Although more than 90 percent of smokeless tobacco users in the United States are male, a substantial number of women also use smokeless tobacco products. In 1998, 0.5 percent of females over the age of 12, about 573,000, were current users of smokeless tobacco products, according to the National Household Survey on Drug Abuse.

The comparatively small percentage of women who use smokeless tobacco accounts in part for the lack of research on the patterns of smokeless tobacco use among women, says Dr. Dorothy Hatsukami of the University of Minnesota School of Medicine. In addition, "women rarely respond to our advertisements to participate in smokeless tobacco treatment studies," she says. For example, Dr. Hatsukami recently reported that 99.8 percent of 402 people who responded to advertisements for participation in a smokeless tobacco treatment study with the nicotine patch were male. (See "Nicotine Patch Helps Smokeless Tobacco Users Quit, But Maintaining Abstinence May Require Additional Treatment")

"Women may be embarrassed about admitting smokeless tobacco use because the general perception is that smokeless tobacco use is socially undesirable, and women don't use it," Dr. Hatsukami speculates. Among the unattractive features of smokeless tobacco use is the need to spit tobacco juice from time to time and dislodge particles of loose tobacco that get trapped between the teeth. This disadvantage of smokeless tobacco use was the one most frequently cited by women who participated in a study of female smokeless tobacco users who weren't seeking treatment, conducted by Dr. Hatsukami and her colleagues.

In the study, 20 female smokeless tobacco users from the upper Midwest completed a questionnaire and brief interview. The study revealed some similarities between females' smokeless tobacco use and what research has shown about males' smokeless tobacco use. For example, on average, both sexes began using smokeless tobacco between 16 and 18, and friends played a major role in their initiating use. About 25 percent of men and women also indicated they used smokeless tobacco to help them stop smoking.

The study also revealed some differences in patterns of smokeless tobacco use by females and the patterns of use reported in a previous study that assessed features of smokeless tobacco use among males who weren't seeking treatment. For example, on average, the women said they used 3.6 dips of moist snuff daily, compared to the 6.3 dips reported by males, and women held the tobacco in their mouths about 22.5 minutes, compared to 39.9 minutes for men. A tin of snuff lasted women anywhere from 2 days to 3 months with a median duration of 6 days per tin. In contrast, men used approximately 2.8 tins per week.

The women in this study may have used less smokeless tobacco than men because they had used smokeless tobacco for less than 4 years, Dr. Hatsukami says. This contrasts with the men, who averaged more than 5 years of smokeless tobacco use. Perceived social disapproval of women using smokeless tobacco also may contribute to lower patterns of use in women. In fact, 38 percent of the women in Dr. Hatsukami's study said they could not use smokeless tobacco in the presence of certain people, and another 25 percent cited social disapproval as a drawback to smokeless tobacco use. These social concerns may reduce opportunities for women to use smokeless tobacco and lead to lower levels of use, Dr. Hatsukami says. In spite of these drawbacks, a significant percentage of women in the study said the relaxing and calming effects and pleasure they associate with smokeless tobacco use are advantages of using these products.

Identifying factors associated with smokeless tobacco use by women and their current patterns of use could generate ways to prevent and treat smokeless tobacco use among women, Dr. Hatsukami says. "The data from this research could help target some of the educational and prevention messages that we should be giving to women," she says. "However, first we have to make women smokeless tobacco users aware that other women use smokeless tobacco products and that they are not abnormal, so they are willing to seek help," she says.

Sources

Boyle, R.G.; Gerend, M.A.; Peterson, C.B.; and Hatsukami, D.K. Use of smokeless tobacco by young adult females. Journal of Substance Abuse 10:19-25, 1998. [Abstract]

Hatsukami, D.K.; Keenan, R.M.; and Anton, D.J. Topographical features of smokeless tobacco use. Psychopharmacology 96:428-429, 1988.