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February 2002, Vol 92, No. 2 | American Journal of Public Health 250-256
© 2002 American Public Health Association

RESEARCH AND PRACTICE

Chewing Tobacco: Who Uses and Who Quits? Findings From NHANES III, 1988–1994

Beth Howard-Pitney, PhD and Marilyn A. Winkleby, PhD, MPH

The authors are with the Stanford Center for Research in Disease Prevention, Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif.

Correspondence: Requests for reprints should be sent to Marilyn A. Winkleby, PhD, MPH, Stanford Center for Research in Disease Prevention, 1000 Welch Rd, Palo Alto, CA 94304-1825 (e-mail: winkleby{at}stanford.edu).

Objectives. This study identified mutually exclusive groups of men at high and low risk for use of chewing tobacco and for quitting.

Methods. Analyses used a national sample of 1340 non-Hispanic Black, 1358 Mexican American, and 1673 non-Hispanic White men, aged 25 to 64, who participated in the National Health and Nutrition Examination Survey III from 1988 to 1994. Signal detection analysis was used to delineate high- and low-risk subgroups; survival analysis was used to estimate hazard curves for comparing age at onset for chewing tobacco use with that for smoking.

Results. Rural, lower-income Black and White men had the highest regular use of chewing tobacco (33.3%), followed by rural, higher-income men regardless of race/ethnicity (14.9%). Southern men who began using chewing tobacco during adulthood had the lowest quit rate (22.5%). In sharp contrast to smoking, chewing tobacco showed a continued onset throughout adulthood.

Conclusions. Because subgroups of men show highly different chewing tobacco use and quit rates and because age at chewing tobacco onset occurs across the life span, prevention and cessation programs should be specific to different risk groups and distinct from smoking programs.




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