Smokeless Tobacco

Menstuff® has compiled information and books on the issue of Smokeless Tobacco/snuff/dip.

Information
Past Month Smokeless Tobacco Use Among Boys, Grades 9-12
Smokeless Tobacco Use Among Men Aged 18 years and Older
Cold Hard Facts about Dip
So what is snuff?
Snuff Maker Reportedly Settles Case
Will the nicotine patch help me quit smokeless tobacco? - DrDrew

Related Issues: Talking With Kids About Tough Issues,

Information

Consumption of moist snuff and other smokeless tobacco products in the United States almost tripled from 1972 through 1991. Long-term use of smokeless tobacco is associated with nicotine addiction and increased risk of oral cancer---the incidence of which could increase if young persons who currently use smokeless tobacco continue to use these products frequently. To monitor trends in the prevalence of use of smokeless tobacco products, CDC's 1991 National Health Interview Survey--Health Promotion and Disease Prevention supplement (NHIS-HPDP) collected information on snuff and chewing tobacco use and smoking from a representative sample of the U.S. civilian, noninstitutionalized population aged greater than or equal to 18 years. This report summarizes findings from this survey.

The Surgeon General's Report for Kids about Smoking

Spit (Smokeless) Tobacco
In 1986, the U.S. Surgeon General concluded that the use of spit tobacco is not a safe substitute for smoking cigarettes or cigars, as these products can cause various cancers and noncancerous oral conditions, and can lead to nicotine adiction. Some of these conditions are listed below.

The most serious health effect of spit tobacco is an increased risk of cancer of the mouth and pharynx. Oral cancer occurs several times more frequently among snuff dippers compared with non-tobacco users. The risk of cancer of the cheek and gums may increase nearly 50-fold among long-term snuff users.

Leukoplakia is a white sore or patch in the mouth that can become cancerous. Studies have consistently found high rates of leukoplakia at the place in the mouth where users place the "chew." One study found that almost 3/4 of daily users of moist snuff, and chewing tobacco had non-cancerous or pre-cancerous lesions (sores) in the mouth. The longer you use spit tobacco, the more likely you are to have leukoplakia.

Studies have shown that about 7% to 27% of regular spit tobacco users have gum recession and bone loss around the teeth. The surface of the tooth root may be exposed where gums have drawn back. Tobacco can irritate or destroy the tissue.

Spit tobacco may also play a role in cardiovascular disease and high blood pressure. Nicotine enters the users' bloodstream through the lining of the mouth and/or the gastrointestinal tract. Nicotine causes your heart to beat faster and your blood pressure to go up.

Why Is It So Hard To Quit?

Spit tobacco delivers a high dose of nicotine. An average dose for snuff is 3.6 mg, for chewing tobacco, 4.6 mg - compared to 1.8 mg for cigarettes. Blood levels of nicotine throughout the day are similar among smokers and those who use spit tobacco.

A report in the Journal of the American Medical Association calculated that smokeless tobacco users ". . . who use dip or chew 8-10 times a day might be exposed to the same amount of nicotine as people who smoke 30-40 cigarettes a day." Stopping spit tobacco use causes symptoms of nicotine withdrawal that are similar to those smokers get when they quit.

In a study of Swedish oral snuff users, many of the participants said they were addicted to snuff, and they reported having as much trouble giving up spit tobacco as did cigarette smokers trying to quit smoking. Evidence also suggests that when regular snuff users can't use snuff, they will smoke cigarettes to satisfy their need for nicotine.

How Nicotine Affects the Body

Nicotine is a drug found naturally in tobacco. It is highly addictive, as addictive as heroin and cocaine. The body becomes physically and psychologically dependent on nicotine, and studies have shown that users must overcome both of these to be successful at quitting and staying quit.

