Smokeless tobacco treatment: Measures, interventions, recommendations, and future directions

There are almost 9 million regular smokeless tobacco (ST) users in the United States. Because ST products, manufacturing methods, distribution, use patterns, regulations, and research differ by country, this chapter focuses on interventions in the United States and is limited to studies in adults. The challenges of measuring use and dependence are discussed, and tools appropriate to particular forms of ST products and conditions of use are assessed. The various behavioral and pharmacological interventions for which reliable data exist are evaluated, and recommendations for intervention methods and research are offered. In general, research has yielded good evidence and support for several methods, with some outcomes exceeding those for smoking cessation. However, refinement of existing methods and delivery systems is needed, as well as innovation in methods. Future directions in which studies and therapeutic applications might go are projected.