What are the common causes of smokeless tobacco use?

From the Guidelines

Chewing tobacco use is commonly caused by a combination of social and cultural influences, nicotine addiction, and perceived stress relief, with the strongest evidence suggesting that nicotine addiction is a primary driver, as chewing tobacco delivers nicotine that creates physical dependence 1.

Key Factors Contributing to Chewing Tobacco Use

• Social and cultural influences: The behavior is often normalized within certain communities or passed down through generations, with significant disparities in tobacco use remaining among young people nationwide, and the prevalence of cigarette smoking being highest among American-Indian and Alaska Native people compared with other ethnic groups 1.
• Nicotine addiction: Chewing tobacco delivers nicotine that creates physical dependence, making it a primary driver of its use, and concurrent use of multiple tobacco products is common, with 9.9% of US high school students reporting use of 2 or more different tobacco products 1.
• Peer pressure and curiosity: Many users begin during adolescence due to peer pressure or curiosity, with the 2012 US National Youth Tobacco Survey (NYTS) describing 6.7% of middle school students as currently using any tobacco products, and 23.3% of high school students reporting current use of any tobacco product 1.
• Perceived stress relief: Some people use chewing tobacco as a perceived stress reliever or to cope with anxiety, although it still carries significant health risks, including oral cancers, gum disease, tooth loss, and nicotine addiction.
• Cultural traditions and occupational settings: In certain regions, chewing tobacco is deeply embedded in cultural traditions or occupational settings, with the use of smokeless tobacco increasing among self-identified white male high school students, and cigar smoking possibly increasing among black female high school students 1.
• Marketing efforts: The tobacco industry's marketing efforts, particularly those targeting young people or specific cultural groups, also contribute to initiation, with flavors and lower cost appealing to children, and the use of e-cigarettes dramatically escalating among youth, with the 2014 NYTS reporting current e-cigarette use in 3.9% of middle school students and 13.4% of high school students 1.

From the Research

Common Causes of Chewing Tobacco Use

• Nicotine addiction and dependence is a major factor in chewing tobacco use, driven by addiction to nicotine 2
• Biological, psychological, behavioral, and cultural factors contribute to nicotine addiction, which can influence chewing tobacco use 3
• Performance, stress, and body weight are three factors that can influence chewing tobacco use, with nicotine affecting behavior and cognitive abilities 3
• Stress can result in increased chewing tobacco use, although the relationship between stress and chewing tobacco use is complex and not fully understood 3
• There is no direct evidence in the provided studies on the specific causes of chewing tobacco use, but nicotine addiction and dependence are common themes in tobacco use 4, 5, 6

Factors Influencing Chewing Tobacco Use

• Nicotine replacement therapy (NRT) can help reduce motivation to consume tobacco and nicotine withdrawal symptoms, easing the transition to abstinence 4
• Varenicline and combination NRT can be effective in suppressing craving and smoking expectancies, leading to higher quit rates 5
• Electronic cigarettes and other pharmacotherapies can also be effective in aiding smoking cessation, although more research is needed to inform treatment decisions and policies 6
• Behavioral and cognitive effects of nicotine, such as attentional and cognitive abilities, can be impaired in nicotine-deprived smokers, and reversed with nicotine administration 3