... to cancer Recent research shows the dangers of smokeless tobacco may go beyond the mouth. It might also ... role in other cancers, heart disease and stroke. Smokeless tobacco contains more nicotine than cigarettes. Nicotine is a ...
... Cancer Genetics Services Directory Cancer Prevention Overview Research Smokeless Tobacco and Cancer On This Page What is smokeless tobacco? Are there harmful chemicals in smokeless tobacco? Does ...
Underner, M; Perriot, J
Use of smokeless tobacco (ST) (chewing tobacco and snuff) can lead to a number of consequences detrimental to health. ST rapidly delivers high doses of nicotine, which can lead to dependence and is also a source of carcinogenic nitrosamines. Changes usually develop in the mouth area where the ST is most often placed. Non-malignant oral lesions include leuko-oedema, hyperkeratotic lesions of the oral mucosa and localised periodontal disease. Oral premalignant lesions are leukoplakia, erythroplakia, submucosal fibrosis and lichen planus. Betel chewing, with or without tobacco, may increase the incidence of oral cancer. There is conflicting evidence with regard to snuff users about the risk of oral and gastro-oesophageal cancer. ST use is a risk factor for pancreatic cancer and may increase the risk of fatal myocardial infarction and ischemic stroke. During pregnancy, ST is associated with an increase in pre-eclampsia, preterm delivery and stillbirth. Nicotine replacement therapy and bupropion reduce withdrawal symptoms and tobacco craving during ST cessation. However, they have not been shown to help long-term abstinence. Information concerning the potential hazards of ST products should be incorporated into educational programmes to discourage its use and to help users to quit. Smokeless tobacco is not recommended to help smoking cessation. Copyright © 2011 SPLF. Published by Elsevier Masson SAS. All rights reserved.
... Use and Pregnancy Text Size: A A A Smokeless Tobacco and Your Health Can smokeless tobacco affect my ... smokeless tobacco use cause other health problems? Can smokeless tobacco affect my oral health? It may cause tooth ...
... Are Here: Home → Multiple Languages → All Health Topics → Smokeless Tobacco URL of this page: https://medlineplus.gov/languages/ ... V W XYZ List of All Topics All Smokeless Tobacco - Multiple Languages To use the sharing features on ...
Ayo-Yusuf, Olalekan A; Odukoya, Oluwakemi O; Olutola, Bukola G
This study sought to determine the sociodemographic correlates of exclusive and concurrent use of smokeless tobacco (SLT) and smoking (i.e., dual use) and to explore the association between SLT use and the amount of cigarettes smoked per day. Data were obtained from a nationally representative sample of Nigerian men aged 15-59 years (N = 15,453) who participated in the 2008 Nigerian Demographic and Health Survey (NDHS). The NDHS used an interviewer-administered questionnaire to collect data on participants' sociodemographic characteristics and tobacco use status. Taking account of the multistage sampling used in the NDHS, data analyses included descriptive statistics, chi-square analysis, and multivariable adjusted multinomial logistic regression analysis. Of the respondents, 12.2% (n = 1,842) were tobacco users, out of which 24.5% (n = 477) were exclusive SLT users, 69% (n = 1,236) were exclusive smokers, and 6.5% (n = 129) were dual users. Both SLT use and smoking were most prevalent among the Igbo ethnic group and among the least educated men. SLT use was most prevalent among those in the southeast (9.75%) and north-central (7.71%) regions, where smoking was also common. The number of cigarettes smoked per day was not significantly different among dual users when compared with exclusive smokers (7.3 vs. 5.6; p = .088). Dual users were also more likely to self-identify as traditionalists (RRR = 6.03; 95% CI = 2.96-12.28) compared with self-identifying as practicing Islam or Christianity. There are distinctive ethnic and regional differences in tobacco use patterns among Nigerian men, and SLT use was not associated with reduced smoking intensity among dual users.
Janbaz, Khalid Hussain; Qadir, M. Imran; Basser, Hibba Tul; Bokhari, Tanveer Hussain; Ahmad, Bashir
Tobacco products which are used in a way other than smoking are known as smokeless tobacco. The most common smokeless tobaccos are chewing tobacco, naswar, snuff, snus, gutka, and topical tobacco paste. Any product which contains tobacco is not safe for human health. There are more than twenty-five compounds in smokeless tobacco which have cancer causing activity. Use of smokeless tobacco has been linked with risk of oral cancer. Smokeless tobacco contains tobacco-specific nitrosamines (TSNAs...
Ebbert, Jon O.; Glover, Elbert D.; Shinozaki, Eri; Schroeder, Darrell R.; Dale, Lowell C.
Objectives: To investigate predictors of tobacco abstinence among smokeless tobacco (ST) users. Methods: Logistic regression analyses assessed characteristics associated with tobacco abstinence among ST users receiving bupropion SR. Results: Older age was associated with increased tobacco abstinence in both placebo and bupropion SR groups at end…
Laflin, Molly; And Others
Pamphlets, posters, films, videotapes, slide/tape programs, models, teaching guides and packets, booklets, and other resources for smokeless tobacco education are listed. Many of the resources are from nonprofit agencies and are free or minimal cost. (CB)
Glover, Elbert D.; And Others
This literature review delineates the current status of smokeless tobacco, including prevalence, terminology, periodontal effects, and addiction potential. Also discussed is the possible influence on youth of smokeless tobacco use by popular sports figures. (Author/CB)
Wichmann, Susan; Martin, D. R.
Major League Baseball's ban on players using tobacco during minor league games may provide physicians with a timely excuse to discuss smokeless tobacco with young patients. Chewing and dipping remain a significant health problem, especially among young men, many of whom view it as a secret ingredient in sports success. (SM)
Chaloupka, Frank J.; Michael Grossman; John A. Tauras
While much is known about the effects of prices and tobacco control policies on cigarette smoking, relatively little is known about their impact on smokeless tobacco use. This paper addresses these issues using data on smokeless tobacco use by adolescent males taken from the 1992, 1993, and 1994 Monitoring the Future Surveys. Site-specific smokeless tobacco tax data and several measures of limits on youth access to tobacco products are added to the survey data. Ordered probit methods are used...
Wisconsin Clearinghouse, Madison.
This booklet presents, in comic book format, information for children and adolescents on the hazards of using smokeless tobacco. It touches on the use of smokeless tobacco by baseball players, the advertising of smokeless tobacco, and the illegality of selling smokeless tobacco to minors. Health consequences of using smokeless tobacco, including…
Koop, C. Everett
The Surgeon General explains the health risks associated with smokeless tobacco use, analyzes the appeal of tobacco chewing to young males, and looks at what various levels of government and parents can do to discourage the use of smokeless tobacco. (MT)
Burak, Lydia J.
Chewing tobacco and taking snuff are common practices among college athletes. This article describes one college's smokeless tobacco education program for students athletes in the health, physical education, and recreation department. Research on the multiple-strategy intervention indicated decreases in student athletes' smokeless tobacco use and…
Janbaz, Khalid Hussain; Qadir, M Imran; Basser, Hibba Tul; Bokhari, Tanveer Hussain; Ahmad, Bashir
Tobacco products which are used in a way other than smoking are known as smokeless tobacco. The most common smokeless tobaccos are chewing tobacco, naswar, snuff, snus, gutka, and topical tobacco paste. Any product which contains tobacco is not safe for human health. There are more than twenty-five compounds in smokeless tobacco which have cancer causing activity. Use of smokeless tobacco has been linked with risk of oral cancer. Smokeless tobacco contains tobacco-specific nitrosamines (TSNAs), polonium, formaldehyde, cadmium, lead, and benzo[a]pyrene, which are carcinogenic agents. Although there is presence of some compounds, carotenoids and phenolic compounds, that have cancer inhibiting properties, they are in low concentrations. Dry snuff use is linked with higher relative risks, while the use of other smokeless tobacco is of intermediate risk. Moist snuff and chewing tobacco have a very low risk for oral cancer. Therefore, from this review article, it was concluded that smokeless tobacco has risk for oral cancer - either low, medium or high depending on the balance between cancer causing agents and cancer inhibiting agents.
Somatunga, L C; Sinha, D N; Sumanasekera, P; Galapatti, K; Rinchen, S; Kahandaliyanage, A; Mehta, F R; Nishirani Lanka, J D
To comprehensively review the issues of smokeless tobacco use in Sri Lanka . This review paper is based on a variety of sources including Medline, WHO documents, Ministry of Health and Nutrition, Colombo and from other sources. The prevalence of smokeless tobacco (SLT) use in Sri Lanka has been reported high, especially among rural and disadvantaged groups. Different smokeless tobacco products were not only widely available but also very affordable. An increasing popularity of SLT use among the youth and adolescents is a cause for concern in Sri Lanka. There were evidences of diverse benign, premalignant, and malignant oral diseases due to smokeless tobacco use in the country. The level of awareness about health risks related to the consumption of smokeless tobacco products was low, particularly among the people with low socio-economic status. In Sri Lanka various forms of smokeless tobacco products, some of them imported, are used. At the national level, 15.8% used smokeless tobacco products and its use is three-fold higher among men compared to women. Betel quid is by far the traditional form in which tobacco is a general component. Other manufactured tobacco products include pan parag/pan masala, Mawa, Red tooth powder, Khaini, tobacco powder, and Zarda. Some 8.6% of the youth are current users of smokeless tobacco. There are studies demonstrating the harmful effects of smokeless tobacco use, especially on the oral mucosa, however, the level of awareness of this aspect is low. The highest mean expenditure on betel quid alone in rural areas for those earning Rs. 5,000/month was Rs. 952. The core issue is the easy availability of these products. To combat the smokeless tobacco problem, public health programs need to be intensified and targeted to vulnerable younger age groups. Another vital approach should be to levy higher taxation.