Nicotine affects many parts of the body, including your heart and blood vessels, your hormonal system, your metabolism, and your brain. During pregnancy, nicotine freely crosses the placenta and has been found in amniotic fluid and the umbilical cord blood of newborn infants. Nicotine is metabolized mainly by the liver and lungs, but a small amount is excreted by the kidneys. Nicotine is broken down by the body into the by-products cotinine and nicotine-N'-oxide.

Nicotine produces pleasurable feelings that make the tobacco user want to use more and also acts as a depressant by interfering with the flow of information between nerve cells. As the nervous system adapts to nicotine, tobacco users tend to increase the amount of tobacco they use, and hence the amount of nicotine in their blood. After a while, the tobacco user develops a tolerance to the drug, which leads to an increased use over time. Eventually, the tobacco user reaches a certain nicotine level and then keeps up the usage to maintain this level of nicotine.

Immediate Benefits of Quitting

There are many reasons to stick it out through withdrawal and quit using tobacco for good. In addition to the health reasons mentioned earlier, consider the following.

Chewing and dipping carry a heavy social stigma, especially with the opposite sex. Bad breath, gum disease, and discolored teeth are very unappealing. The spitting associated with spit tobacco use is offensive and has a potential health risk as well.

The tobacco habit can be expensive. It isn't hard to figure out how much you spend on tobacco: multiply how much money you spend on tobacco every day by 365 (days per year). The amount may surprise you. Now multiply that by the number of years you have been using tobacco and that amount will probably astound you.

Multiply the cost per year by 10 (for the upcoming 10 years) and ask yourself what you would rather do with that much money. Do you really want to continue wasting your money with nothing to show for it except possible health problems?

If you have children, you want to set a good example for them. When asked, nearly all tobacco users say they don't want their children to chew or dip. You can become a good role model for them if you quit now.

Quitting Spit Tobacco

Surveys show that most people who use snuff or chew would like to quit. In one survey, more than half said they would try to quit in the next year.

In many ways, quitting spit tobacco is a lot like quitting smoking. Both involve tobacco products that contain nicotine and both involve the physical and psychological components of addiction. Many of the methods of handling the psychological hurdles of quitting are the same. Two elements are unique for smokeless users, however:

There is often a stronger need for oral substitutes to take the place of the chew or snuff.

Because spit tobacco often causes sores in the mouth and gum problems, the disappearance of these after quitting provides a readily visible benefit.

People can get help quitting by calling ACS at 800.ACS.2345.
Source: www.cancer.org/docroot/PED/content/PED_10_2x_Smokeless_Tobacco_and_Cancer.asp?sitearea=PED

Is smokeless tobacco safer than cigarettes?

NO WAY! It's true that many people think smokeless tobacco (also known as chewing or spit tobacco, or snuff) isn't as bad as cigarettes. One study quoted in the SGR said that 77 percent of kids thought cigarette smoking was very harmful, but only 40 percent thought smokeless tobacco was very harmful. Very wrong! The truth is that smokeless tobacco use is connected with all sorts of problems.

Finally, one more fact to chew on -- according to the SGR, kids who use smokeless tobacco are more likely to start using cigarettes, too. That's a double whammy that no healthy body can survive! So spit it out; say no to smokeless tobacco.

 

6 Facts about Kids and Smoking

The SGR contains six major conclusions about kids and smoking:

The Real Deal about Tobacco

The Surgeon General says that 3,000 kids start smoking every day. They must not know the facts about tobacco -- if they did, they'd stay miles away from the stuff! So let's cut through the smoke and get to the real deal about tobacco.

Most kids my age smoke...don't they?

The Real Deal

It might look that way, because tobacco companies pay lots of money to fill magazines and billboards with pictures of people smoking. But according to the Surgeon General, only 13 percent of (or 13 out of 100) adolescents have smoked in the last 30 days. And only 8 percent are "frequent" smokers. That means most kids -- 87 percent, to be exact -- are smart enough not to smoke.

We don't need to worry -- smoking won't affect our health until we're a lot older...right?

