Learning Objectives: Identify the major US worker groups with the highest rates of smokeless tobacco use
Methods: The National Health Interview Survey is a nationally-representative survey of the US civilian population. Current smokeless tobacco use and occupational status were assessed over survey periods 1987, 1991-1994, 1998, 2000, and 2005 (n=141,171). To assess smokeless tobacco use trends, a weighted linear regression model was fitted to the annual design-adjusted rates within occupational groups. The weight used for each annual rate was the inverse of its variance.
Results: There were no significant upward or downward trends in smokeless tobacco rates within blue-collar, white-collar, service workers, and farm workers. However there were significant differences in the prevalence rates between worker categories. For example, in 2005 the survey-adjusted prevalence rates were significantly higher in farm workers (12.5%; [95% CI 5.0-19.9]) and blue-collar workers (5.6% [4.5-6.7]) versus white-collar (1.7% [1.4-2.0]) and service workers (1.9% [1.3-2.6]).
Conclusions: Smokeless tobacco rates are stable, but there are large differences in use across worker groups. Smokeless tobacco prevention strategies specifically targeting farm workers and blue-collar groups are warranted.