Mushtaq, Nasir; Boeckman, Lindsay M; Beebe, Laura A
The prevalence of smokeless tobacco use in the U.S. is increasing and its use is a risk factor for a number of adverse health outcomes. Currently, there is limited evidence on the effectiveness of quitlines for tobacco cessation among smokeless tobacco users. To examine factors related to tobacco abstinence among exclusive smokeless tobacco users registering for services with the Oklahoma Tobacco Helpline. Participants included 959 male exclusive smokeless tobacco users registering with the Helpline between 2004 and 2012; a total of 374 completed a follow-up survey 7 months post-registration. Data were collected between 2004 and 2013 and included baseline data at Helpline registration, services received, and 7-month follow-up for 30-day point-prevalence for tobacco abstinence. Univariate and multiple logistic regression examined associations between abstinence and participant characteristics, intensity of Helpline intervention, and behavioral factors. ORs and 95% CIs were reported. Analyses were completed in 2013. At the 7-month follow-up, 43% of the participants reported 30-day abstinence from tobacco. Each additional completed Helpline call increased the likelihood of tobacco cessation by 20% (OR=1.20, 95% CI=1.05, 1.38). Smokeless tobacco users with higher levels of motivation to quit at baseline were twice as likely to be abstinent than those with low or moderate levels of motivation (OR=2.05, 95% CI=1.25, 3.35). Use of nicotine replacement therapy was not associated with abstinence when adjusted for Helpline calls, income, and level of motivation. Tobacco quitlines offer an effective intervention to increase smokeless tobacco abstinence. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
Adlaf, Edward M.; Smart, Reginald G.
Estimated use and characteristics of users of smokeless tobacco among probability sample of 4,267 Ontario (Canada) teenagers. Results indicated that smokeless tobacco use was not common, varying from one to three percent depending on age and gender, but was more likely to occur among smokers (10% to 32%). Group most prone to use was young smoking…
... 27 Alcohol, Tobacco Products and Firearms 2 2010-04-01 2010-04-01 false Smokeless tobacco tax rates. 40.25 Section 40.25 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE... AND TUBES, AND PROCESSED TOBACCO Taxes § 40.25 Smokeless tobacco tax rates. Smokeless tobacco products...
Agaku, Israel T; Ayo-Yusuf, Olalekan A; Vardavas, Constantine I; Alpert, Hillel R; Connolly, Gregory N
To assess the prevalence and correlates of use of conventional and novel smokeless tobacco products among a national sample of US middle and high school students. Data from the 2011 National Youth Tobacco Survey were analyzed to determine national estimates of current use of conventional ("chewing tobacco", "snuff," or "dip"), novel ("snus" and "dissolvable tobacco products"), and any smokeless tobacco products (novel and/or conventional products) within the past 30 days. The overall prevalence of current use of any smokeless tobacco product was 5.6% (n = 960). Among all students, 5.0% used chewing tobacco, snuff, or dip; 1.9% used snus; and 0.3% used dissolvable tobacco products. Among users of any smokeless tobacco, 64.0% used only conventional products, 26.8% were concurrent users of novel plus conventional products, whereas 9.2% exclusively used novel products. Approximately 72.1% of current any smokeless tobacco users concurrently smoked combustible tobacco products, and only 40.1% expressed an intention to quit all tobacco use. Regression analyses indicated that peer (adjusted odds ratio [aOR]: 9.56; 95% confidence interval [CI]: 7.14-12.80) and household (aOR: 3.32; 95% CI: 2.23-4.95) smokeless tobacco use were associated with smokeless tobacco use, whereas believing that all forms of tobacco are harmful was protective (aOR: 0.55; 95% CI: 0.38-0.79). Conventional smokeless tobacco products remain the predominant form of smokeless tobacco use. Most users of novel smokeless tobacco products also concurrently smoked combustible tobacco products. Smokeless tobacco use was associated with lower perception of harm from all tobacco products and protobacco social influences, indicating the need to change youth perceptions about the use of all tobacco products and to engage pediatricians in tobacco use prevention and cessation interventions.
... 27 Alcohol, Tobacco Products and Firearms 2 2010-04-01 2010-04-01 false Smokeless tobacco tax rates. 41.33 Section 41.33 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE... AND TUBES, AND PROCESSED TOBACCO Taxes Tax Rates § 41.33 Smokeless tobacco tax rates. Smokeless...
Kyaing, N N; Sein, T; Sein, A A; Than Htike, M M; Tun, A; Shein, N N N
Smokeless tobacco (SLT) use in various forms is highly prevalent in Myanmar. The aim of this paper is to study the socio-cultural background of SLT use and products of SLT in Myanmar and the prevalence of SLT based on surveys and from other published data bases. Information was obtained from the literature review and through search on PubMed and Google. The use of SLT is deep rooted in Myanmar culture, and there is also wide-spread belief that it is not as dangerous as smoking. SLT use is growing in Myanmar. About 9.8% of the 13-15-year-old school children and 20.8% adults use SLT; it is many-fold higher among men. The use of SLT is prevalent using many different types of tobacco and forms of its use in Myanmar. The socio-cultural acceptance and the myths were compounded by the lack of specific SLT control component in the National Tobacco Control Legislation adopted needs to be addressed as a priority through intensified community awareness programs, public education programs, and advocacy campaigns. Effective enforcement of the law and amendment to include specific components of SLT in the provisions of the law is highly recommended. The prevalence of SLT is high among school children and adults (especially in men) in Myanmar. Betel quid and tobacco is a common form of SLT use. Although control of smoking and consumption of tobacco product law exists, its implementation is weak.
This study compared the knowledge differences related to specific health concerns of middle school students (N=841) who had never tried, who had tried, and who were regular users of smokeless tobacco. (IAH)
Noland, Melody Powers; Riggs, Richard S.
This article describes a teaching technique based on a method intended to develop skills among junior and senior high school youth to resist pressure to use smokeless tobacco. This method is referred to as "inoculation" and "resistance training." (IAH)
Wilson, Mark G.; Wilson, Katherine Mallender
Instructional materials for teaching about and preventing use of smokeless tobacco are briefly described, including primary prevention sources, secondary prevention sources, films and videotapes, slides and slide-tape sets, and printed materials. (CB)
National Institutes of Health (DHHS), Bethesda, MD. Office of Medical Applications of Research.
Concerned with the increase in use of chewing tobacco and snuff, this brochure looks at the health risks of using smokeless tobacco. It presents five questions about smokeless tobacco use and provides answers to the questions developed by a consensus development conference on health implications of smokeless tobacco use convened by the National…
Mushtaq, Nasir; Beebe, Laura A; Thompson, David M; Skaggs, Valerie J
Few studies have examined the possible increased risk of cardiovascular disease with smokeless tobacco. Existing studies have yielded inconsistent results and have been based on limited populations. The purpose of this study was to assess whether the use of smokeless tobacco increases the risk of cardiovascular disease and to identify higher risk groups. Data from the Behavioral Risk Factor Surveillance System (BRFSS) from 1999 to 2001 for the state of Oklahoma were analyzed. We analyzed 10332 complete records to assess association of any use of smokeless tobacco (over the respondent's life time) with cardiovascular disease. Similarly, the association between cardiovascular disease and individual socio-demographic covariates such as age, gender, smoking, and BMI was checked. As a secondary analysis we explored associations among three categories for smokeless tobacco users, current, former, and never users, with cardiovascular disease. Logistic regression models, which controlled for age, sex, race-ethnicity, obesity, and smoking, estimated the odds of having cardiovascular disease were 1.18 (95% CI: 0.96, 1.45) times higher among smokeless tobacco users. This odds ratio was more than two fold in the Non-White/Hispanic group (O.R. 2.31, 95% CI: 1.42, 3.73). Similarly the odds of cardiovascular disease were higher among female ST users than among females who were non-users of ST (O.R. 1.72 95% CI: 1.12, 2.65). A modest increase in the odds of cardiovascular disease was associated with smokeless tobacco. Two risk groups were identified, females and Non-Whites/Hispanics, whose odds of cardiovascular disease increased with the use of smokeless tobacco.
