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This article describes a study conducted as part of the Robeson Osteoporosis Screening Study, conducted May-November 2000. The motivation for the study described herein was the adverse health consequences of smoking and smokeless tobacco use, particularly for older women. Possible consequences include cardiovascular disease, cancer, osteoporosis and fractures, and gastrointestinal diseases. The authors hope their research will inform the design of tobacco-cessation interventions for older, rural women.

The study collected data on 240 Robeson County women, aged 60-94 (median age 72). The group had approximately the same number of African Americans, Native Americans, and Whites. Most were overweight; 51% did not complete high school; 27% had education beyond high school; 68% reported themselves in either good or fair health. Only 12% had used alcohol in the past year. Smoking status: 16% current smokers, 22% former smokers, and 71% had never smoked. Smokeless tobacco status: 16% current users, 10% former users, and 74% had never used.

Analyses of the data revealed the following:

• There was no correlation between smokeless tobacco use and BMI or age.
• Smokeless tobacco use was higher among African-American women (20.3%) and Native American women (25%) than among white women (2.5%).
• Current smokeless tobacco use was higher among women who had not completed high school (26%) or had only completed high school (9.4%) than among women who had education beyond high school (3.1%).
• More women who reported poor health were also current smokeless tobacco users (27%).
• Among current and former smokeless tobacco users, the median age of beginning use was 17. One-fourth of these women began use before the age of 8.
• Current and former smokers were significantly younger and women who had never smoked.
• Current and former smokers showed no significant differences regarding health status, ethnicity, or educational level.
• The median age of beginning smoking was 19 for current smokers.

  Comparisons of the data from this study with other studies revealed the following:

• Rates of smokeless tobacco use among older women in Robeson County were 7 times higher than national averages for African-American women of all ages, 8 times higher than national averages for White women of all ages, and 21 times higher than national averages for Native American women of all ages.
• Other studies show that smokeless tobacco use is more common in the southeastern United States.
• Current smoking rates among older women were surprising low, compared to national rates.
• Evidence from other studies that smokeless tobacco is more addictive than cigarettes was corroborated by this study. Thirty-eight of 62 ever-users of smokeless tobacco (61%) were current users, while 16 of 69 ever-smokers (23%) were current smokers. Other explanations for this finding may be higher mortality among cigarette smokers or continued use of smokeless tobacco in the belief that it is safer than smoking.
• The average consumption of smokeless tobacco products among older Robeson County women would provide the same nicotine content as smoking half a pack of cigarettes per day.

  The authors recommend that health interventions for this Robeson County population, as well as for other rural populations of older women, keep in mind both the ethnic variations and the lower educational level of smokeless tobacco users.