Smokeless Tobacco Use in Rural Alaska

Reported rates of smokeless tobacco use have been consistently much lower for females than for males (1-8). Approximately 2% of females of all ages are estimated to have used smokeless tobacco in the last year (1). However, among American Indian/Alaskan Native (AI/AN) children, female and male usage rates are similar (9,10,11). In addition, the reported number of smokeless tobacco users in this population is substantially higher than in the general U.S. population of the same age (9,10,11).

Data from a 1986 Indian Health Service (IHS) survey conducted in Alaska showed that almost as many Alaskan school-aged girls are using smokeless tobacco products as school-aged boys. Data were collected in the spring of 1986 from voluntary respondents, both Alaskan Natives and non-Natives, in eight rural regions of Alaska. A nine-question, self-administered survey was distributed by IHS dental staff to students in grades K-12 who had volunteered to participate in the survey. The number of girls and boys responding was 2,454 and 2,511, respectively; they ranged from 5 to 18 years of age. Results indicated that 27.5% of girls and 33.7% of boys who responded use smokeless tobacco products (Table 2). A user was defined as anyone who responded "yes" to the question, "Do you use smokeless tobacco products?" For 5-year-olds, 16.9% of girls and 9.8% of boys reported using smokeless tobacco products.

For girls, the duration of use for smokeless tobacco products ranged from 1.3 years for 5-year-olds to 7.9 years for 18-year-olds (Table 3). For boys, duration of use ranged from 1.0 year for 5-year-olds to 6.5 years for 18-year-olds. The average 18-year-old had been using smokeless tobacco for about 7.5 years.

The IHS survey did not question whether responding smokeless tobacco users used snuff or chewing tobacco. However, 84% of users indicated that they used a particular brand of snuff most often. On average, girls used 1.1 cans of snuff a week, and boys used 1.4 cans; there were no consistent age-specific trends (Table 4). In contrast, data from the Inspector General's survey conducted in 1985 revealed that smokeless tobacco users 11 to 19 years of age used an average of 2.9 cans of snuff per week (2). The most frequently reported level of snuff use was one can per week.

In the IHS survey, 43% of girls and 45% of boys who responded reported having tried smokeless tobacco. Sixty percent of respondents indicated that they were aware of health risks associated with smokeless tobacco use, and 93% of those respondents listed cancer as a possible health problem. The Inspector General's survey reported that 89% of users knew that smokeless tobacco can be harmful to health, and 79% reported oral cancer as a risk associated with smokeless tobacco use; 46% thought they were personally at risk for these adverse health effects (2). Reported by C Schlife, Alaska Area Native Health Svc, Indian Health Svc; Dental Disease Prevention Activity, Center for Prevention Services, CDC.

Editorial Note

Editorial Note: The Health Consequences of Using Smokeless Tobacco: A Report of the Advisory Committee to the Surgeon General states that the highest rates of smokeless tobacco use in the United States are among teenage and young adult males (1). A report by the Office of the Inspector General and the Office of Analysis and Inspections of the U.S. Department of Health and Human Services, Youth Use of Smokeless Tobacco: More Than a Pinch of Trouble, also reports that smokeless tobacco users among youth are predominately white males (2). The prevalence of smokeless tobacco use among male adolescents as reported from regional and state surveys indicate usage rates as high as 30%-40% in some junior and senior high schools (3-8). A 1985 Dane County, Wisconsin, survey of students in grades 7-12 reported regular use of smokeless tobacco products from 9% of 7th-grade boys to 22% of 12th-grade boys (12).

Additional data indicate that smokeless tobacco use in AI/AN children is substantially higher than in the general population of the same age. Weekly smokeless tobacco use was reported by 34% of girls and 43% of boys from 144 AI/AN adolescents (mean age 12.3 years) from Alaska and Washington (9). Another survey reported weekly smokeless tobacco use of 27.4% for 135 American Indian girls and 20.2% for 119 boys (mean age 13.8 years) in Washington (10). Two surveys conducted by IHS in the 1984/85 school year in grades 4-8 at four schools on Pine Ridge Reservation, South Dakota, and at Browning Public School, Blackfoot Indian Reservation, Montana, indicated that 47% of boys and 45% of girls currently use smokeless tobacco products (11).

