Minnesota has one of the highest rates in the nation of smokers who also use smokeless tobacco, according to a new report from the Centers for Disease Control and Prevention.
The report indicates that anti-smoking policies may be encouraging smokers to use chewing tobacco, snuff or snus packets to get nicotine during times when smoking is prohibited -- rather than encouraging them to quit smoking.
The report is the first time the Centers for Disease Control and Prevention has published data on smokeless tobacco use in all 50 states.
Minnesota shares a 6th place ranking in the CDC report with Virginia. In both states, more than 10 percent of the smoking population also use smokeless tobacco. Only Utah, Arkansas, North Dakota, Montana and Wyoming have higher rates.
"This is of concern because the available data indicates that the people who are using both products may have a harder time in quitting," said Dr. Terry Pechacek, associate director for science with CDC's Office on Smoking & Health.
It's not entirely clear why Minnesota has so many smokers who also use smokeless tobacco. Public health officials say the practice is most often associated with lower levels of education, and rural cultures centered around farming or sporting activities, like hunting and fishing.
Robert Seekins of St. Paul says he used smokeless tobacco when he worked on a farm a few years ago.
"Cleaning barns especially, because you can't smoke in the barn because you don't want to burn the place down. So you chew tobacco," he said.
“The biggest concern is that they will continue to use both [types of tobacco], and therefore have the hazards of both.”Dr. Richard Hurt, Mayo Clinic
Young men are the biggest users of smokeless tobacco. In Minnesota, nearly 16 percent of all male smokers use smokeless products. But the CDC's Terry Pechacek says tobacco companies have also succeeding in getting women to buy chew, snuff and snus.
"We are concerned that they are marketing more broadly, and particularly to women," Pechacek said. "And the fact that the rates of smokeless tobacco use among women in Minnesota are much higher than most other states is a reason for concern."
Nearly 4 percent of female smokers in Minnesota also use smokeless tobacco, according to the CDC survey.
Kerri Gordon, a spokeswoman for ClearWay Minnesota, a group working to decrease tobacco use, says many women have been enticed by a new generation of smokeless products.
"There's cherry flavor and grape flavor, which could be more appealing to women," said Gordon. "We're also seeing a movement towards smokeless and spitless tobacco."
ClearWay Minnesota is a non-profit organization funded by the state's tobacco settlement, with a mission to reduce tobacco use.
In addition to redesigning products, Gordon says tobacco companies have also effectively changed their advertising message. They're now promoting their smokeless products as an easy alternative to cigarettes.
"They'll have an insert in the foil pack and it'll say, when you can't smoke at your desk or on a plane, here's a product -- a Marlboro or Camel-branded product -- that you can use, and here's a coupon, you can try it for free," she said.
Kristine Drusch, 28, from St. Paul, saw a similar ad for smokeless tobacco at a gas station recently. The ad was persuasive enough to get her to try smokeless tobacco for the first time.
"Those taste really gross, honestly. I've tried one and didn't like it at all," she said.
Whether Drusch is in the minority remains to be seen.
Dr. Richard Hurt of Mayo Clinic's Nicotine Dependence Center says he's treated many young smokers recently who say they switched to smokeless tobacco because they believe it's less harmful than cigarettes.
Hurt says that's a rational strategy, but it rarely works.
"The biggest concern is that they will continue to use both, and therefore have the hazards of both," said Hurt.
Minnesota lawmakers have been scrambling to keep up with the changes in tobacco marketing. This year they passed a law requiring all smokeless tobacco products to be kept behind the counter, in the same way that cigarette displays are restricted.
But anti-smoking advocates say the most effective way to deter young people from developing new tobacco dependencies is to increase taxes on the products. They say many smokeless products are priced so cheaply that the taxes aren't a significant disincentive.