Chagué, Frédéric; Guenancia, Charles; Gudjoncik, Aurélie; Moreau, Daniel; Cottin, Yves; Zeller, Marianne
Smokeless tobacco (snuff) is a finely ground or shredded tobacco that is sniffed through the nose or placed between the cheek and gum. Chewing tobacco is used by putting a wad of tobacco inside the cheek. Smokeless tobacco is widely used by young athletes to enhance performance because nicotine improves some aspects of physiology. However, smokeless tobacco has harmful health effects, including cardiovascular disorders, linked to nicotine physiological effects, mainly through catecholamine release. Nicotine decreases heart rate variability and the ventricular fibrillation threshold, and promotes the occurrence of various arrhythmias; it also impairs endothelial-dependent vasodilation and could therefore promote premature atherogenesis. At rest, heart rate, blood pressure, inotropism, cardiac output and myocardial oxygen consumption are increased by nicotine, leading to an imbalance between myocardial oxygen demand and supply. The same occurs at submaximal levels of exercise. These increases are accompanied by a rise in systemic resistances. At maximal exercise, heart rate, cardiac output and maximal oxygen uptake (V˙O2max) are unaffected by nicotine. Because endothelial dysfunction is promoted by nicotine, paradoxical coronary vasoconstriction may occur during exercise and recovery. Nicotine induces a decrease in muscular strength and impairs anaerobic performance. However, nicotine is used in sports as it diminishes anxiety, enhances concentration and agility, improves aerobic performance and favours weight control. Importantly, smokeless tobacco, similar to cigarette smoking, leads to nicotine dependence through dopaminergic pathways. Smokeless tobacco has harmful cardiovascular effects and is addictive: it fulfils all the criteria for inclusion in the World Anti-Doping Agency prohibited list as a doping product. Smokeless tobacco use in sporting activities must be discouraged. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
...'' or ``Commission'') has terminated the regulatory review of its regulations (``smokeless tobacco regulations''), implementing the Comprehensive Smokeless Tobacco Health Education Act of 1986 (``Smokeless...-3116. SUPPLEMENTARY INFORMATION: In 1986, Congress enacted the Smokeless Tobacco Act, requiring...
Glover, Elbert D.; And Others
Results are reported from a study which sought to determine prevalence and to delineate patterns of smokeless tobacco use among college students (N=5,894). Analysis of findings produced a profile of the typical college user. Implications of the data for intervention strategies and cessation programs are discussed. (IAH)
Colborn, James W.; And Others
Data are presented on the prevalence and correlates of smokeless tobacco use among 568 adolescents in New York State. Findings suggest that programs that prepare students to cope with social pressures and stress negative consequences of use are more successful than those educating solely about health effects. (JOW)
Hatsukami, Dorothy K; Stepanov, Irina; Severson, Herb; Jensen, Joni A; Lindgren, Bruce R; Horn, Kimberly; Khariwala, Samir S; Martin, Julia; Carmella, Steven G; Murphy, Sharon E; Hecht, Stephen S
Smokeless tobacco products sold in the United States vary significantly in yields of nicotine and tobacco-specific nitrosamines (TSNA). With the passage of the Family Smoking Prevention and Tobacco Control Act, the Food and Drug Administration now has the authority to establish product standards. However, limited data exist determining the relative roles of pattern of smokeless tobacco use versus constituent levels in the smokeless tobacco product in exposure of users to carcinogens. In this study, smokeless tobacco users of brands varying in nicotine and TSNA content were recruited from three different regions in the U.S. Participants underwent two assessment sessions. During these sessions, demographic and smokeless tobacco use history information along with urine samples to assess biomarkers of exposure and effect were collected. During the time between data collection, smokeless tobacco users recorded the amount and duration of smokeless tobacco use on a daily basis using their diary cards. Results showed that independent of pattern of smokeless tobacco use and nicotine yields, levels of TSNA in smokeless tobacco products played a significant role in carcinogen exposure levels. Product standards for reducing levels of TSNA in smokeless tobacco products are necessary to decrease exposure to these toxicants and potentially to reduce risk for cancer. ©2014 American Association for Cancer Research.
Rankin, K Vendrell; Jones, Daniel L; Benton, Elain
Tobacco companies continue to develop and aggressively market new products for oral use. Most new products are intended to dissolve in the mouth and swallow rather than spit out the juices. These products effectively circumvent smoke-free policies, decrease tobacco cessation efforts, and create individuals who use both smokeless tobacco (ST) and cigarettes. All ST products contain nicotine, carcinogens, and pose multiple health risks. The cancer and health risks associated with ST use extend well beyond the changes in the oral cavity and the risk of oral cancer. Unlike cigarettes, the contents of ST vary widely by brand and product posing difficulty in the use of the available pharmacotherapy for cessation. Although no uniform guidelines exist for the use of pharmacotherapy for smokeless tobacco cessation, research suggests that use of these drugs is effective. The most important motivator for quitting ST cessation remains in the hands of the dentist.
Bhisey, R A
In most parts of the world, tobacco is used for smoking, whereas, in India, tobacco is used for smoking as well as in diverse smokeless forms. Absorption of toxic and carcinogenic chemicals in tobacco and other ingredients added to various products are causally associated with several non-communicable diseases including cancer, especially oral cancer, which is the leading cancer among men and the third most common cancer among women in India. This article highlights the toxicity, mutagenecity and carcinogenic effects of hazardous chemicals present in smokeless tobacco products. This endeavor was based on the extensive review of literature from various sources. The SLT products have influence on cellular metabolism, ability to cause DNA damage, and cancer in experimental animals. It is, therefore, essential to consider the collective role of chemical constituents of SLT products in the causation of adverse effect on human health.
Sand, Lars; Wallström, Mats; Hirsch, Jan-Michaél
Oral Squamous Cell Carcinoma (OSCC) is the most common epithelial malignancy in the oral cavity. OSCCs and their variants constitute over 90% of oral malignancies, and the disease is associated with poor prognosis. OSCC is a complex malignancy where environmental factors, viral infections, and genetic alterations most likely interact, and thus give rise to the malignant condition. The International Agency for Research on Cancer (IARC) in 2007 concluded: "there is sufficient evidence in humans to establish smokeless tobacco as carcinogenic, i.e. smokeless tobacco causes cancer of the oral cavity and pancreas". ST products contain a large array of carcinogens, although the number found is actually smaller than in cigarette smoke. Worldwide, ST products have many different names depending on the region where it is produced. However, there are two main types of ST, chewing tobacco and snuff. It is estimated that approximately 150 million people in the world use ST. Herein, we review available literature regarding smokeless tobacco and oral Carcinogenesis. We also discuss the role of viral infections in combination with ST in OSCC development.
Conway, Terry L.; Cronan, Terry A.
This study examined the relationships among physical fitness, exercise activity, and both cigarette smoking and smokeless tobacco use among 2,800 United States Navy men. Subgrouping individuals according to their self-reported use of tobacco resulted in maximum sample sizes of 1,406 nonusers, 161 smokeless tobacco users, and 1,233 cigarette…
Kulkarni, Varun; Uttamani, Juhi Raju; Bhatavadekar, Neel B
Investigating the comparative effect of cigarette smoking and smokeless-tobacco use on periodontal health. There is a dearth of studies comparing the effects of smoking and smokeless tobacco on periodontal health. Smokeless tobacco is emerging as a major public health hazard, but is often neglected as a risk factor by many clinicians. A cross-sectional study of 286 subjects was conducted. The participants were divided into mutually exclusive groups (i.e. any subject who had the habit of both smoking as well as smokeless tobacco usage was excluded from the study), as follows: a smoking group (SG; n=121); a smokeless-tobacco group (ST; n=81); and a non-tobacco-consuming group (NT; n=84). Data were obtained using a questionnaire and by clinical examination. The Periodontal Disease Index (PDI) and Oral Hygiene Index-Simplified (OHI-S) were used to clinically evaluate the periodontal and dental health status of the subjects. Multivariate analysis was performed to identify statistical correlations. The Plaque Index was higher in the ST group than in the SG group and was statistically significantly higher in the ST group than in the NT group. Probing depth and gingival inflammation (components of the PDI) were also higher in the ST group than in the SG and NT groups, but this was not statistically significant. Within the limits of the study, and for this study population, the impact on the periodontium as a result of smokeless tobacco use appeared to be comparable with that of smoking tobacco. The results of this study affirm the need to consider smokeless tobacco as a possible contributory factor to periodontal disease, in addition to smoking, and to counsel patients accordingly. Further randomised clinical trials are necessary to validate the long-term impact of smokeless tobacco on periodontal disease. © 2015 FDI World Dental Federation.
McCarthy, William J.; And Others
Surveyed 2,926 seventh, ninth, and eleventh graders on smokeless tobacco and other substance use. Examined patterns smokeless tobacco use relative to other drug use, particularly cigarette smoking. Data supported view that recent increases in smokeless tobacco use were related to male tobacco users' belief that smokeless tobacco was less harmful…
Background: Tobacco use in smokeless and smoked forms is preventable cause of mortality and morbidity worldwide. Objective: To determine the prevalence of smokeless tobacco use and the association with tooth loss and oral health problems among adults in Cameroon. Methods: Adults dwelling in the Fokoue area of ...
Glover, Elbert D.; And Others
Describes the evaluation of various components of a self-help smokeless tobacco cessation manual that used relapse prevention, social contracting, and peer education to help high school seniors. Results suggest that use of the manual effectively helped reduce smokeless tobacco use. Recommendations for persons using the manual are included. (SM)
Dignan, Mark; And Others
Surveyed seventh-grade students from two school districts in rural North Carolina to determine the prevalence and correlates of smokeless tobacco use. Of those reporting use of smokeless tobacco, virtually all were male. Locus of control of "occasional" users was significantly more internal than those reporting "regular" use.…
Epithelial cells are the first line of defense against pathogens in the oral cavity. The results suggest that smokeless tobacco not only inhibits the growth of epithelial cells but also induce the generation of inflammatory cytokines which leads to smokeless tobacco-exacerbated disease.
... HUMAN SERVICES Food and Drug Administration 21 CFR Part 1142 Smokeless Tobacco Product Warning... the use of smokeless tobacco products. DATES: Submit electronic or written comments by April 1, 2013... the Comprehensive Smokeless Tobacco Health Education Act (Smokeless Tobacco Act) (15 U.S.C. 4402) to...
