1. Current Trends in Smokeless Tobacco Use Among Wisconsin Adults Daphne Kuo, Karen Palmersheim, Mark Wegner, and Patrick Remington UW Carbone Cancer Center University of Wisconsin School of Medicine and Public Health Wisconsin Department of Health Services 5 th National Summit on Smokeless & Spit Tobacco Madison, Wisconsin September 22, 2009 Daphne Kuo, Karen Palmersheim, Mark Wegner, and Patrick Remington UW Carbone Cancer Center University of Wisconsin School of Medicine and Public Health Wisconsin Department of Health Services 5 th National Summit on Smokeless & Spit Tobacco Madison, Wisconsin September 22, 2009

2. BackgroundBackground Trends in smokeless tobacco (SLT) use have varied over time, depending on type of product Most data have shown a slow, but steady decline of SLT use after the mid-1990’s and through early the 2000’s---particularly of chewing tobacco and dry snuff However, tobacco consumption and sale data have shown an increase in the sale of snus (a moist type of snuff, doesn’t require spitting) Trends in smokeless tobacco (SLT) use have varied over time, depending on type of product Most data have shown a slow, but steady decline of SLT use after the mid-1990’s and through early the 2000’s---particularly of chewing tobacco and dry snuff However, tobacco consumption and sale data have shown an increase in the sale of snus (a moist type of snuff, doesn’t require spitting)

3. ObjectivesObjectives To examine trends in the prevalence of SLT use among Wisconsin adults To compare trends in SLT use in Wisconsin to that observed across the US To investigate whether trends differ by type of smokeless product To investigate whether trends differ by adult smoking status To examine trends in the prevalence of SLT use among Wisconsin adults To compare trends in SLT use in Wisconsin to that observed across the US To investigate whether trends differ by type of smokeless product To investigate whether trends differ by adult smoking status

4. Data – Sample Wisconsin Data are somewhat limiting! Tobacco Use Supplement, Current Population Survey (US Census Bureau) 1995-96, 1998-99, 2001-02, 2003 and 2006-07 Wisconsin and US adults (18+) Wisconsin Data are somewhat limiting! Tobacco Use Supplement, Current Population Survey (US Census Bureau) 1995-96, 1998-99, 2001-02, 2003 and 2006-07 Wisconsin and US adults (18+)

5. Variables and Methods Ever use and current use of chewing tobacco, snuff (may include snus), and the combination of both Cigarette smoking status of the respondent Analyzed trends in the prevalence of ever use and current use---in the general population and by the smoking status of the respondents Ever use and current use of chewing tobacco, snuff (may include snus), and the combination of both Cigarette smoking status of the respondent Analyzed trends in the prevalence of ever use and current use---in the general population and by the smoking status of the respondents

6. QuestionsQuestions Ever Use (question has changed over time) 1. Have you ever used pipes, cigars, chewing tobacco, or snuff on a regular basis? (if “Yes”---which ones?) 2. … even one time? 3. … ever used chewing tobacco, such as … ? such as … ? … ever used snuff, such as … ? … ever used snuff, such as … ? Ever Use (question has changed over time) 1. Have you ever used pipes, cigars, chewing tobacco, or snuff on a regular basis? (if “Yes”---which ones?) 2. … even one time? 3. … ever used chewing tobacco, such as … ? such as … ? … ever used snuff, such as … ? … ever used snuff, such as … ?

7. Questions, continued… Current Use 1. Do you now use … ? 2. Do you now use … every day, some days or not at all? some days or not at all? Current Use 1. Do you now use … ? 2. Do you now use … every day, some days or not at all? some days or not at all?

8. Instrument change Ever Use of SLT among Adults in Wisconsin and the US, TUS-CPS 1995-2007 0% 5% 10% 15% 20% 1995-961998-992001-0220032006-07 US ever chewing WI ever chewing US ever snuff WI ever snuff US ever SLT WI ever SLT

9. Findings The ever use of SLT, chewing tobacco and snuff appears to have increased among the adult population in Wisconsin and in the US since 1995. Wisconsin adults were more likely to try chewing tobacco (and, thus, SLT) than the US adults. Wisconsin adults were as likely to try snuff as US adults. The ever use of SLT, chewing tobacco and snuff appears to have increased among the adult population in Wisconsin and in the US since 1995. Wisconsin adults were more likely to try chewing tobacco (and, thus, SLT) than the US adults. Wisconsin adults were as likely to try snuff as US adults.

