Despite the recent decline in the number of people who smoke cigarettes in the United States, use of smokeless tobacco products has continued to grow, especially in adolescent boys.
Smokeless tobacco is marketed nationally as snuff and chewing tobacco.
Snuff is cured, ground tobacco available in dry and moist forms, the latter commonly used by placing a small quantity between the cheek and gum. Chewing tobacco is sold in a loose-leaf pouch, a block or plug, and a twist form, all of which are actually chewed. Smokeless tobacco use in the United States almost tripled between 1972 and 1991, reaching an estimated five to 10 million American adult users. Although the use of smokeless tobacco products is perceived by some as a safe alternative to smoking cigarettes, prolonged use of smokeless tobacco has been strongly associated with oral cancer and other health risks such as esophageal cancer and nicotine addiction. It also may play a role in the development of coronary artery disease, hypertension, and peptic ulcers.