Bimodal initiation of smokeless tobacco usage: implications for cancer education

One hundred fifty (150) randomly chosen adult male subjects (average age 37) drawn from a university general dental clinic were classified by self-report into three equal categories of fifty smokeless tobacco users, fifty cigarette smokers (non-smokeless tobacco users), and fifty non-tobacco users. According to questionnaire results, a bimodal curve was exhibited among smokeless tobacco users with the two peaks of initiation at ages 12 and 18 compared to a unimodal age of initiation for cigarette smokers at age 16. Two different cohorts of smokeless tobacco users based on age of initiation were observed with differences reported in level of education, urban versus rural origin, average length of time in using smokeless tobacco, and the type of smokeless tobacco product used. Young initiators appeared to be primarily from rural communities having a strong parental or familial influence when initiating smokeless tobacco usage, whereas older initiators appeared to be primarily from more urbanized regions with peer influences as the most significant for initiating smokeless tobacco usage. Other characteristics associated with one or the other cohort were also reported, pointing to different educational measures that may be necessary for prevention and intervention, based on the age of initiating smokeless tobacco usage, as well as place of residence.