The Real Deal: You already know that smoking can cause things like cancer and heart disease, but the report also lists symptoms that start to develop as soon as you smoke your first cigarette -- no matter how young you are. These include shortness of breath, coughing, nausea, dizziness, and "phlegm production." Pretty gross, huh?

But if you only smoke a little bit, that can't hurt...can it?

The Real Deal: According to the Surgeon General, symptoms like wheezing and coughing have been found in kids who smoke just one cigarette a week.

Well, at least tobacco use doesn't lead to other drug use...does it?

The Real Deal: It doesn't always, but it certainly can. Many times tobacco is the first drug used by kids who use alcohol and illegal drugs. The SGR says that, compared with nonsmokers, kids who smoke are 3 times more likely to use alcohol. They're 8 times more likely to smoke marijuana, and 22 times more likely to use cocaine. Scary, huh?

Kids who smoke think they're cool...are they?

The Real Deal: Only if by "cool" you mean kids who probably aren't doing very well in school. The SGR found that students with the highest grades are less likely to smoke than those with the lowest grades. The same is true for smokeless tobacco -- daily tobacco use is highest among drop-outs, lowest among college students.

Kids who smoke have lower self-images. They look to smoking because they think it will give them a better image -- cooler, maybe, or more attractive, or more popular. And because their self-image is low, they don't have the confidence to say no when someone wants them to use tobacco.

Well, if smoking is so bad, all you have to do is quit. How hard can that be?

The Real Deal

Most teens who smoke want to stop. Nearly half of the high school seniors in the survey said they'd like to quit smoking. But they can't because, according to the SGR, "most young people who smoke daily are addicted to nicotine." In the same survey, about 40 percent said they tried to quit and couldn't.

So maybe we're better off if we never start smoking.

The Real Deal

Quitting is not a pretty sight, because nicotine is as addictive as alcohol, heroin, or cocaine. According to the SGR, when people quit, they might experience "frustration, anger, anxiety, difficulty concentrating, restlessness, and decreased heart rate." The Surgeon General found that most smokers start before they finish high school. So if you make it to graduation day without starting to smoke, chances are you never will!

Up in Smoke!

The typical smoker spends about $700 a year on cigarettes. Think of what you could do with all that dough: Play 2,800 video-arcade games.

Have the world's greatest slumber party: Take your 40 best friends to the movies, then order 19 pizzas (with everything, of course!) to munch on while reading your 162 new comic books.

Talk on the phone to your friend in another state for 126 hours and 22 minutes.

Make a donation to your favorite charity. That way you could really help others!

Buy 1,400 seedlings to plant three acres of oak, hickory, walnut, or ash trees.

It's boring, we know, but if you put $700 every year in a bank account earning 5 percent interest, you'd have $25,003.47 after 20 years. With a sum like that you could really have some fun!

Is smokeless tobacco safer than cigarettes?

NO WAY! It's true that many people think smokeless tobacco (also known as chewing or spit tobacco, or snuff) isn't as bad as cigarettes. One study quoted in the SGR said that 77 percent of kids thought cigarette smoking was very harmful, but only 40 percent thought smokeless tobacco was very harmful. Very wrong! The truth is that smokeless tobacco use is connected with all sorts of problems.

BAD HEALTH! Smokeless tobacco can cause bleeding gums and sores of the mouth that never heal. Eventually you might end up with cancer.

TOUGH TO QUIT! Tobacco is tobacco: it all contains nicotine, and nicotine is addictive!

VERY DISGUSTING! It stains your teeth a yellowish-brown color. It gives you bad breath. It can make you dizzy, give you the hiccups, even make you throw up. (Definitely NOT cool!)

Finally, one more fact to chew on -- according to the SGR, kids who use smokeless tobacco are more likely to start using cigarettes, too. That's a double whammy that no healthy body can survive! So spit it out; say no to smokeless tobacco.

