tobacco use have remained stable since 2002, and among males, the trend has been fairly stable with only the 2004 and 2005 rates differing from the 2012 rate. In every year between 2002 and 2012, males were more likely than females to have used smokeless tobacco.

Figure 2. Past month smokeless tobacco use among persons aged 12 or older, by gender: 2002 to 2012
This is a line graph comparing past month smokeless tobacco use among persons aged 12 or older, by gender: 2002 to 2012. Accessible table located below this figure.

Figure 2 Table. Past month smokeless tobacco use among persons aged 12 or older, by gender: 2002 to 2012
Gender 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Total 3.3% 3.3%  3.0%* 3.2% 3.3% 3.3% 3.5% 3.4% 3.5% 3.2% 3.5%
Male 6.4% 6.2%  5.8%*  6.1%* 6.6% 6.3% 6.8% 6.7% 6.8% 6.2% 6.7%
Female 0.4% 0.5% 0.3% 0.4% 0.3% 0.4% 0.4% 0.3% 0.4% 0.4% 0.4%
* Difference between this estimate and the 2012 estimate is statistically significant at the .05 level.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2012.

The generally stable trend in past month smokeless tobacco use also was consistent among adolescents and adults aged 26 or older (Figure 3). Between 2002 and 2012, rates among adolescents aged 12 to 17 were in the 2.0 to 2.5 percent range, and rates among adults aged 26 or older were in the 2.7 to 3.3 percent range. Some variation was, however, seen among young adults. The 2012 rate of past month smokeless tobacco use among young adults aged 18 to 25 was higher than the rates in 2002 through 2004 but lower than the rate in 2010. In every year between 2002 and 2012, young adults aged 18 to 25 were more likely to have used smokeless tobacco than adolescents aged 12 to 17 or adults aged 26 or older.

Figure 3. Past month smokeless tobacco use among persons aged 12 or older, by age group: 2002 to 2012
This is a line graph comparing past month smokeless tobacco use among persons aged 12 or older, by age group: 2002 to 2012. Accessible table located below this figure.

Figure 3 Table. Past month smokeless tobacco use among persons aged 12 or older, by age group: 2002 to 2012
Age 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Aged 12 to 17 2.0% 2.0% 2.3% 2.1% 2.4%  2.5%* 2.2% 2.4% 2.3% 2.1% 2.1%
Aged 18 to 25  4.8%*  4.7%*  4.9%* 5.1% 5.2% 5.2% 5.3% 6.1%  6.4%* 5.4% 5.5%
Aged 26 or Older 3.2% 3.2%  2.7%* 3.0% 3.1% 3.0% 3.3% 3.1% 3.1% 3.0% 3.3%
* Difference between this estimate and the 2012 estimate is statistically significant at the .05 level.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2002 to 2005, 2006 to 2010 (revised March 2012), and 2011 to 2012.
Initiation of Smokeless Tobacco Use

In 2012, an estimated 1.0 million persons aged 12 or older used smokeless tobacco for the first time (i.e., past year initiates); this represents 0.5 percent of persons who had not previously used smokeless tobacco (i.e., those at risk for initiation). The number of past year initiates and the percentage of persons using for the first time among those at risk for initiation were generally higher among males than females, and among adolescents and young adults than among adults aged 26 or older (Figure 4). In 2012, 739,000 males and 258,000 females used smokeless tobacco for the first time. These numbers represent 0.8 and 0.2 percent of males and females at risk for initiation, respectively. An estimated 415,000 persons aged 12 to 17, 496,000 persons aged 18 to 25, and 85,000 persons aged 26 or older used smokeless tobacco for the first time. These numbers represent 1.7 percent of adolescents, 1.8 percent of young adults, and 0.1 percent of adults aged 26 or older at risk of initiation.

Figure 4. Past year initiation of smokeless tobacco use among persons aged 12 or older at risk for initiation, by gender and age group: 2012
This is a bar graph comparing past year initiation of smokeless tobacco use among persons aged 12 or older at risk for initiation, by gender and age group: 2012. Accessible table located below this figure.

Figure 4 Table. Past year initiation of smokeless tobacco use among persons aged 12 or older at risk for initiation, by gender and age group: 2012
  Number of Adults (millions) Percent
Gender
Male 739,000 0.8%
Female 258,000 0.2%
Age
Aged 12 to 17 415,000 1.7%
Aged 18 to 25 496,000 1.8%
Aged 26 or Older   85,000 0.1%
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2012.

Rates of past year initiation of smokeless tobacco use among persons at risk for initiation were lower in 2012 than in the years between 2005 and 2011 but matched the levels between 2002 and 2004 (Figure 5). Similar trends were seen among males, adolescents aged 12 to 17, and young adults aged 18 to 25 who were at risk for initiation (Figures 5 and 6).

