Chewing Tobacco: Who Uses and Who Quits? Findings From NHANES III, 1988-1994. National Health and Nutrition Examination Survey III

Am J Public Health. 2002 Feb;92(2):250-6. doi: 10.2105/ajph.92.2.250.


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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Age of Onset
  • Ethnic Groups / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Models, Statistical
  • Prevalence
  • Residence Characteristics
  • Risk Factors
  • Rural Population / statistics & numerical data
  • Socioeconomic Factors
  • Survival Analysis
  • Tobacco Use Disorder / epidemiology*
  • Tobacco Use Disorder / prevention & control
  • Tobacco, Smokeless / supply & distribution*
  • United States / epidemiology
  • Urban Population / statistics & numerical data