Be an Ad Buster

What is advertising? It's a way for companies to help sell their products (and make money). Unfortunately, tobacco ads don't tell the whole truth. They're a smoke screen designed to cover up one simple fact -- smoking is very, very bad for your health!

Even worse, some cigarette companies target their ads to kids. How? They use ads with bright colors and lots of pictures. And they put these ads in magazines that appeal to kids, like Sports Illustrated, Rolling Stone, and Mademoiselle.

The tobacco companies are selling an image to kids. Their ads try to make it look like you'll be independent if you smoke. But the best way to be independent is to think of yourself -- and not let a big company do your thinking for you. To get to the truth, we asked kids in Ignacio, a small town in the mountains of Colorado, to read between the lines of some popular ads

©Philip Morris Inc.

Michael Newman PHOTOEDIT Jeremy: "They make it seem like you'll be tough and strong, like a cowboy, if you smoke their brand."

Mick: "They show this clean, refreshing outdoor scene. They don't show the air filled with gross-smelling cigarette smoke."

Reality Check: One of the models who played the Marlboro Man died of lung cancer. The model who played the Winston Man is paralyzed on one side because of smoking -- he can no longer climb mountains like he did in those tough-guy ads. Cigarette ads are often set in clean, wholesome settings, and they never show smoke. They don't give you a clue about how gross a burning cigarette smells!

©1993 B&WT Co. Alison: "Look at how white her teeth are. They wouldn't really look that white if she smoked."

Daniel: "People who buy the cigarettes think if they can smoke and be pretty and thin and have fun, maybe I can too."

Reality Check: According to the SGR, "cigarette ads for women have always promoted slimness." But cigarettes are not healthy. Exercising and eating right are two of the smartest things you can do to stay fit and healthy.

©Lorillard 1991 Gabriella: "They're trying to show that if you smoke, you'll have a good time."

Daniel: "The models are always young, good-looking, and popular.

Reality Check: Cigarette ads have a hidden message: "Smoking helps you make friends and will make you desirable." But do you know anybody who desires someone with bad breath, smelly clothes, and yellow teeth? In one survey, 72 percent of high school seniors considered smoking a "dirty habit" -- and the same number said they'd rather date someone who doesn't smoke.

©1992R.J. Reynolds Tobacco Co. Daniel: "Camel cigarettes uses Joe Camel, a cartoon character, to catch kids. Kids like cartoons more than adults do."

Tana: "If the cigarette companies can get kids hooked on a brand, then they just might buy that brand their whole life."

Reality Check: The youth market is very important to the big tobacco companies, because young smokers are needed to replace older smokers who quit or die. Kids like humor, and kids like cartoons -- and Camel ads use both. According to the SGR, most kids pick Camel ads as their favorite ads for cigarettes.

A Tricky Way to Advertise

Cigarette ads have been banned from TV and radio since 1971. But, the tobacco companies do sponsor sporting events that are shown on TV. Then they plaster their names all over everything. During one 90-minute car race, the word "Marlboro" appeared on TV 5,933 times! How can they say that's not advertising?

©Philip Morris Inc.

Melanie Brown PHOTOEDIT Alison: "An athlete would never smoke, because it would affect her tennis playing."

Tana: "It's a way for them to advertise without advertising -- and they don't have to put the Surgeon General's warning on the signs."

Reality Check: Six years after Virginia Slims cigarettes for women were introduced, more than twice as many teenage girls were smoking. And tobacco companies say they don't target kids!

http://www.cdc.gov/tobacco/sgr/sgr4kids/adbust.htm (see for actual ads)

Smoke-Free Coast To Coast

Kids everywhere are banding together to stamp out tobacco. Let's travel coast-to-coast and see what kids are doing.