... warning statements on smokeless tobacco packages. 307.11 Section 307.11 Commercial Practices FEDERAL TRADE COMMISSION REGULATIONS UNDER SPECIFIC ACTS OF CONGRESS REGULATIONS UNDER THE COMPREHENSIVE SMOKELESS TOBACCO... smokeless tobacco packages. (a) In the case of the package of a smokeless tobacco product, each of the three...
Sein, T; Swe, T; Toe, M M; Zaw, K K; Sein, T O
Myanmar Tobacco Control Law of 2006 covers the control of all forms of tobacco use. After 7-year, tobacco use among adults did not see a decrease. The paper aimed to study the prevalence, details of the products, trade, legislation, tax, marketing, advertising and evidence on morbidity and mortality, and to make recommendations for policy options. Personal communications by authors and colleagues, and searches by keywords in PubMed and on Google, literature review and research from published reports, and various studies and surveys conducted in Myanmar and other countries. Smokeless tobacco use in Myanmar is the highest among ASEAN countries. A variety of SLT products used together with betel chewing poses a challenge; betel quid chewing has been accepted as a cultural norm in both rural and urban areas. Betel quid chewing usually starts at younger ages. Sale, marketing, and advertising of SLT are not under control and thus, road-side kiosks selling betel quid with SLT are mushrooming. Considerable trade of SLT products by illegal and legal means created an increase in access and availability. Low cost of SLT product enables high volume of use, even for the poor families. Taxation for raw tobacco and tobacco products is half the values of the tax for cigarettes. Effective enforcement, amendment of the law, and action for social change are needed.
Davila Evelyn P; Arheart Kristopher L; McCollister Kathryn E; LeBlanc William G; Fleming Lora E; Lee David J; Dietz Noella A; Caban-Martinez Alberto J
Abstract The primary aim was to examine whether increasing workplace smoking restrictions have led to an increase in smokeless tobacco use among US workers. Smokeless tobacco exposure increases the risk of oral cavity, esophageal, and pancreatic cancers, and stroke. The prevalence of smokeless tobacco use decreased from 1987-2000, except among men 25-44. While smokeless tobacco use has declined in the general population, it may be that the prevalence of smokeless tobacco use has increased amo...
... 20 Cigarettes and Smokeless Tobacco--Prohibited in All Outbound and Inbound International Mail... inbound and outbound tobacco cigarettes and smokeless tobacco with an incorrect effective date. This... 20, that provides that cigarettes (including roll-your-own tobacco) and smokeless tobacco products...
Han, Jing; Sanad, Yasser M; Deck, Joanna; Sutherland, John B; Li, Zhong; Walters, Matthew J; Duran, Norma; Holman, Matthew R; Foley, Steven L
There are an estimated 8 million users of smokeless tobacco products (STPs) in the United States, and yet limited data on microbial populations within these products exist. To better understand the potential microbiological risks associated with STP use, a study was conducted to provide a baseline microbiological profile of STPs. A total of 90 samples, representing 15 common STPs, were purchased in metropolitan areas in Little Rock, AR, and Washington, DC, in November 2012, March 2013, and July 2013. Bacterial populations were evaluated using culture, pyrosequencing, and denaturing gradient gel electrophoresis (DGGE). Moist-snuff products exhibited higher levels of bacteria (average of 1.05 × 106 CFU/g STP) and diversity of bacterial populations than snus (average of 8.33 × 101 CFU/g STP) and some chewing tobacco products (average of 2.54 × 105 CFU/g STP). The most common species identified by culturing were Bacillus pumilus, B. licheniformis, B. safensis, and B. subtilis, followed by members of the genera Oceanobacillus, Staphylococcus, and Tetragenococcus. Pyrosequencing analyses of the 16S rRNA genes identified the genera Tetragenococcus, Carnobacterium, Lactobacillus, Geobacillus, Bacillus, and Staphylococcus as the predominant taxa. Several species identified are of possible concern due to their potential to cause opportunistic infections and reported abilities to reduce nitrates to nitrites, which may be an important step in the formation of carcinogenic tobacco-specific N'-nitrosamines. This report provides a microbiological baseline to help fill knowledge gaps associated with microbiological risks of STPs and to inform potential regulations regarding manufacture and testing of STPs. It is estimated that there 8 million users of smokeless tobacco products (STPs) in the United States; however, there are limited data on microbial populations that exist within these products. The current study was undertaken to better understand the potential microbiological
Williams, Tom; And Others
This study determined the prevalence of smokeless tobacco use among high school students in selected rural communities in Arkansas and identified factors associated with initiation and maintenance of use. Implications for health educators are discussed. (Author/MT)
Shammah is a preparation of smokeless tobacco (ST) that is frequently used in the Arabian Peninsula, especially in Saudi Arabia. A mixture of powdered tobacco, lime, ash, black pepper, oils and flavorings, shammah in is placed in the buccal cavity or lower labial vestibule of the mouth. The user (or dipper) spits out insoluble debris. ST is linked to a number of harmful effects such as dental disease, oral cancer, oesophagus cancer, and pancreas cancer. It also causes adverse reproductive effects including stillbirth, premature birth and low birth weight. The importation of ST products is prohibited in Saudi Arabia. Legislative action to combat the use of ST (moist snuff and chewing tobacco) in Saudi Arabia appeared in 1990. The actual percentage use may be higher than reported since shammah is illegal in Saudi Arabia and there may be some unwillingness to admit to its use. Data on ST use in the Arabian Peninsula are sparse. Most studies conducted there focused on the prevalence of shammah use among adolescents rather than among adults. This review paper aimed to understand the pattern of use of shammah and its adverse health effects. It also aimed to provide suitable epidemiological data for public health policy makers. Creative Commons Attribution License
Mushtaq, Nasir; Beebe, Laura A
Variants of the Fagerström Tolerance Questionnaire and Fagerström Test for Nicotine Dependence (FTND) are widely used to study dependence among smokeless tobacco (ST) users. However, there is a need for a dependence measure which is based on the clinical definition of dependence and is easy to administer. The Tobacco Dependence Screener (TDS), a self-administered 10-item scale, is based on the Diagnostic and Statistical Manual, fourth edition (DSM-IV) and ICD-10 definitions of dependence. It is commonly used as a tobacco dependence screening tool in cigarette smoking studies but it has not been evaluated for dependence in ST users. The purpose of this study is to evaluate the TDS as a measure of tobacco dependence among ST users. Data collected from a community-based sample of exclusive ST users living in Oklahoma (n = 95) was used for this study. TDS was adapted to be used for ST dependence as the references for smoking were changed to ST use. Concurrent validity and reliability of TDS were evaluated. Salivary cotinine concentration was used as a criterion variable. Overall accuracy of the TDS was assessed by receiver's operating characteristic (ROC) curve and optimal cutoff scores for dependence diagnosis were evaluated. There was no floor or ceiling effect in TDS score (mean = 5.42, SD = 2.61). Concurrent validity of TDS as evaluated by comparing it with FTND-ST was affirmative. Study findings showed significant association between TDS and salivary cotinine concentration. The internal consistency assessed by Cronbach's alpha indicated that TDS had acceptable reliability (α = 0.765). TDS was negatively correlated with time to first chew/dip and positively correlated with frequency (number of chews per day) and years of ST use. Results of logistic regression analysis showed that at an optimal cutoff score of TDS 5+, ST users classified as dependent had significantly higher cotinine concentration and FTND-ST scores. TDS demonstrated acceptable reliability and
McAdam, Kevin; Kimpton, Harriet; Vas, Carl; Rushforth, David; Porter, Andrew; Rodu, Brad
There is considerable interest from a regulatory and public health perspective in harmful and potentially harmful constituents in tobacco products, including smokeless tobacco products (STPs). A wide range of commercial STPs from the US and Sweden, representing 80-90 % of the 2010 market share for all the major STP categories in these two countries, were analysed for the IARC Group 2A carcinogen acrylamide. These STPs comprised the following styles: Swedish loose and portion snus, US snus, chewing tobacco, moist snuff, dry snuff, soft pellet, hard pellet and plug. Acrylamide was detected in all the products tested and quantified in all but one product. Concentrations ranged from 62 to 666 ng/g wet weight basis (WWB). The average levels of acrylamide (WWB) by type of STP were not significantly different (p > 0.05) except for US snus which had, on average, greater levels but with a very wide range of individual levels according to the manufacturer. Acrylamide levels in STPs were significantly and positively correlated with pH, but not with levels of either reducing sugars or ammonia nitrogen. Levels of acrylamide increased by sixfold or more (on a dry weight basis) during manufacture of a snus sample and then decreased during subsequent storage for up to 22 weeks. Acrylamide generation in tobacco generally appears to occur at lower temperatures, but longer time scales than found with food production. Acrylamide is a common contaminant of STPs, formed through heat treatment of tobacco. Our data show that exposure to acrylamide from consumption of STPs is small compared with exposure from food consumption or cigarette smoking.
Kostygina, Ganna; Ling, Pamela M
While fruit, candy and alcohol characterising flavours are not allowed in cigarettes in the USA, other flavoured tobacco products such as smokeless tobacco (ST) continue to be sold. We investigated tobacco manufacturers' use of flavoured additives in ST products, the target audience(s) for flavoured products, and marketing strategies promoting products by emphasising their flavour. Qualitative analysis of internal tobacco industry documents triangulated with data from national newspaper articles, trade press and internet. Internally, flavoured products have been consistently associated with young and inexperienced tobacco users. Internal studies confirmed that candy-like sweeter milder flavours (eg, mint, fruit) could increase appeal to starters by evoking a perception of mildness, blinding the strong tobacco taste and unpleasant mouth feel; or by modifying nicotine delivery by affecting product pH. Similar to cigarettes, flavoured ST is likely to encourage novices to start using tobacco, and regulations limiting or eliminating flavours in cigarettes should be extended to include flavoured ST products. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Horn, Kimberly A.; Maniar, Sameep D.; Dino, Geri A.; Gao, Xin; Meckstroth, Richard L.
