Background: Although cigarette use has decreased within the United States, the promotion of smokeless tobacco has increased. This report presents information on smokeless tobacco use and initiation. Method: This report uses data from the 2002 to 2014 National Surveys on Drug Use and Health to examine smokeless tobacco use and initiation among people aged 12 or older in 2014 and presents trends between 2002 and 2014. Results: In 2014, an estimated 8.7 million people aged 12 or older used smokeless tobacco in the past month. Males were more likely than females to have used smokeless tobacco in the past month. Percentages of people using smokeless tobacco in the past month remained relatively stable between 2002 and 2014. Around 1.0 million people aged 12 or older used smokeless tobacco for the first time in the past year. Although there were higher percentages of people initiating smokeless tobacco use in the past year among people at risk for initiation in 2005 through 2011, the 2014 estimates were similar to the levels between 2002 and 2004. Conclusion: Smokeless tobacco is not a healthy alternative to cigarette smoking. Although the number of Americans who smoke cigarettes has been significantly reduced, the overall use of smokeless tobacco has remained mostly unchanged since 2002. On the positive side, there have been declines in initiation of smokeless tobacco between 2006 and 2014 among males, adolescents, and young adults. Taken together, the findings in this report suggest a continuing need for prevention messages and tobacco cessation programs that specifically address the inherent risk of smokeless tobacco.