Huntington Park, California

Angie Yocupicio broke the law -- lucky for her she was working with the police department when she did it! Angie was part of a "sting operation" to prove how easily kids can buy cigarettes. She walked into a store and boldly asked for a pack -- or a carton! Even though she was 15 at the time, "I was rarely turned down," she says. "They sold it to me gladly." The health agency that sponsored the sting hopes stores will get the message and obey the law. Today, all 50 states and Washington, D.C., prohibit stores from selling tobacco to kids under 18.

Santa Fe, New Mexico

It's amazing what kid power -- and a little peanut butter and jelly -- can accomplish! Last year, 350 students packed the New Mexico state capitol to talk to their lawmakers about passing a law that would make it illegal to sell tobacco to kids under 18. They even brought the lawmakers p.b.&j. sandwiches to lunch on! A month later, the law passed.

Marmath, North Dakota

What can just two kids do? Plenty, it turns out, when the two are Justin Fischer and Eric Sonsalla! The only students in their grade (the whole school has only 32 students), they wanted to make their school smoke-free. Eric, age 11, admits he was "pretty nervous" when they shared this idea with the school board. But the board agreed that smoking stinks -- and now nobody can smoke at Marmath Public School. "It was a really fun experience," Eric says.

Belvidere, Illinois

Students at the Perry Elementary School think magazines read by kids should not print tobacco ads. So they picked some magazines -- including Sports Illustrated and Hot Rod -- from the school library and wrote letters to the editors, asking them to stop running these ads. When the editors didn't write back, the library canceled the subscriptions.

Perth Amboy, New Jersey

"Sometimes adults think kids don't know what they're talking about," says George Vega, 17. But George can tell grown-ups a thing or two about tobacco advertising -- and he did! His group, HORA (Hispanics On the Rise Again), took a survey of cigarette billboards in his hometown. They found there were more signs in Hispanic neighborhoods than anyplace else. "They put billboards by churches and schools and in parks where kids play," he complains. HORA is talking to the city council about dumping the signs. "We want to remove tobacco billboards," says George, "and replace them with ones for milk or vegetables -- something healthy and positive for kids."

Sean Donahue, Boston, Massachusetts

"Read my lips -- don't smoke!" With TV and newspaper reporters looking on, Sean Donahue heard his voice ring out across the lawn of the Massachusetts statehouse. More than 100 kids -- waving banners and signs that read "FRESH AIR" and "SMOKING STINKS" -- let out a giant roar. "It was exciting," says Sean, remembering his first antismoking rally.

But Sean did more than just talk. After his rousing speech, he led a parade of wagons to the state capitol. The wagons were filled with petitions asking the Secretary of State to raise the state tobacco tax by 25 cents. (According to the Surgeon General, cigarette taxes save lives because high prices make many people stop smoking.)

The hard work gathering those petitions paid off: Massachusetts voters approved the law raising the tax.

Sean was asked to speak at the rally because he's a celebrity in Boston -- even though he's only 14! He appears weekly on a WBZ radio show called "Kid Company" and even landed a guest spot on "The Tonight Show."

All the attention isn't going to his head, though. He's still a down-to-earth guy who cares about kids. "I'm not just saying this to get publicity -- I'm concerned about what's going on," he says. "Kids have to lay off smoking, because it can really ruin their bodies and their lives." www.cdc.gov/tobacco/sgr/sgr4kids/coast.htm

To become part of the movement against tobacco! Here are 10 ways you can help to make your world smoke-free:

Like Justin and Eric in North Dakota, you can make your school smoke-free. Take a petition door-to-door for people to sign. Then take the petition to a school board meeting and present it to school officials. Here's what a petition should look like.

As we've seen, cigarette companies try to link tobacco with athletics. You can show that smoking and sports don't mix by writing a letter to the owners of your local sports teams, asking them to make the stadium free of tobacco ads. Many pro teams are already taking action---like the Baltimore Orioles, Colorado Rockies, Seattle Seahawks, Houston Rockets, and Minnesota Vikings. These teams don't allow any tobacco advertising in their stadiums.

