Chapter THREE - Epidemiology of smokeless tobacco use in the United States and other countries

Abstract

Smokeless tobacco (ST) is widely used in the United States and internationally. Differences in the definition of ST affect estimates derived from surveys. Use prevalence and trends are reviewed for the United States and for other countries. In general, use has declined in the United States in the past 25 years, with prevalence now <10%. One reason for higher use in some countries outside the United States is that ST is promoted as a safer alternative to smoking. Rates are low in Europe except for Sweden. High rates of use in India and Bangladesh are highlighted. Risk factors for increasing use are poly-use with tobacco, flavoring agents, and demographics.