Figure 5. Past year initiation of smokeless tobacco use among persons aged 12 or older at risk for initiation, by gender: 2002 to 2012
This is a line graph comparing past year initiation of smokeless tobacco use among persons aged 12 or older at risk for initiation, by gender: 2002 to 2012. Accessible table located below this figure.

Figure 5 Table. Past year initiation of smokeless tobacco use among persons aged 12 or older at risk for initiation, by gender: 2002 to 2012
Gender 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Total 0.5% 0.5% 0.5%  0.6%*  0.7%*  0.6%*  0.7%*  0.7%*  0.7%*  0.6%* 0.5%
Male 0.9% 0.9% 0.9%  1.0%*  1.3%*  1.2%*  1.2%*  1.3%*  1.2%*  1.2%* 0.8%
Female 0.2% 0.2% 0.2% 0.2% 0.2%  0.3%*  0.3%*  0.3%*  0.3%* 0.2% 0.2%
* Difference between this estimate and the 2012 estimate is statistically significant at the .05 level.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2002 to 2005, 2006 to 2010 (revised March 2012), and 2011 to 2012.
Figure 6. Past year initiation of smokeless tobacco use among persons aged 12 or older at risk for initiation, by age group: 2002 to 2012
This is a line graph comparing past year initiation of smokeless tobacco use among persons aged 12 or older at risk for initiation, by age group: 2002 to 2012. Accessible table located below this figure.

Figure 6 Table. Past year initiation of smokeless tobacco use among persons aged 12 or older at risk for initiation, by age group: 2002 to 2012
Age 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Aged 12 to 17 2.0% 2.1% 1.9%  2.3%*  2.5%*  2.6%*  2.6%*  2.8%*  2.5%*  2.1%* 1.7%
Aged 18 to 25 1.6%  1.4%* 1.7% 1.9% 2.1%  2.2%*  2.2%*  2.4%*  2.4%* 2.1% 1.8%
Aged 26 or Older 0.1% 0.1% 0.1% 0.1% 0.1% 0.1%  0.1%* 0.1%  0.1%* 0.1% 0.1%
* Difference between this estimate and the 2012 estimate is statistically significant at the .05 level.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2002 to 2005, 2006 to 2010 (revised March 2012), and 2011 to 2012.

In every year between 2002 and 2012, the rate of recent initiation of smokeless tobacco use among those at risk for initiation was higher among males than females. Among those at risk of initiation, adolescents and young adults were more likely than adults aged 26 or older to have used smokeless tobacco for the first time in every year between 2002 and 2012.


Discussion

Smokeless tobacco is not a healthy alternative to cigarette smoking. Although national, state, and local smoking cessation campaigns have resulted in a significant reduction in the number of Americans who smoke, the overall use of smokeless tobacco has remained mostly unchanged since 2002. On the positive side, however, declines in initiation of smokeless tobacco between 2006 and 2012 among males, adolescents, and young adults suggest that prevention messages may be having an effect. Taken together, the findings in this report suggest a continuing need for prevention messages and tobacco cessation programs that specifically address the inherent risk of smokeless tobacco use.

Quitting smokeless tobacco use is as challenging as smoking cessation. For more information and resources on tobacco cessation, please visit http://www.integration.samhsa.gov/health-wellness/wellness-strategies/tobacco-cessation-2.

End Notes
1 Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. (2014). The health consequences of smoking—50 years of progress: A report of the Surgeon General. Retrieved from http://www.surgeongeneral.gov/library/reports/50-years-of-progress/full-report.pdf
2 National Institutes of Health, National Institute on Drug Abuse. (2009). Smokeless tobacco (Topics in Brief). Retrieved from http://www.drugabuse.gov/publications/topics-in-brief/smokeless-tobacco


Suggested Citation
Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (July 24, 2014). The NSDUH Report: Trends in Smokeless Tobacco Use and Initiation: 2002 to 2012. Rockville, MD.

The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities.

The National Survey on Drug Use and Health (NSDUH) is an annual survey sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA). The survey collects data by administering questionnaires to a representative sample of the population through face-to-face interviews at their place of residence.

The NSDUH Report is prepared by the Center for Behavioral Health Statistics and Quality (CBHSQ), SAMHSA, and by RTI International in Research Triangle Park, North Carolina. (RTI International is a trade name of Research Triangle Institute.)

Information on the most recent NSDUH is available in the following publication:

Center for Behavioral Health Statistics and Quality. (2011). Results from the 2010 National Survey on Drug Use and Health: Summary of national findings (NSDUH Series H-41, HHS Publication No. SMA 11-4658). Rockville, MD: Substance Abuse and Mental Health Services Administration.

Also available online: https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health.

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