Write a letter to your favorite restaurant, asking them to go completely smoke-free. (Having a separate nonsmoking section does not eliminate your exposure to secondhand smoke. Just like you can't put chlorine in half of a swimming pool, you can't keep smoke in half of a room.) Tell them that when the air in their restaurant is clean, their food will taste better---and that you'll come back and bring your friends!

Try this project: In Lincolnwood, Illinois, students took a survey of local businesses. Then they used the school newspaper to encourage kids to shop at stores that didn't sell cigarettes.

Promise you'll never, ever smoke. In Minnesota, kids called Body Guards get members of their families (and other people in the community) to sign a pledge saying they'll be tobacco-free. Of course the kids sign the pledge too!

Paint posters to encourage younger kids not to smoke. With your teacher's permission, plaster them all over your classroom, library, or cafeteria.

Kids who are too young to buy cigarettes from a store often turn to vending machines. It's illegal, but usually they get away with it. So talk to your town board or city council about banning vending machines in your area. Many towns are already doing it---and in places like Perth Amboy, New Jersey, it's kids who are leading the way.

Send a letter to your local newspaper---the more people that know about the dangers of smoking, the better. After his mom died of lung cancer, Wiley Seigler of New Mexico wrote the Albuquerque Journal. Surely everyone who read Wiley's sad letter thought twice before lighting up a cigarette.

If you will graduate from high school in the year 2000, you can ask your teacher if your class can join the Smokefree Class of 2000. It's a group of kids who have promised to stay smoke-free forever! For more information, write:

SFC 2000, 20 North Wacker Drive, Suite 1240, Chicago, IL 60606-2969. Or call 1-800-562-4447 If you already smoke, quit! Here are some people who can help you---or a friend---kick the habit. Call for more information---or ask how you can volunteer.

American Lung Association, 1-800-586-4872, (1-800-LUNG-USA)

American Heart Association, 1-800-242-8721, (1-800-AHA-USA1)

American Cancer Society, 1-800-227-2345, (1-800-ACS-2345)

Centers for Disease Control and Prevention, Office on Smoking and Health, 1-800-232-1311, (1-800-CDC-1311)

Educational Materialswww.cdc.gov/tobacco/edumat.htm

Health Professionals: New Guidelines Challenge All Clinicians to Help Smokers Quit - Agency for Health Care Policy and Research.

Parents, Educators, Youth Group Leaders, MediaSharp SM: Help your kids with today's 3 R's Reading, 'Riting & Real Life.

 

SLAM: SLAM is a fifteen-minute video developed to help young people be more aware of the power and pervasiveness of cigarette advertising and to help them explore ways to resist the influences of the tobacco industry. "Smoke Screeners" is an educational program that helps teach media literacy skills to young people. My Kids Direct involvement in your children's life is the single most important step you can take in helping them stay substance free.

Parents — Help Keep Your Kids Tobacco-Free: Tip Sheet Parenting never was easy, and keeping up-to-date with how to relate to your youngsters today requires steady attention to rapidly changing youthful activities and interests. This tip sheet suggests ways to enhance your children’s decision-making skills about tobacco use without turning them off. This one-pager is an excellent resource for all sorts of groups including PTAs, scouts, neighborhoods, and any other parent groups.

A Smoke Free Message From Christy TurlingtonCoaches — You Can Influence Youth

Tip Sheet

This artistic one-pager makes the connection between how tobacco use affects physical performance and well-being, but it does so in an entertaining way. If you are a coach, you can have a big influence on youngsters’ decisions regarding their health.

MTV Talks Tobacco

The Office on Smoking and Health has developed a video and facilitator's guide to provoke thought and stimulate discussion about teen smoking. The two-part video features former cast members of MTV's Real World and professional volleyball player and model Gabrielle Reece.

