Smokeless tobacco use among children: the New Hampshire Study

Rural public school children initially in grades 4, 5, and 6 participated in a 36-month follow-up study of substance abuse prevention. Children completed self-report questionnaires at baseline and annually for three years after the introduction of prevention programs. We compared outcomes of (1) a comprehensive school curriculum ("Here's Looking at You, 2000"), (2) the curriculum plus a parenting course ("Parent Communication Course") and a community task force (Johnson Institute Model), and (3) control condition. Neither the curriculum nor the curriculum plus parent and community intervention had any effect on smokeless tobacco use by this preadolescent and young adolescent population. We used stepwise logistic regression to determine prediction models for smokeless tobacco use. Initiation of smokeless tobacco use is associated with sex, grade, and having friends who use drugs. Although regular use increases with grade, poor family relations, and low school satisfaction, the greatest risk factor was ever trying smokeless tobacco. We describe the culture of smokeless tobacco use in this population, and we discuss the implications of our research for smokeless tobacco use prevention.