In order to deal with the potential health risks from smokeless tobacco use, the U.S. Congress passed the "Comprehensive Smokeless Tobacco Health Education Act of 1986," P.L. 99-252 on February 27, 1986. This act provides for the following:

1. Development and implementation of health education programs, materials, and public service announcements to inform the public of the health risks resulting from the use of smokeless tobacco products.

2. Public health education technical assistance concerning smokeless tobacco.

3. Research on the effects of smokeless tobacco on human health and the collection, analysis, and dissemination of information and studies on smokeless tobacco and health.

4. Health warning labels on all smokeless tobacco products and advertisements, except for outdoor billboards, effective February 27, 1987.

5. Banning of radio and television advertising, effective August 27, 1986.

6. Disclosure to the Secretary of Health and Human Services of the ingredients used in the production of smokeless tobacco as well as the quantity of nicotine in each such product by all manufacturers, packagers, and importers of smokeless tobacco. Data from the survey in Alaska, as well as other AI/AN surveys, report high usage rates for boys and girls and an early age of initiation for smokeless tobacco use. While P.L. 99-252 may have an impact on AI/AN children, it is important that primary prevention and cessation programs be developed and implemented for these special populations. A 5-year-old who uses smokeless tobacco until he or she is 18 years of age will be exposed to a number of health risk factors for 13 years. To be effective, smokeless tobacco intervention programs need to be implemented in preschool and kindergarten.

References

1. Public Health Service. The health consequences of using smokeless tobacco: a report of the Advisory Committee to the Surgeon General. Bethesda, Maryland: US Department of Health and Human Services, 1986; DHHS publication no. (NIH)86-2874.

2. Office of the Inspector General, Office of Analysis and Inspections, US Department of Health and Human Services. Youth use of smokeless tobacco: more than a pinch of trouble. Dallas, Texas: US Department of Health and Human Services, 1986.

3. Jones RB. Smokeless tobacco: a challenge for the 80's. J Wisconsin Dental Assoc 1985;10:717-21.

4. Chassin L, Presson CC, Sherman SJ, McLaughlin L, Gioia D. Psychosocial correlates of adolescent smokeless tobacco use. Addict Behav 1985;10:431-5.

5. Marty PJ, McDermott RJ, Williams T. Patterns of smokeless tobacco use in a population of high school students. Am J Public Health 1986;76:190-2.

6. Bonaguro JA, Pugy M, Bonaguro EW. Multivariate analysis of smokeless tobacco use by adolescents in grades four through twelve. Health Educ (in press).

7. Hunter SM, Croft JB, Burke GL, Parker FC, Webber LS, Berenson GS. Longitudinal patterns of cigarette smoking and smokeless tobacco use in youth: the Bogalusa heart study. Am J Public Health 1986;76:193-5.

8. Guggenheimer J, Zullo TG, Kruper DC, Verbin RS. Changing trends of tobacco use in a teenage population in western Pennsylvania. Am J Public Health 1986;76:196-7.

9. Schinke SP, Schilling RF, Gilchrist LD, Ashby MR, Kitajima E. Pacific Northwest Native American youth and smokeless tobacco use. Int J Addict (in press).

10. Schinke SP, Gilchrist LD, Schilling RF, Walker RD, Locklear VS, Kitajima E. Smokeless tobacco use among Native American adolescents (Letter). N Engl J Med 1986;314:1051-2.

11. Batliner T, Kaltenbach R, Bothwell E. Smokeless tobacco use by rural and reservation children. Pub Health Rep (in press).

12. CDC. Use of smokeless tobacco--Wisconsin. MMWR 1986;35:641-4.

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