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The primary purpose of this study was to determine the extent to which regular use of smokeless tobacco is associated with hypercholesterolemia (greater than or equal to 6.2 mmol/L) among 2,840 adult males. The confounding effects of age, education, physical fitness, body fatness, and other tobacco use were also examined. After adjustment, smokeless tobacco users were 2.5 times, heavy smokers were 2 times and mild/moderate smokers were 1.5 times more likely to have hypercholesterolemia than non-users of tobacco. Cigarette smokers did not differ significantly from users of smokeless tobacco regarding hypercholesterolemia. Users of smokeless tobacco were younger and less educated compared to non-users of tobacco, while smokers were less educated and less physically fit.