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While the South consistently leads the nation in smokeless-tobacco use, the West is close behind especially the rural West, where use is nearly four times the national average
Still, efforts against smokeless tobacco face growing advertising by tobacco companies
The effects of tobacco have been a topic of discussion among physicians since 1888 when Doctor Robert Koch, the leading authority on infectious diseases at the time, argued that the spitting of chewing tobacco was leading to a spread of tuberculosis
This includes not only cigarette smoking but also the use of smokeless tobacco, which is often chewed, snuffed or applied locally in the oral cavity. The study warns that if the use of tobacco among women in lower- to middle-income countries is ignored as a public health issue and the tobacco industry continues marketing tobacco products to women, the level of tobacco use may increase as it did in high-income countries
"Spatial, temporal, and demographic patterns in prevalence of chewing tobacco use in 204 countries and territories, 19902019: a systematic analysis from the Global Burden of Disease Study 2019"
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