title: Trends in smokeless tobacco use among men in four states, 1988 through 1993.
abstract: OBJECTIVE
  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.
authors.affiliation: Division of Adult and Community Health, Centers for Disease Control and Prevention, Atlanta, Ga. 30341-3724, USA.
authors.forename: D E
authors.initials: DE
authors.lastname: Nelson
authors.forename: S L
authors.initials: SL
authors.lastname: Tomar
authors.forename: P
authors.initials: P
authors.lastname: Mowery
authors.forename: P Z
authors.initials: PZ
authors.lastname: Siegel
mesh_terms: D000293:Adolescent; D000328:Adult; D004522:Educational Status; D006306:Health Surveys; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010947:Plants, Toxic; D011156:Population Density; D014030:Tobacco, Smokeless; D014481:United States