Evidence that smokeless tobacco use is a gateway for smoking initiation in young adult males

C. Keith Haddock, Mark Vander Weg, Margaret DeBon, Robert C. Klesges, G. Wayne Talcott, Harry Lando, Alan Peterson

Research output: Contribution to journalArticlepeer-review

118 Scopus citations


Background. This study was designed to test the hypothesis that smokeless tobacco (SLT) serves as a gateway drug for smoking among young adult males. Methods. A cohort (n = 7,865) of U.S. Air Force recruits who claimed to have never smoked cigarettes was followed prospectively for 1 year. The participants were male, 32.9% were ethnic minorities, and their average age was 19.84 years (SD = 2.29). Among recruits entering basic military training, 403 (5.1%) reported current SLT use and 198 (2.5%) reported a past history of SLT use. Results. At the 1-year follow-up current SLT users were 233% more likely to have initiated smoking than nonusers (odds ratio = 2.33, 95% CI = 1.84-2.94). Similarly, recruits who reported past SLT use were 227% more likely to begin smoking than participants who had never used SLT (odds ratio = 2.27, 95% CI = 1.64-3.15). SLT use remained a potent predictor of smoking initiation in a multivariate logistic model that included demographic factors and other risk factors for initiation. Conclusions. SLT use appears to be an important predictor of smoking initiation among young adult males. This study suggests that smoking prevention and cessation programs should also include strategies related to SLT use.

Original languageEnglish (US)
Pages (from-to)262-267
Number of pages6
JournalPreventive medicine
Issue number3
StatePublished - 2001

Bibliographical note

Funding Information:
The Wilford Hall/University of Memphis and Minnesota Smoking Cessation Program is a collaborative endeavor between the two above-cited universities and the U.S. Air Force (USAF), funded by a grant from the National Institutes of Health (NHLBI). In this investigation, the entire population of Air Force Basic Military Training (BMT) recruits was randomized to either a smoking cessation program or control condition during a 6-week BMT-imposed tobacco ban. Every individual who entered the active duty service in USAF from August 1995 to August 1996 was a participant in the study (n = 29,044). A detailed description of the treatment portion of this project is published elsewhere [14]. Human subject protocol approval was obtained from the University of Memphis institutional review board as well as the USAF.

Funding Information:
1This paper was supported by a grant from the U.S. National Institutes of Health (HL-53478) awarded to the University of Memphis (R.C. Klesges, Principal Investigator). The views expressed in the article are those of the authors and are not the official policy of the U.S. Government, Department of Defense, or U.S. Air Force.


  • Gateway drug
  • Military recruits
  • Smokeless tobacco
  • Smoking initiation
  • Young adults


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