Tobacco Update: Scientific Advances, Clinical Perspectives
What Have We Learned from 20 Years of Research on Smokeless Tobacco Cessation?

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ABSTRACT

Although smoking cessation continues to get most of the attention from both researchers and practitioners, treatment for smokeless tobacco (SLT) dependence gets little consideration. The reasons are varied, but essentially smoking is more prevalent, has greater public health implications, and has been the subject of clean air laws and environmental issues that have focused the attention on a burned tobacco, thereby leaving SLT with scant public health attention. This is unfortunate, because the sales of SLT products, especially moist snuff, have increased consistently over the past decade; regular use of these products can result in oral cancer, other negative effects on oral health, and nicotine dependence or addiction. This article will review some unique issues of SLT use that affect cessation and the empirical research on interventions.

Section snippets

Unique Issues for SLT Treatment

There are unique issues associated with SLT cessation treatment. First, unlike smokers, most users of moist snuff or chewing tobacco are male, which offers both challenges and opportunities. Male users are less likely to seek treatment, but they are more likely to respond to self-help programs for quitting than are female users. The opportunity to use spouse or partner support for the male quitter is greater because the female partner can be mobilized to help the male partner in quitting.

Review of Published Treatment Studies

Behavioral treatments for SLT dependence have been shown to be effective, but the literature has been modest compared with the voluminous research literature on smoking cessation, with an estimated 6,000 studies being published between 1975 and 1999.9 Among the studies on SLT reviewed for this article, only 20 met the criteria for offering adequate methodological rigor; of those 20, only 14 were randomized clinical trials (RCT). The studies reviewed here have been divided into (1) behavioral

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