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


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

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Epidemiology


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