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Craig Hughes grew up with friends who chewed tobacco and smoked cigarettes during afternoons at the beach in Crystal River, Fla.

So when a friend offered then 13-year-old Hughes chewing tobacco, a smokeless tobacco product, he eagerly accepted a piece. “I did it to fit in,” said Hughes, a maintenance technician with Duke Forest. “Everyone smoked or chewed tobacco. Nobody thought anything of a teenager doing it. [...] He chewed tobacco or used snuff, smokeless tobacco placed between your lower lip and gum, after every meal and before bed, going through a can of Longhorn tobacco a day. [...]