Surveyed West Virginia middle- and high-school coaches' attitudes toward smokeless tobacco, actions toward athletes who used smokeless tobacco, intentions to provide interventions for users, and tobacco-use history. Results indicated that coaches had unfavorable attitudes toward smokeless tobacco, perceived it as a problem, and were willing to…
Dave, Dhaval; Saffer, Henry
While the prevalence of smokeless tobacco (ST) is low relative to smoking, the distribution of ST use is highly skewed with consumption concentrated among certain segments of the population (rural residents, males, whites, low-educated individuals). Furthermore, there is suggestive evidence that use has trended upwards recently for groups that have traditionally been at low risk of using ST, and thus started to diffuse across demographics. This study provides the first estimates, at the national level, of the effects of magazine advertising on ST use. The focus on magazine advertising is significant given that ST manufacturers have been banned from using other conventional media since the 1986 Comprehensive ST Act and the 1998 ST Master Settlement Agreement. This study is based on the 2003–2009 waves of the National Consumer Survey (NCS), a unique data source that contains extensive information on the reading habits of individuals, matched with magazine-specific advertising information over the sample period. This allows detailed and salient measures of advertising exposure at the individual level and addresses potential bias due to endogeneity and selective targeting. We find consistent and robust evidence that exposure to ST ads in magazines raises ST use, especially among males, with an estimated elasticity of 0.06. There is suggestive evidence that both ST taxes and cigarette taxes reduce ST use, indicating contemporaneous complementarity between these tobacco products. Sub-analyses point to some differences in the advertising and tax response across segments of the population. The effects from this study inform the debate on the cost and benefits of ST use and its potential to be a tool in overall tobacco harm reduction. PMID:23660106
Whitehead, Todd P; Havel, Christopher; Metayer, Catherine; Benowitz, Neal L; Jacob, Peyton
Smokeless tobacco products, such as moist snuff or chewing tobacco, contain many of the same carcinogens as tobacco smoke; however, the impact on children of indirect exposure to tobacco constituents via parental smokeless tobacco use is unknown. As part of the California Childhood Leukemia Study, dust samples were collected from 6 homes occupied by smokeless tobacco users, 6 homes occupied by active smokers, and 20 tobacco-free homes. To assess children's potential for exposure to tobacco constituents, vacuum-dust concentrations of five tobacco-specific nitrosamines, including N'-nitrosonornicotine [NNN] and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone [NNK], as well as six tobacco alkaloids, including nicotine and myosmine, were quantified by liquid chromatography-tandem mass spectrometry (LC-MS/MS). We used generalized estimating equations derived from a multivariable marginal model to compare levels of tobacco constituents between groups, after adjusting for a history of parental smoking, income, home construction date, and mother's age and race/ethnicity. The ratio of myosmine/nicotine was used as a novel indicator of the source of tobacco contamination, distinguishing between smokeless tobacco products and tobacco smoke. Median dust concentrations of NNN and NNK were significantly greater in homes with smokeless tobacco users compared to tobacco-free homes. In multivariable models, concentrations of NNN and NNK were 4.8- and 6.9-fold higher, respectively, in homes with smokeless tobacco users compared to tobacco-free homes. Median myosmine/nicotine ratios were lower in homes with smokeless tobacco users (1.8%) compared to homes of active smokers (7.7%), confirming that cigarette smoke was not the predominant source of tobacco constituents in homes with smokeless tobacco users. Children living with smokeless tobacco users may be exposed to carcinogenic tobacco-specific nitrosamines via contact with contaminated dust and household surfaces.
Messer, Karen; Vijayaraghavan, Maya; White, Martha M.; Shi, Yuyan; Chang, Cindy; Conway, Kevin P.; Hartman, Anne; Schroeder, Megan J.; Compton, Wilson M.; Pierce, John P.
Introduction Concurrent use of cigarettes and smokeless tobacco is common, but little is known regarding the association of smokeless tobacco use with cigarette smoking cessation. Dual users may have lower cigarette consumption levels, which may also play a role in smoking cessation. Methods The 2010–2011 Tobacco Use Supplement to the Current Population Survey included 26,760 current cigarette smokers, of which 675 concurrently used smokeless tobacco. We compared characteristics of the most recent cigarette smoking quit attempt of the past year between dual users and exclusive smokers, using multivariate regression. Results Dual users (45%) were more likely than exclusive smokers (37%) to have made a cigarette smoking quit attempt during the previous year (pcigarette dependence levels (ORadj 1.33, 95% CI 1.15–1.53). Half (48%) of dual users who made a quit attempt tried to quit “by switching to smokeless tobacco”. However, once in a quit attempt, dual users relapsed more quickly than exclusive smokers (Cox regression HRadj 1.13, 95% CI 1.02–1.26). There was no difference in 30-day abstinence rates on the most recent quit attempt (ORadj 1.09, 95% CI 0.88–1.37). For both groups, the best predictor of past 30-day abstinence was cigarette consumption level. Conclusions Current cigarette smokers who also use smokeless tobacco are more likely to have tried to quit, but relapse more quickly than exclusive smokers, and are not more likely to have attained 30 day smoking cessation. Prospective studies at the population level are needed. PMID:26253939
GULYAMOV SURAT S.; GAYBULLAEV ELBEK A; Sadykov, R. R.
Oral cancer is one of the most common cancers in Uzbekistan and is appeared to be most common cancers worldwide. All forms of tobacco have been implicated as causative agents including cigarette, cigar and pipe tobacco, as well as chewing tobacco. It is important to differentiate between conventional loose leaf (traditional) forms of smokeless tobaccos and the newer types such as snus, there is a significant difference in risk. Gingival inflammation, periodontal inflammation, and alveolar bon...
Smokeless tobacco products were branded as nutritional supplements with different tastes and strengths, ideal for enticing the curiosity of adolescents. Given the crafty practice of the tobacco industry and salesmen, there is need for monitoring of availability of these products in circulation and enforcement of the ban ...
The study aim was to establish the prevalence and determinants of smokeless tobacco use in Nigerian adults' population. Across-sectional survey of 1776 adults inYola, North-East Nigeria was carried out in June 2007.A modified World Health Organization (WHO) tobacco survey questionnaire was used for interview and ...
Spangler, John; Song, Eunyoung; Pockey, Jessica; Sutfin, Erin L.; Reboussin, Beth A.; Wagoner, Kimberly; Wolfson, Mark
Objective: Smokeless tobacco (SLT) use is associated with specific adverse health effects. Knowledge of student tobacco use, including SLT, may guide inquiry into other risky health behaviors, and provide opportunities for health education of students. Design: An incentivized email invitation to complete a web-based survey was sent to students at…
Lopez, Linda C.
A modified version of the Illinois Department of Public Health Tobacco Use Survey was used to assess smokeless tobacco consumption among students attending a state university in New Mexico. Respondents included 65 male and 83 female Mexican-Americans, as well as 59 male and 118 female Anglo-Americans. Ages ranged from 16 to 67; subgroup median…
Newman, Ian M.; Shell, Duane F.
Objective: To examine the role of expectancies in adolescent smokeless tobacco (ST) use. Methods: Self-report measures of students' ST expectancies, cigarette and ST use, and peer and family tobacco use were collected from a sample of 978 rural high school students. Results: Student expectancy beliefs significantly predicted ST use and intention…
Nargis, N; Hussain, A K M G; Fong, G T
Smokeless tobacco use occupies a significant portion of overall tobacco consumption in Bangladesh. Yet very little is known about the effectiveness of tax and price policy in controlling the use of smokeless tobacco use in the country. The paper examines the price distribution of various smoked (cigarette, bidi) and smokeless tobacco products (zarda, gul) using the univariate Epanechnikov kernel density function. It estimates the own and cross price elasticity of demand for the most widely used smokeless tobacco product zarda using two-step regression analysis. The analysis is based on data from the ITC Bangladesh Wave 3 Survey which is a nationally representative cohort survey of tobacco users and nonusers conducted in in Bangladesh during 2011-12. The price elasticity of lower price brands of zarda is estimated at -0.64 and of higher priced brands at -0.39, and the cross price elasticity of zarda with respect to cigarette price at 0.35. The tax increase on smokeless tobacco needs to be greater than the tax increase on smoked tobacco to bridge the wide price differential between the two types of products that currently encourages downward substitution from smoked to smokeless tobacco and discourages quitting behavior. This paper argues that increasing tax on smokeless tobacco simultaneously with the tax increase on smoked tobacco can have significant negative impact on the prevalence of smokeless tobacco use in Bangladesh. Finally, a specific excise system replacing the existing ad valorem excise tax can substantially contribute to the revenue collection performance from smokeless tobacco products.
