title: The impact of inter-survey differences in the definition of current smokeless tobacco use on comparability of US national and state-specific prevalence estimates, 2009-2011.
abstract: BACKGROUND
  We assessed how varying definitions of adult current smokeless tobacco (SLT) use affected overall prevalence estimates.
  
  
  METHODS
  National prevalence estimates were from five surveys: 2009-2010 National Health and Nutrition Examination Survey (NHANES), 2009-2010 National Adult Tobacco Survey (NATS), 2010-2011 Tobacco Use Supplement of the Current Population Survey (TUS-CPS), 2010 National Survey on Drug Use and Health (NSDUH), and 2010 National Health Information Survey (NHIS). State-specific prevalence estimates were from three surveys: 2009-2010 NATS, 2010-2011 TUS-CPS, and 2010 Behavioral Risk Factor Surveillance System (BRFSS). Current SLT use definitions were as follows: past 5-day use (NHANES), past 30-day use (NATS and NSDUH), and "every day" or "some days" use (TUS-CPS, NHIS, and BRFSS). Inter-survey variations further existed in number and types of SLT products assessed.
  
  
  RESULTS
  National prevalence estimates of current SLT use were as follows: NATS (3.9%), NSDUH (3.6%), NHIS (2.8%), NHANES (2.3%), and TUS-CPS (1.6%). State-specific prevalence estimates of SLT use were generally lower for TUS-CPS (median=2.1%, range: 0.5% in California and New York, to 7.2% in Wyoming) compared to either BRFSS (median=4.0%: range: 0.9% in Washington D.C., to 8.2% in Wyoming) or NATS (median=4.7%; range: 1.3% in New Jersey, to 9.8% in Wyoming).
  
  
  CONCLUSIONS
  Concerted efforts are needed among interagency groups to harmonize SLT definition within different surveys.
authors.affiliation: Department of Social and Behavioral Sciences, Center for Global Tobacco Control, Harvard School of Public Health, Boston, MA, USA. Electronic address: iagaku@post.harvard.edu.
authors.forename: Israel T
authors.initials: IT
authors.lastname: Agaku
authors.affiliation: Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA.
authors.forename: Ayodeji J
authors.initials: AJ
authors.lastname: Awopegba
authors.affiliation: School of Public Health, Imperial College London, United Kingdom.
authors.forename: Filippos T
authors.initials: FT
authors.lastname: Filippidis
mesh_terms: D000293:Adolescent; D000328:Adult; D002140:California / Q000453:epidemiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D015995:Prevalence; D014030:Tobacco, Smokeless / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014959:Wyoming / Q000453:epidemiology; D055815:Young Adult
keywords: Chewing tobacco; Comparison; Dip; Dissolvable tobacco; Smokeless tobacco; Snuff; Snus; Survey