Smokeless Tobacco
American Indian and Alaska Natives have the highest rate of smokeless tobacco usage of all races in the U.S. at 9.3%, compared with 5.0% non-hispanic whites, according to a 2012 study by the Centers for Disease Control and Prevention. About 16 of every 100 American Indian and Alaska Native males were current smokeless tobacco users in 2012.
Containing 28 known carcinogens, smokeless tobacco is a known cause of oral, esophageal and pancreatic cancer, gum disease, tooth loss, and increases the risk of chronic conditions like heart disease.
The most commonly used forms of smokeless tobacco are loose-leaf chewing tobacco and dipping tobacco (moist snuff), though some regions may see usage of other forms at higher rates. In Alaska, for example, iqmik is commonly used form of smokeless tobacco, especially among Alaskan Native populations.
Smokeless tobacco may be seen by some users as being a safer form of tobacco because no smoke is inhaled into the lungs; however, smokeless tobacco is not a safe alternative to smoking commercial tobacco. Education regarding the harmful effects of smokeless tobacco is needed within tribal communities and it is important for health practitioners to ask about smokeless tobacco when screening patients for commercial tobacco use.
additional RESOURCES

CDC: Smokeless Tobacco Product Use in the United States (2024)
Overview from CDC:
This fact sheet provides information on how many people use smokeless tobacco. it also describes what the U.S. Government has done to protect the public's health from the harmful effects of smokeless tobacco use.

Campaign for Tobacco-Free Kids: Health Harms from Smokeless Tobacco Use
From Campaign for Tobacco Free Kids:
Public Health authorities including the Surgeon General and the National Cancer Institute have found that smokeless tobacco use is hazardous to health and can lead to nicotine addiction. Smokeless tobacco contains at least 28 cancer-causing chemicals and causes oral, pancreatic and esophageal cancer. Use of smokeless tobacco is also associated with other health problems including lesions in the mouth and tooth decay.

CDC and NCI: More than 300 million people in at least 70 countries use smokeless tobacco (2014)

PDF SMOKELESS TOBACCO FACT SHEET
A two-page fact sheet on smokeless tobacco created by the Great Plains Tribal Chairmen's Health Board for use in tribal communities.

CDC SMOKELESS TOBACCO health impacts FACT SHEET
An online fact sheet on smokeless tobacco use, health impacts, and up-to-date resources compiled by the Centers for Disease Control and Prevention.

Smokeless Tobacco Use Among Working Adults -- Unites States, 2005 and 2010
June 6, 2014
Morbidity and Mortality Weekly Report (MMWR)
Jacek M. Mazurek, MD, Girija Syamlal, MPH, Brian A. King, PhD, Robert M. Castellan, MD