Koregol, Arati C; Kalburgi, Nagaraj B; Wagh, Apoorva U Kamat; Warad, Shivraj
Oxidative Stress (OS) is implicated in the pathogenesis of many systemic and oral diseases such as periodontal disease. Smokeless tobacco extract produces apoptosis and causes an imbalance between reactive oxygen species and antioxidants, such as Gamma Glutamyl Transpeptidase (GGT). Epidemiological research implied serum GGT within its normal range to be an early sensitive enzyme related to OS. To assess how GGT fares as a biomarker in periodontitis subjects with or without the usage of smokeless tobacco and correlate it with clinical parameters. Ninety subjects were divided into three groups of healthy, chronic periodontitis, and smokeless tobacco users with chronic periodontitis from the dental outpatient department of P.M. Nadagouda Memorial Dental College and Hospital. Serum samples of patients were collected after obtaining consent and analyzed for GGT. Statistical Analysis was performed using ANOVA, and Pearson's correlation coefficient. GGT levels were found to be significantly higher in chronic periodontitis patients compared to smokeless tobacco users with chronic periodontitis and healthy subjects. Conclusion: GGT may be used as a quick, easy and precise marker for measuring OS in patients with chronic periodontitis and smokeless tobacco users.
Begum, Shahina; Schensul, Jean J; Nair, Saritha; Donta, Balaiah
The use of smokeless tobacco (SLT) among women is increasing in India, especially among those with limited education and resources. Preventing the initiation of SLT among women is critical since it has known negative consequences for oral and reproductive health. Most research on tobacco initiation in India focuses on adolescents. This paper addresses the unrecognized issues of post marital initiation among women of reproductive age, highlighting the importance of reproductive stages in women's tobacco initiation. The objective is to examine the correlates of SLT initiation among low income women in Mumbai from pre-marriage through early marriage, first pregnancy and beyond, using case examples to illustrate initiation during each of these stages. In 2011-2012, cross-sectional community level survey data were collected from a representative sample of 409 daily SLT-using married women aged 18-40 years in a low income community in Mumbai. Information on socio-demographics, initiation by reproductive stage, types of tobacco use, childhood exposure to tobacco, learning to use, and initiation influences and reasons were collected through a researcher-administered survey. Univariate and bivariate analysis assessed factors influencing initiation of SLT use by reproductive stage. In addition 42 narratives of tobacco use were collected from a purposive sample of pregnant and non-pregnant married women addressing the same questions in detail. Narratives were transcribed, translated, and coded for key concepts including initiation of tobacco use. Thirty-two percent of women initiated SLT use before marriage, 44% initiated after marriage but before pregnancy, 18.1% initiated during their first pregnancy and the remainder started after their first pregnancy. Mean age of marriage among women in this study was 16 years. Younger women (i.e. age at time of the interview of less than 30 years) were 0.47 [95% CI (0.32, 0.87)] percent less likely to initiate after marriage than women
... CFR Part 307 Regulations under the Comprehensive Smokeless Tobacco Health Education Act; Termination...''), , implementing the Comprehensive Smokeless Tobacco Health Education Act of 1986 (``Smokeless Tobacco Act''). The... out a method for the display and rotation of the statutory health warnings on the objects subject to...
... 20 Cigarettes and Smokeless Tobacco--Prohibited in All Outbound and Inbound International Mail AGENCY... tobacco cigarettes and smokeless tobacco. These provisions implement specific requirements of the Prevent All Cigarette Trafficking (PACT) Act, which restricts the mailability of cigarettes and smokeless...
LF, Lopez-Guzman A, Hodges JS. The association of periodontal disease parameters with systemic medical conditions and tobacco use. J Clin...reproductions will be in black and white. 14. ABSTRACT While smoking cessation has received considerable attention within the military, the use of...smokeless tobacco (chewing tobacco and snuff) has not been a focus of medical services or research. Epidemiological data suggest that while smoking
This podcast helps retailers understand new federal regulations surrounding the sale of unpackaged tobacco products. To comply with the law, retailers may not break open packages of cigarettes or smokeless tobacco to sell or distribute as single or smaller quantities. Created: 10/28/2010 by The CDC Division of News and Electronic Media and the FDA Center for Tobacco Products. Date Released: 10/28/2010.
Robertson, J.B.; Bray, J.T.
Using X-ray fluorescence spectrometry, 11 heavy elements at concentrations that are easily detectable have been identified in smokeless tobacco products. These concentrations were found to increase in cheek epithelium samples of the user after exposure to smokeless tobacco. This feasibility study suggests that the level of strontium in the cheek epithelium could be a valid measure of recent smokeless tobacco use. It also demonstrates that strontium levels become undetectable within several days of smokeless tobacco cessation. This absence of strontium could validate a self-report of abstinence from smokeless tobacco. Finally, the X-ray spectrum of heavy metal content of cheek epithelium from smokeless tobacco users could itself provide a visual stimulus to further motivate the user to terminate the use of smokeless tobacco products.
... satisfactory plan for advertising in newspapers, magazines, or other periodicals could provide for rotation... warning statements in smokeless tobacco advertising. 307.12 Section 307.12 Commercial Practices FEDERAL... warning statements in smokeless tobacco advertising. (a) In the case of advertising for a smokeless...
Sep 3, 2013 ... received previous dental care than smokeless tobacco users. However, it was only age ... poor oral hygiene, dental caries, gingival recession, leukoplakia, erythroplakia, abnormal growth, tooth wear lesion, experienced tooth loss and .... of wear facets from attrition, abrasion and erosion. The presence of ...
Williams, Nancy J.; And Others
Reports a study that evaluated the appropriateness and effectiveness of a self-help manual for postsecondary education students who used smokeless tobacco. Students participated in groups that received either two or four sessions of support for using the self-help manual. Results indicated both groups produced similar cessation rates. (SM)
Lopez, Linda C.; Hamlin, Penelope A.
A survey of 208 female and 191 male students attending a public high school in southwestern New Mexico assessed the extent of student use of smokeless tobacco products. The sample included 179 Mexican-American and 26 Anglo-American females, as well as 152 Mexican-American and 26 Anglo-American males. The average age of both female and male…
Hatsukami, Dorothy; And Others
Examined the effects of 2 mg of nicotine polacrilex versus placebo gum and a group behavioral treatment versus minimal contact on cessation of smokeless tobacco use. Participants (n=210) were randomly assigned 1 of the 4 treatment conditions. Withdrawal symptoms were assessed throughout the treatment. Discusses findings. (KW)
Levenson-Gingiss, Phyllis; And Others
This study was designed to identify the frequency, patterns, and determinants of smokeless tobacco use among undergraduate college and university athletes (N=261) and to explore whether these factors were associated with athletic status (varsity and intramural) and sport (football and baseball) participation. (IAH)
Wisniewski, John F.; And Others
Results are reported from a study in which high school baseball players (N=511) were surveyed to determine the prevalence and cultural distribution of smokeless tobacco usage and to assess the level of knowledge regarding its harmful effects. Subjects resided in the New York City-New Jersey metropolitan area. (IAH)
Nemeth, J.M.; Liu, S.-T.; Klein, E.G.; Ferketich, A.K.; Kwan, M.P.; Wewers, M.E.
The burden of smokeless tobacco (ST) use disproportionally impacts males in rural Ohio Appalachia. The purpose of this study was to describe the cultural factors contributing to this disparity and to articulate the way in which culture, through interpersonal factors (i.e. social norms and
Kostova, Deliana; Dave, Dhaval
Although the primary form of tobacco use worldwide is cigarette smoking, the large majority of users in India consume smokeless forms of tobacco. There is little evidence on the role of policy-related factors in shaping the demand for smokeless tobacco (ST) in India. This study evaluates the relationship between two such factors, prices and advertising, and ST use in India, using data on 67,737 individuals from the Global Adult Tobacco Survey (GATS) India 2009. We find that ST advertising is more likely to influence ST consumption in women than men, while men are more likely to respond to changes in ST price. We estimate that among adult males in India, the total price elasticity of ST demand is -0.212, which is close to estimates reported for males in the U.S. We do not find strong direct evidence on the economic substitutability or complementarity of smoked and smokeless products. However, the positive association between former smoking and current smokeless use may point to temporal substitutability at the individual level. The findings have implications on the relative effectiveness of policy tools across genders in India - increasing the prices of ST products may discourage ST use particularly among men, and advertising restrictions may play a relatively larger role in the consumption behavior of women in India. Published by Elsevier Ltd.
LeSage, Mark G; Burroughs, Danielle; Muelken, Peter; Harris, Andrew C
Preclinical abuse liability assessment is an essential component of tobacco regulatory science. The goal of this project was to evaluate the relative abuse liability of smokeless tobacco products in rats using aqueous extracts of those products. These extracts provide exposure to an extensive range of nicotine and non-nicotine tobacco constituents as occurs in humans. Rats were trained to self-administer either nicotine alone or extracts of Camel Snus or Kodiak smokeless tobacco at an equivalent nicotine unit dose. In Experiment 1, the relative reinforcing efficacy of these formulations was assessed in adults and adolescents using a progressive ratio schedule under limited-access conditions. In Experiment 2, relative reinforcing efficacy was assessed in adolescents under unlimited-access conditions using behavioral economic demand curve analysis. The reinforcing efficacy of nicotine formulations was higher in adolescents than adults, but no difference was observed between formulations in either age group. Similarly, there was no difference in elasticity of demand between formulations in adolescents. The present findings suggest that the abuse liability of these smokeless tobacco products is similar to nicotine alone, and that nicotine dose is the primary determinant of the reinforcing efficacy of systemic exposure to these products.
Mejia, Adrienne B.
