title: Undocumented smokeless tobacco use in a family practice population.
abstract: BACKGROUND
  Smokeless tobacco (ST) use is associated with significant health risks and is increasing in prevalence in the United States. This study examined the prevalence of ST use among patients seen in two family practice centers and the documentation of that ST use in the medical record.
  
  
  METHODS
  A survey of 209 patients seen in two family practice centers in northeast Tennessee was done to determine current and former smoking and ST use. Charts of all current ST users were reviewed for additional data.
  
  
  RESULTS
  Current ST use was reported by 7.7% of patients. Highest rates were found in middle-aged men (27.8%) and elderly women (14.8%). Physicians rarely recorded ST use as a significant problem in the medical record. In several cases, management of other medical conditions may have been compromised by the physicians' lack of awareness of the ST use.
  
  
  CONCLUSIONS
  The use of smokeless tobacco may be an important unrecognized problem in patients seen in family physicians' offices.
authors.affiliation: Department of Family Medicine, James H. Quillen College of Medicine, East Tennessee State University, Bristol Family Practice Center, 37620, USA.
authors.forename: R H
authors.initials: RH
authors.lastname: Feierabend
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010947:Plants, Toxic; D015995:Prevalence; D012907:Smoking / Q000453:epidemiology*; D013714:Tennessee / Q000453:epidemiology; D014030:Tobacco, Smokeless