Facts on Sports and Smokefree Youth Including Special Benefits for Girls Fact Sheet

Guidelines for School Health Programs to Prevent Tobacco Use and Addiction Outlines steps to help school personnel plan, implement, and assess programs and policies for preventing tobacco use. (PDF-227K) This document is available in Portable Document Format. You will need Acrobat Reader to view this document.

Additional Web Sites for Parents/Educators/Youth Group Leaders

Youth

What You(th) Should Know about Tobacco Tip Sheet

If you are in a youth group, or if you help with a youth group, this tip sheet is an easy resource to communicate the common sense of avoiding tobacco use.

Kick Butts Online---TIPS 4 Kids

Prevent the Addiction---TIPS 4 Teens

Topics

Fact Sheets


Pre Teen Boys
Past Month Smokeless Tobacco Use Among Boys, Grades 9-12
United States, 1993
State Prevalence
(Percentage)

Rank
State
Percentage
1

District of Columbia

2.7
2

Hawaii

8.9
3

Utah

11.9
4

New Jersey

13.3
5

Delaware

15.0

Northeastern Region

15.5
6

Illinois

16.2
7

Massachusetts

17.0
8

Georgia

17.6

Western Region

18.6
9

Maine

18.8

Southern Region

19.0
10

Nevada

19.0
11

New York

19.4
12

New Hampshire

19.5

Average U.S.

20.4
13

South Carolina

20.4
14

North Carolina

20.5
15

Wisconsin

21.0
16

Ohio

22.5
17

New Mexico

24.1
18

Mississippi

24.2
19

Louisiana

25.1

Midwestern Region

25.2
20

Oregon

25.5
21

Arkansas

26.2
22

Nebraska

26.5
23

Idaho

26.7
24

Wyoming

32.6
25

Tennessee

33.8
26

Montana

36.5
27

South Dakota

37.9
28

Kentucky

39.0
29

West Virginia

40.3
Source: In 1993, past month cigarette smoking among youth was measured in 28 states and DC using the Youth Risk Behavior Surveillance System. www.cdc.gov/tobacco/research_data/spit/sltboys.htm

Current Smokeless Tobacco Use Among Men Aged 18 years and Older
United States, 1992-1993

Rank State Prevalence
(Percentage)

Rank
State
Percentage
1

Connecticut

0.1
2

New Jersey

0.4
3

Rhode Island

0.4
4

District of Columbia

0.5
5

Massachusetts

0.5
6

New York

1.0
7

Hawaii

1.2
8

Maryland

1.3
9

Delaware

1.5
10

California

1.6
11

Maine

1.7
12

New Hampshire

1.7
13

Illinois

2.1
14

Florida

2.3
15

Vermont

2.5
16

Nevada

2.6
17

Utah

2.6
18

Michigan

2.8
19

Ohio

3.6
20

Wisconsin

3.7

Overall

4.0
21

Washington

4.0
22

Minnesota

4.1
23

Arizona

4.3
24

Pennsylvania

4.4
25

South Carolina

4.4
26

Indiana

4.9
27

New Mexico

5.2
28

Colorado

5.3
29

Virginia

5.3
30

Nebraska

5.7
31

Oregon

5.7
32

Missouri

6.0
33

North Dakota

6.0
34

Iowa

6.1
35

Alaska

6.3
36

Texas

6.3
37

Kansas

6.5
38

Louisiana

6.7
39

Georgia

6.8
40

North Carolina

6.8
41

Idaho

7.7
42

Oklahoma

8.0
43

South Dakota

8.2
44

Kentucky

8.5
45

Alabama

9.0
46

Tennessee

9.0
47

Arkansas

11.1
48

Mississippi

11.1
49

Montana

11.9
50

Wyoming

13.5
51

West Virginia

15.6
Source: Current Population Survey (CPS), 1992-1993, State & National Tobacco Control Highlights. www.cdc.gov/tobacco/research_data/spit/sltmen.htm

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