Since 2006, RJ Reynolds (RJR) and Philip Morris have both introduced new smokeless “snus” tobacco products. We analyzed previously secret tobacco industry documents describing the history of RJR and Philip Morris's consumer research, smokeless product development, and marketing strategies. We found that RJR had invested in smokeless research, development, and marketing since 1968. RJR first targeted low-income males through sampling and sponsorship at fishing, rodeo, and baseball events, and through advertising portraying the user as “hard working.” In the early 1990s, Philip Morris and RJR hoped to attract more urban, female smokeless users. The current “snus” campaigns appear to appeal to these targeted consumers and smokers in smoke-free environments. These efforts may expand the tobacco market and undermine smoking cessation. PMID:19910355
Mejia, Adrienne B; Ling, Pamela M
Since 2006, RJ Reynolds (RJR) and Philip Morris have both introduced new smokeless "snus" tobacco products. We analyzed previously secret tobacco industry documents describing the history of RJR and Philip Morris's consumer research, smokeless product development, and marketing strategies. We found that RJR had invested in smokeless research, development, and marketing since 1968. RJR first targeted low-income males through sampling and sponsorship at fishing, rodeo, and baseball events, and through advertising portraying the user as "hard working." In the early 1990s, Philip Morris and RJR hoped to attract more urban, female smokeless users. The current "snus" campaigns appear to appeal to these targeted consumers and smokers in smoke-free environments. These efforts may expand the tobacco market and undermine smoking cessation.
Rostron, Brian L.; Chang, Cindy M.; van Bemmel, Dana M.; Xia, Yang; Blount, Benjamin C.
Background It has been suggested that smokeless tobacco users have high levels of exposure to nicotine and some toxic substances as measured by biomarker concentrations, but studies with nationally representative data have been limited. Methods We analyzed biomarkers of tobacco exposure for 23,684 adult participants from the National Health and Nutrition and Examination Survey (NHANES) from 1999-2012. The biomarkers analyzed were serum cotinine, urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), blood lead, blood cadmium, blood mercury, urinary arsenic, and urinary N-acetyl-S-(2-cyanoethyl)-L-cysteine (CYMA). We calculated geometric mean concentrations for each biomarker by tobacco use category (exclusive smokeless tobacco use, exclusive cigarette smoking, dual cigarette and smokeless tobacco use, and non-cigarette and smokeless tobacco use) and geometric mean ratios adjusting for demographic factors. Results Exclusive smokeless tobacco users had higher geometric mean concentrations of cotinine (178.9 ng/mL, 95% CI = 145.5, 220.0) and NNAL (583.0 pg/mg creatinine, 95% CI = 445.2, 763.5) than exclusive cigarette smokers, (130.6 ng/mL, 95% CI = 122.3, 139.6 and 217.6 pg/mg creatinine, 95% CI = 193.0, 245.2, respectively). Smokeless tobacco users also had higher concentrations of blood lead compared with non-tobacco users (adjusted geometric mean ratio = 1.30, 95% CI = 1.21, 1.38). Differences in concentrations of cadmium, mercury, and CYMA between smokeless tobacco users and non-tobacco users were not observed. Based on limited sample sizes, NNAL concentrations for smokeless tobacco users appear to have declined from 2007-2008 (geometric mean = 1013.7 pg/mg creatinine, 95% CI = 738.9, 1390.8) to 2011-2012 (geometric mean = 325.7 pg/mg creatinine, 95% CI = 159.6, 664.9). Conclusions Smokeless tobacco users have higher observed levels of exposure to nicotine and carcinogenic tobacco-specific nitrosamines, as measured by cotinine and NNAL biomarker
Meli, Maria Assunta; Desideri, Donatella; Roselli, Carla; Feduzi, Laura
The occurrence and mobility of Po in oral smokeless tobacco products (STPs) were determined because its effects on human health must be taken into account. This research was subdivided into two parts: determination by alpha spectrometry of the Po activity concentration in 16 oral smokeless tobacco products of different brands purchased in local specialty stores in Europe and evaluation of its percent extraction into an artificial salivary gland during sucking or chewing operations. Polonium-210 was detected in all samples, and its concentrations ranged from 3.46 to 14.8 Bq kg (mean value of 7.45 ± 3.82 Bq kg). The highest concentration was found in chewing tobacco. The samples showed no significant difference in the content of Po level. The data obtained in this study show that the polonium, although poorly extracted (12.8 ± 8.96%) by artificial saliva, is not totally retained within the smokeless tobacco products, with a consequent potential health hazard associated with oral use of these products.
Full Text Available Background: Smokeless tobacco has been advocated as a substitute for cigarette smoking. On the contrary, the use of smokeless tobacco is fraught with health risk and needs to be discouraged. Although previous reports have described long-term harmful effects of smokeless tobacco on various body parameters, little is known about short-term effects of smokeless tobacco on cardio-respiratory parameters. Very few studies have been undertaken on the effect of short-term use of smokeless tobacco in India on cardio-respiratory parameters of youngsters. This aspect of use of smokeless tobacco needs to be attended to. Material and Methods: The present study has been undertaken to study the effect of smokeless tobacco on cardio-respiratory fitness tests in young healthy tobacco chewers compared to age- and sex-matched nontobacco chewing healthy controls. Various cardio-respiratory parameters like resting HR, delta HR, MVV, VE max, VO 2 max were studied by using treadmill exercise testing and computerized spirometry. Results: In the present study no statistically significant difference was found in any parameter studied that can be attributed to the residual effect of short-term use of smokeless tobacco. Conclusion: This is the reason enough to discourage smokeless tobacco from this unhealthy habit at this early stage itself before permanent residual effects on health is seen.
Glover, Elbert D.; And Others
Investigated prevalence and patterns of use for tobacco products, especially smokeless tobacco, among 632 college students. Smokeless tobacco use was considerably more prevalent among males than among females; the reverse was true for cigarette smoking. Implications for health education programs are discussed. (Author/NB)
Full Text Available This study targets the lesser-known ingredients of smokeless tobacco products, i.e., the toxic metals, in Indian brands. The metals selected in the study included lead (Pb, cadmium (Cd, arsenic (As, copper (Cu, mercury (Hg, and selenium (Se. The differential pulse anodic stripping voltammetry (DPASV technique was used for estimating the metals Pb, Cd, and Cu; square wave voltammetry for As; and the cold vapor atomic absorption technique for Hg. The resulting levels of the metals were compared to the daily consumption of the smokeless tobacco products. It was observed that almost 30% of gutkha brand samples exceeded the permissible levels of metals Pb and Cu, when compared to the provisional tolerable intake limits determined by the FAO/WHO. The reliability of data was assured by analyzing standard reference materials.
Davila Evelyn P
Full Text Available Abstract The primary aim was to examine whether increasing workplace smoking restrictions have led to an increase in smokeless tobacco use among US workers. Smokeless tobacco exposure increases the risk of oral cavity, esophageal, and pancreatic cancers, and stroke. The prevalence of smokeless tobacco use decreased from 1987-2000, except among men 25-44. While smokeless tobacco use has declined in the general population, it may be that the prevalence of smokeless tobacco use has increased among workers due to workplace smoking restrictions, which have been shown to have increased over the years. Using the most current nationally representative National Health Interview Survey (NHIS data, we examined whether increasing workplace smoking restrictions have led to an increase in smokeless tobacco use among US workers (n = 125,838. There were no significant changes in smokeless tobacco use prevalence from 1987-2005 (pooled prevalence = 3.53%; rates also were lower in smoke free workplaces. Worker groups with high rates of smokeless tobacco use included farm workers (10.51% and blue collar workers (7.26%. Results indicate that smokeless tobacco prevention strategies targeting particular worker groups are warranted.
Freedman, Neal D
In this issue of the Journal, Wyss et al. (Am J Epidemiol. 2016;000(00):000-000) describe the association between use of smokeless tobacco and head and neck cancer in 11 US case-control studies. Despite use by an estimated 300 million people worldwide and prior evidence for a causal association with cancer, these products remain understudied. Data are particularly needed for persons who do not use cigarettes or other smoking tobacco products. With 6,772 cancer cases and 8,375 controls, the current study is larger than previous efforts, allowing evaluation of associations among never cigarette smokers. Importantly, snuff use was positively associated with head and neck cancer, particularly for cancers of the oral cavity, whereas associations were weaker for chewing tobacco. Associations were observed among never cigarette smokers but not among ever cigarette smokers. Yet, despite the large sample size, only 44 cases and 62 controls had used snuff and only 61 cases and 96 controls had used chewing tobacco in the absence of cigarettes, precluding detailed examinations of dose response and cessation. Future studies set in high-prevalence populations with detailed assessment of lifetime use are needed to better understand the cancer risks of exclusive smokeless tobacco use and dual use of smokeless tobacco with other tobacco products, including cigarettes. © Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.
