The objective of the current study was to examine demographic, tobacco-related, and psychosocial factors associated with cotinine concentration in a group of 256 male smokeless tobacco (ST) users living in the Ohio Appalachian region. Participants completed a survey that included questions on: 1) current and past tobacco use behaviors; 2) demographics; 3) tobacco dependence; 4) decisional balance; 5) health behaviors; and 6) perceived stress and depressive symptoms. Saliva samples were obtained for measurement of cotinine. The variables related to salivary cotinine concentration in the multiple regression model were age, marital status, occupation, quit attempts, years of ST use, and tobacco dependence score (adjusted R(2)=0.24). Among the 199 snuff only users, cotinine concentration was positively related to age, being divorced/widowed/separated, no quit attempts in the previous year, dependence score, and brand of snuff (adjusted R(2)=0.29). This is one of the largest studies to examine influences beyond topography on cotinine concentration in a group of rural ST users. These findings suggest that smokeless tobacco users and smokers share some similarities with respect to tobacco dependence.