Smokeless Tobacco Use Among Rural Women in the Southeast USA

Tuesday, 31 July 2012: 4:20 PM

Brenda Talley, PhD, RN, NEA-BC1
Rose Mary Gee, PhD, RN2
Deborah Allen, PhD, FNP-C, BC2
Alison Rushing, PhD, RN2
Dellaire Shilling, FNP-C, RN2
(1)College of Nursing, University of Alabama in Huntsville, Huntsville, AL
(2)School of Nursing, Georgia Southern University, Statesboro, GA

Learning Objective 1: At the end of this session, the learner will be able to discuss patterns smokeless tobacco use among women.

Learning Objective 2: At the end of this session, the learner will be able to apply knowledge of smokeless tobacco use in women in primary and secondary prevention.

Purpose: The purpose is to share patterns of smokeless tobacco in women derived from qualitative research and to underscore the need to assess and discuss the health risks of smokeless tobacco.  Target audience is nurses, other health care providers, and researchers interested in exploring smokeless tobacco use in other populations.

Methods: A qualitative approach elicited personal descriptions of patterns of smokeless tobacco use in women in rural South East U.S.A. Ten women participated in 1-5 interviews.  Data collected included medical history, onset of use, duration of use, and frequency and quantity of tobacco use. 

Results: Analysis identified family history and influence of others, cultural and social underpinnings, “secrecy” against “outsiders”, and lack of knowledge of health risks.  Of the ten participants, three had significant health problems attributable to use (two oral cancers, one recurring cardiac arrhythmia requiring ablation).  Themes related to patterns of use were identified. .  At least two distinctive groups emerged:  age at onset (range 8-42) and predications of initial use (childhood initiation-culturally imbedded vs. adult initiation-cigarette substitution behavior).

Conclusion: “Secrecy” of use is a deterrent to health education and early diagnosis and treatment. Communication is lacking between health care providers and female users of smokeless tobacco.  Needed is improved attention to screening by health care providers and culturally appropriate primary and secondary prevention strategies


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Lee, J. H. (2009). Smokeless tobacco and head and neck cancer: There is risk even without fire. South Dakota Medicine, Spec No, 38-39. 

Talley, B., Gee, R., Allen, D., Marshall, E., Encinas, K., & Lim, S. (2011).  Assessment of smokeless tobacco use in the history and physical examination by primary health care providers. Journal of the American Academy of Nurse Practitioners. 3(8), 445-447.