Association of smokeless tobacco use and smoking in adolescents in the United States: an analysis of data from the Youth Risk Behavior Surveillance System survey, 2011


R C. Wiener

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Background—Using smokeless tobacco and smoking are risk behaviors for oral cancer, soft tissue lesions, caries, periodontal disease and other oral conditions. The purpose of this study was to examine adolescent smokeless tobacco use and smoking. Methods—The study was a cross-sectional analysis of participants with complete data on smoking, smokeless tobacco use, and other variables of interest in the 2011 Youth Risk Behavior Survey (n=9655). Descriptive analysis and multivariable logistic regression analyses were performed. Results—The unadjusted odds ratio for smokeless tobacco use and smoking was 9.68 (95% CI: 7.72, 12.13, p<.0001); the adjusted odds ratio was 3.92 (95%CI: 2.89, 5.31, p<.0001). Adolescents using smokeless tobacco were more likely to be male, to smoke, and to have engaged in binge drinking. Conclusions—Adolescents who are using smokeless tobacco are more likely to also be engaging in concomitant smoking and are participating in other risk-taking behaviors. Practice implications—Dentists are involved in helping patients in tobacco cessation. The strong association of smoking with smokeless tobacco needs to be considered in designing cessation programs for adolescents.