title: Is smokeless tobacco use becoming more common among U.S. male smokers? Trends in Alaska.
abstract: BACKGROUND
  The tobacco industry has promoted the use of smokeless tobacco (SLT) to smokers as a substitution for cigarettes when smoking is not possible, and some smokers are using SLT this way. However, few publications have examined recent trends in dual cigarette and SLT use (dual use) over time in the U.S.
  
  
  METHODS
  We examined trends in the use of SLT among current, former and never cigarette smokers using data on adult (aged 18+ years) males (n=16,590) from the 1996-2008 Alaska Behavioral Risk Factor Surveillance System (BRFSS). We also examined trends from 2004 to 2008 in cigarette consumption among dual users.
  
  
  RESULTS
  Between 1996 and 2008, the overall prevalence of current SLT use and prevalence of current smoking among Alaskan men did not significantly change over time (p-value from age-adjusted models p=.63, p=.09, respectively). When we examined trends in SLT use by smoking status, we found that the prevalence of current SLT use remained unchanged between 1996 and 2008 among former and never smokers, but almost doubled among current smokers (age-adjusted p=.004). Between 2004 and 2008, cigarette consumption remained steady among current smokers who did not use SLT, but significantly decreased among dual users (age-adjusted p<.001).
  
  
  CONCLUSIONS
  Our findings suggest that male smokers in Alaska are increasingly likely to use SLT, but do not appear to be switching to SLT use exclusively. We recommend that other state tobacco control programs examine trends in dual use to confirm our findings, and for programs to continue encouraging cessation of all tobacco products.
authors.affiliation: Program Design and Evaluation Services, Oregon Public Health Division and Multnomah County Health Department, USA. julie.e.maher@state.or.us
authors.forename: Julie E
authors.initials: JE
authors.lastname: Maher
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Bushore
authors.forename: Kristen
authors.initials: K
authors.lastname: Rohde
authors.forename: Clyde W
authors.initials: CW
authors.lastname: Dent
authors.forename: Erin
authors.initials: E
authors.lastname: Peterson
mesh_terms: D000328:Adult; D000413:Alaska / Q000453:epidemiology; D003430:Cross-Sectional Studies; D006801:Humans; D008297:Male; D015995:Prevalence; D012907:Smoking / Q000453:epidemiology* / Q000639:trends; D014030:Tobacco, Smokeless