smokeless tobacco (ST) use is increasing (Institute of Medicine [IOM], 2009). Furthermore, many military personnel use cigarettes and ST concurrently, compounding the health hazards of using either product alone and maintaining the addiction to nicotine (IOM, 2009). According to a recent survey of active duty personnel, nearly half (41.2%) reported using one or more forms of tobacco in the past month (Rae Olmsted, Bray, Guzman, Williams, & Kruger, 2011). Significant differences in ST use rates exist between the military and civilian populations. In 2008, the overall prevalence of ST use among active duty personnel was 14% (Bray et al., 2009). In comparison, 3.5% of civilians (≥18 years) used ST (Substance Abuse and Mental Health Services Administration [SAMHSA], 2010). In both populations, ST use is highest among young adult (aged 18-25) White males. However, even in this demographic group, those in the military use ST at almost twice the rate of their civilian counterparts (19% vs. 11.4%; Bray et al., 2009; SAMHSA, 2010). Significant differences also exist in rates of ST use between the individual service branches. The Marine Corps has the highest prevalence (22%), followed by the Army (16%), Coast Guard (13%), Navy (10%), and Air Force (9%; Bray et al., 2009). ST use is associated with numerous adverse health outcomes, including cancers of the mouth, throat, and pancreas
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