10. Ever Use of SLT among Cigarette Smokers in Wisconsin and the US, TUS-CPS 1995-2007 0% 5% 10% 15% 20% 1995-961998-992001-0220032006-07 US ever chewing WI ever chewing US ever snuff WI ever snuff US ever SLT WI ever SLT Instrument change

11. Findings Current cigarette smokers were more likely to try SLT than other adults; and increases were greater among current cigarette smokers than among the general population. WI smokers were more likely to try chewing tobacco than US smokers. WI smokers were equally as likely to try snuff as US smokers. Current cigarette smokers were more likely to try SLT than other adults; and increases were greater among current cigarette smokers than among the general population. WI smokers were more likely to try chewing tobacco than US smokers. WI smokers were equally as likely to try snuff as US smokers.

12. Current SLT Use among Adults in Wisconsin and the US, TUS-CPS 1995-2007 0% 1% 2% 3% 4% 5% 1995-96 1998-992001-0220032006-07 US current chewing WI current chewing US current snuff WI current snuff US current SLT WI current SLT

13. Findings National trends in current SLT use in our study of the general population, till 2003, were consistent with findings from previous studies. A slow but steady decline since 1998 was observed for chewing tobacco but not for snuff in the US. National trends in current SLT use in our study of the general population, till 2003, were consistent with findings from previous studies. A slow but steady decline since 1998 was observed for chewing tobacco but not for snuff in the US.

14. Findings Trends in current use of SLT and chewing tobacco among Wisconsin adults were different from the national average since 1998. An increase in SLT (chewing tobacco) use was observed in WI in 1998-1999, but not across the US. Trends in current use of SLT and chewing tobacco among Wisconsin adults were different from the national average since 1998. An increase in SLT (chewing tobacco) use was observed in WI in 1998-1999, but not across the US.

15. Findings Percentages of current use of SLT and chewing tobacco in Wisconsin declined slower than those in the US. From 1998 through 2007, the percentage of current chewing tobacco use (and SLT) was consistently higher in Wisconsin than in the US. Percentages of current use of SLT and chewing tobacco in Wisconsin declined slower than those in the US. From 1998 through 2007, the percentage of current chewing tobacco use (and SLT) was consistently higher in Wisconsin than in the US.

16. Findings The percentage of current snuff use in Wisconsin was consistently slightly lower than that observed across the US from 1995 to 2007.

17. Current SLT Use among Cigarette Smokers in Wisconsin and the US, TUS-CPS 1995-2007 0% 1% 2% 3% 4% 5% 1995-961998-992001-0220032006-07 US current chewing WI current chewing US current snuff WI current snuff US current SLT WI current SLT

18. Findings The percentages of current use of SLT, chewing tobacco and snuff steadily increased over time among current cigarette smokers in Wisconsin. In the US, similar increases were observed for snuff, but not for chewing tobacco. The percentages of current use of SLT, chewing tobacco and snuff steadily increased over time among current cigarette smokers in Wisconsin. In the US, similar increases were observed for snuff, but not for chewing tobacco.

19. Conclusions Ever use of (experimentation with) SLT increased between 1995 and 2007 --- but we are not sure how much of this change may be due to methodological issues (survey question) Current overall use of SLT has not change a lot in the general population  In the more recent years, use of chewing tobacco has decreased, use of snuff has increased (perhaps due to the marketing of snus) Ever use of (experimentation with) SLT increased between 1995 and 2007 --- but we are not sure how much of this change may be due to methodological issues (survey question) Current overall use of SLT has not change a lot in the general population  In the more recent years, use of chewing tobacco has decreased, use of snuff has increased (perhaps due to the marketing of snus)

20. Conclusions WI vs. the US average Overall SLT use is slightly higher in Wisconsin than across the US This is due to greater use of chewing tobacco in Wisconsin Whereas, Wisconsinites are slightly less likely to use snuff/snus, than US adults WI vs. the US average Overall SLT use is slightly higher in Wisconsin than across the US This is due to greater use of chewing tobacco in Wisconsin Whereas, Wisconsinites are slightly less likely to use snuff/snus, than US adults

21. Conclusions Cigarette smokers were more likely to ever use, and currently use SLT than the general population in WI and the US. Thus, smokers may be using smokeless products to compensate for the inability to smoke in public places due to smoke-free restrictions Cigarette smokers were more likely to ever use, and currently use SLT than the general population in WI and the US. Thus, smokers may be using smokeless products to compensate for the inability to smoke in public places due to smoke-free restrictions