Abstract
Compared to the association between cigarette smoking and psychiatric disorders, relatively little is known about the relationship between smokeless tobacco use and psychiatric disorders. To identify the psychiatric correlates of smokeless tobacco use, the analysis used a national representative sample from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) wave 1. Smokeless tobacco use was classified as exclusive snuff use, exclusive chewing tobacco, and dual use of both snuff and chewing tobacco at some time in the smokeless tobacco user's life. Lifetime psychiatric disorders were obtained via structured diagnostic interviews. The results show that the prevalence of lifetime exclusive snuff use, exclusive chewing tobacco, and dual use of both snuff and chewing tobacco was 2.16%, 2.52%, and 2.79%, respectively. After controlling for sociodemographic variables and cigarette smoking, the odds of exclusive chewing tobacco in persons with panic disorder and specific phobia were 1.53 and 1.41 times the odds in persons without those disorders, respectively. The odds of exclusive snuff use, exclusive chewing tobacco, and dual use of both products for individuals with alcohol use disorder were 1.97, 2.01, and 2.99 times the odds for those without alcohol use disorder, respectively. Respondents with cannabis use disorder were 1.44 times more likely to use snuff exclusively than those without cannabis use disorder. Respondents with inhalant/solvent use disorder were associated with 3.33 times the odds of exclusive chewing tobacco. In conclusion, this study highlights the specific links of anxiety disorder, alcohol, cannabis, and inhalant/solvent use disorders with different types of smokeless tobacco use.
Highlights
The use of smokeless tobacco is a significant yet understudied public health problem
Exclusive chewing tobacco and use of both snuff and chewing tobacco were less likely to report in persons aged 50 years or older compared to nonsmokeless tobacco use
Exclusive chewing tobacco was more common in people who were married, but less common in those who were never married compared to non-smokeless tobacco use
Summary
The use of smokeless tobacco is a significant yet understudied public health problem. Previous studies have indicated that past-year smokeless tobacco users who met lifetime DSM-IV diagnostic criteria for nicotine dependence were associated with increased risk for specific phobia after controlling for demographic and psychiatric covariates as well as quantity of cigarettes smoked [10].
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