Trends in smokeless tobacco use among men in four states, 1988 through 1993.

OBJECTIVES: Trends in smokeless tobacco use were examined for men in Indiana, Iowa, Montana, and West Virginia from 1988 through 1993. METHODS: State survey data from the Behavioral Risk Factor Surveillance System (BRFSS) were analyzed. RESULTS: Demographic characteristics associated with smokeless tobacco use included age less than 35 years, a high school education or less, and rural residence. Overall, there was little change in smokeless tobacco use among men in these states (range = -0.4-0.4 percentage points annually); only West Virginia had a significant decline. CONCLUSIONS: Reasons for the overall lack of decline may include increased advertising and promotional expenditures or substitution of smokeless tobacco for cigarettes. Increased prevention and cessation efforts are needed.