ORAL MUCOSAL SMOKELESS TOBACCO LESIONS AMONG ADOLESCENTS IN THE UNITED-STATES

The presence of oral smokeless tobacco lesions among adolescents may b e an early indicator of increased risk for oral cancers. Data from the 1986-1987 National Survey of Oral Health in US School Children were u sed to examine the cross-sectional relationship between the use of tob acco and alcohol and the presence of white or whitish oral soft-tissue lesions. The sample included 17,027 schoolchildren (aged 12 to 17 yea rs) who provided information on the use of snuff, chewing tobacco, cig arettes, and alcohol and who received oral clinical examinations. Smok eless tobacco lesions were detected in 1.5% of students (projects to a bout 300,000 nationally), including 2.9% of males and 0.1% of females. These lesions were more prevalent among whites (2.0%) than among Afri can Americans (0.2%) or Hispanics (0.8%). Modeling with multivariate l ogistic regression revealed that, among white males, current snuff use was the strongest correlate of lesions [odds ratio (OR) = 18.4; 95% c onfidence interval (CI) = 8.5-39.8], followed by current chewing tobac co use [OR = 2.5; 95% CI = 1.3-5.0]. Lesions were strongly associated with duration, monthly frequency, and daily minutes of use of snuff an d chewing tobacco. These data suggest that snuff may be a stronger ris k factor than chewing tobacco for smokeless tobacco lesions, but the u se of either of these forms of oral tobacco exhibits a dose-response r elationship with the occurrence of lesions. We found little evidence t hat the use of alcohol or cigarettes may increase the risk of smokeles s tobacco lesions. Preventing smokeless tobacco lesions and their poss ible malignant transformation may be best accomplished among adolescen ts by preventing the use of snuff and chewing tobacco.