This paper compared the use of smokeless tobacco and its effects in rural and urban teenagers. A random sample of 445 subjects from rural Colorado were examined: 82.9 percent of the total sample were Caucasian, and 94.6 percent of those who used smokeless tobacco were Caucasian. This percentage supports the findings of an earlier urban study that the habit is predominantly one of male Caucasians. The average age of the users was 16.7 years, slightly older than in the urban study. Of the rural users, 62.5 percent had lesions of the oral tissues, compared with 48.7 percent lesional incidence in urban users. In both studies, those subjects with lesions had longer daily contact with smokeless tobacco, as well as a longer history of use than those without lesions. These are numerical averages that reflect great individual variations in susceptibility. The average duration of use for rural and urban users with lesions was almost the same; the development of lesions appears to be related to the length of daily exposure, which, on the average, was greater among rural users than urban users. Additionally, more than twice as many degree 3 lesions were found among users in the rural study. The habituating effects of nicotine and the influence of this substance on the future tobacco-usage patterns of youngsters who presently use smokeless tobacco are areas of concern. It is hoped that additional research will further delineate the scope of this current health problem.