Benowitz, Neal L; Renner, Caroline C; Lanier, Anne P; Tyndale, Rachel F; Hatsukami, Dorothy K; Lindgren, Bruce; Stepanov, Irina; Watson, Clifford H; Sosnoff, Connie S; Jacob, Peyton
The prevalence of tobacco use, both cigarette smoking and smokeless, including iqmik (homemade smokeless tobacco prepared with dried tobacco leaves mixed with alkaline ash), and of tobacco-related cancer is high in Alaskan Native people (AN). To investigate possible mechanisms of increased cancer risk we studied levels of nicotine and tobacco-specific nitrosamines (TSNA) in tobacco products and biomarkers of tobacco toxicant exposure in Southwestern AN people. Participants included 163 cigarette smokers, 76 commercial smokeless tobacco, 20 iqmik, 31 dual cigarette smokers and smokeless tobacco, and 110 nontobacco users. Tobacco use history, samples of tobacco products used, and blood and urine samples were collected. Nicotine concentrations were highest in cigarette tobacco and TSNAs highest in commercial smokeless tobacco products. The AN participants smoked on average 7.8 cigarettes per day. Nicotine exposure, assessed by several biomarker measures, was highest in iqmik users, and similar in smokeless tobacco and cigarette smokers. TSNA exposure was highest in smokeless tobacco users, and polycyclic aromatic hydrocarbon exposure was highest in cigarette smokers. Despite smoking fewer cigarettes per day, AN cigarette smokers had similar daily intake of nicotine compared to the general U.S. population. Nicotine exposure was greatest from iqmik, likely related to its high pH due to preparation with ash, suggesting high addiction potential compared to other smokeless tobacco products. TSNA exposure was much higher with smokeless tobacco than other product use, possibly contributing to the high rates of oral cancer. Our data contribute to an understanding of the high addiction risk of iqmik use and of the cancer-causing potential of various forms of tobacco use among AN people.
Phillips, Carl V; Heavner, Karyn K
The health burden from tobacco smoking results almost entirely from inhalation of the components of smoke, although this is not widely known. The primary benefit of smoking is nicotine delivery, but nicotine can be obtained without combustion. Thus there is potential for tobacco harm reduction (THR), the substitution of lower-risk nicotine products for smoking. Epidemiological evidence suggests that smokeless tobacco causes about one one-hundredth the health risk of smoking. Despite the practice of harm reduction being widely accepted in public health, however, THR has faced fierce opposition from antitobacco activists. These activists have effectively misled the public about what aspect of smoking cigarettes causes the harm, convincing them that nicotine and tobacco themselves are harmful, ignoring the smoke. In the interests of promoting public health and rescuing science from politics, experts on inhalation hazards and health could play an important role in educating the public and policy makers about THR.
Oral cancer is second most common cancer in Pakistan and one of the major contributing factors to its high incidence is smokeless tobacco (SLT) use. 5.3% of Pakistan's youth are current SLT users. The World Health Organization requires the signatories of its "Framework Convention on Tobacco Control" to officially ban the sale of tobacco products to minors. We reviewed the Government of Pakistan's tobacco control, and related supporting policies, to assess how these address the issue of sale of SLT products to minors and found evident gaps in this regard. Legislations need to be in place to ban the sale of SLT products to minors and avoid an SLT epidemic in the future.
Schinke, S P; Gilchrist, L D; Schilling, R F; Senechal, V A
Data from a 2-year study describe tobacco use trends, perceptions, and prevention effects for 1,281 5th and 6th graders enrolled in 12 randomly selected Washington State elementary schools. Youths were pretested, then randomly divided by school into skills, discussion, and control groups. Preventive intervention curriculums for the skills and discussion groups included age-relevant information on smoked and smokeless tobacco use, peer testimonials, debates, games, and homework. Youths in the skills group also learned communication and problem-solving methods for handling difficult situations around tobacco use. Following intervention, youths were posttested, then retested semiannually for 2 years. During the 2-year study, three-quarters of all smokers and nonusers and half of all smokeless tobacco users maintained their statuses. Only 10 percent of all smokers and 3 percent of all smokeless users quit their habits. One in six reported new tobacco use, one-third of smokers began using smokeless tobacco, and two-thirds of all smokeless users began smoking during the study. Most youths at final measurement perceived smokeless tobacco as less of a health risk than smoking. Nearly one in two of all smokeless users intended to smoke, and two-thirds were actually smoking at 24-month followup. Both smoked and smokeless tobacco use rates increased in all groups, and youths in the skills intervention group consistently showed the lowest rates relative to the other groups. These findings demonstrate the potential of skills intervention methods for lowering tobacco use rates among adolescents.
... identified alternative mailing options for mailpieces containing cigarettes and smokeless tobacco sent as... 111 Mailing of Cigarettes and Smokeless Tobacco Products to APO/FPO/ DPO Destination Addresses AGENCY... of cigarettes and smokeless tobacco to APO/FPO/DPO destination addresses via Express Mail Military...
Parita K Chitroda
Full Text Available Various oral mucosal lesions are attributed to tobacco use. The presence of these conditions vanes with particular type of tobacco used (smoking or smokeless and the form in which it is used, such as cigarettes, pipes, cigars and chewing moist snuff. The frequency and duration of use as well as the ways in which the tobacco product is used also contributes to the clinical presentation and seventy of the lesion. The present study is mainly focused on the correlation between the smokeless tobacco-induced lesion and smoke-induced leukoplakia on various aspects with an objective to determine smokeless tobacco as a possible cause for leukoplakia.
... CFR Part 307 Rescission of Regulations Under the Comprehensive Smokeless Tobacco Health Education Act... transferred the FTC's authority for those regulations to the Secretary of the Department of Health and Human...., Washington, D.C., 20580. SUPPLEMENTARY INFORMATION: I. Background The Comprehensive Smokeless Tobacco Health...
Morrison, Margaret A.; Krugman, Dean M.; Park, Pumsoon
Objectives. In light of the Smokeless Tobacco Master Settlement Agreement (STMSA) and the fact that smokeless tobacco advertising has received little attention, we examined industry data to assess smokeless tobacco advertising in popular magazines. Of particular interest was the level of advertising in magazines with high youth readership and the amount of reach and frequency that was generated among readers aged 12 to 17 years. Methods. We used readership data from Mediamark Research Inc, advertising expenditure data from TNS Media Intelligence, and Adplus, a media planning program from Telmar to document the composition of adult and youth readership of magazines in which smokeless tobacco products were advertised, industry expenditures on advertising, and adolescents’ exposure to smokeless tobacco advertising. Results. The STMSA appears to have had a limited effect on the advertising of smokeless tobacco products to youth; both before and after the agreement, smokeless tobacco companies advertised in magazines with high adolescent readership. Conclusions. Popular magazines with smokeless tobacco advertising reach a large number of adolescents through a combination of both youth-oriented and adult magazines. These exposure levels have generally increased since the STMSA. PMID:17600263
Glover, Elbert D.; And Others
Presents second part of two-part series reviewing the published literature of smokeless tobacco in the United States. Explores smokeless tobacco as a pharmacologically addicting substance, discusses educational interventions designed to prevent use or help users quit, and outlines areas of future research. (Author)
Glover, Elbert D.; And Others
Results of a study of 289 undergraduate males indicate significant differences in personality traits between cigarette smokers and smokeless tobacco users. Smokeless tobacco users were more practical, conventional, and concerned with immediate interests and issues. Cigarette smokers tended to be more imaginative and Bohemian. (IAH)
McDermott, Steven T.; And Others
Prior to the 1986 advertising ban, a study measured the effects of smokeless tobacco advertising on young people. A questionnaire was administered in the spring of 1985 to 133 sixth, eighth, and tenth grade students in rural Georgia. The probability of exposure to smokeless tobacco ads was measured by: (1) the number of hours per week the student…
Coogan, Patricia F.; Geller, Alan; Adams, Mary
Examines the prevalence of smokeless tobacco use, and its relationship to other risky behaviors in school children in grades 4 through 12 (N=31,861). Among high school males, the prevalence of risk-taking behaviors and feelings of stress and depression were significantly higher among users. Joint users of cigarettes and smokeless tobacco reported…
Lewis, Paul C.; Harrell, Joanne S.; Deng, Shibing; Bradley, Chyrise
Examined age, gender, ethnicity, self-esteem, physical activity, parental smoking, and socioeconomic status as predictors of smokeless tobacco use among middle-school students. Student surveys indicated that males, Hispanics, and older students were more likely to be current smokeless-tobacco users. Other influential factors were low self-esteem…
Brubaker, Robert G.; Loftin, Tonetta L.
Analysis of questionnaire responses of 112 males between the ages of 10 and 14 revealed intention to use smokeless tobacco correlated significantly with attitude toward the behavior and perceived social pressure. Significant differences between those who intended to use smokeless tobacco and those who did not were found on several outcome and…
... not believe that any alternative exists at this time to allow U.S. mailers to tender cigarettes and... 111 Treatment of Cigarettes and Smokeless Tobacco as Nonmailable Matter AGENCY: Postal Service TM... cigarettes and smokeless tobacco. These provisions implement specific requirements to be in compliance with...
Nargis, N; Hussain, AKMG; Fong, GT
Context Smokeless tobacco use is well-recognized as occupying a significant portion of overall tobacco consumption in Bangladesh. Yet very little is known about the effectiveness of tax and price policy in controlling the use of smokeless tobacco use in the country. Aims The aims of this paper are to examine the price distribution of various smoked and smokeless tobacco products and estimate the effects of changes in the prices of tobacco products on the consumption of smokeless tobacco. Settings and Design The data for this paper came from the Wave 3 ITC Bangladesh (ITC BD) Survey conducted between November 2011 and May 2012. It is a cohort survey of a nationally representative sample of adult tobacco users and non-users in Bangladesh selected using a stratified multistage cluster sampling design. Two measures of smokeless tobacco use are used in the analysis—prevalence of smokeless tobacco use indicating the decision to use smokeless tobacco products, and the frequency of using smokeless tobacco per day indicating intensity of smokeless tobacco use. Methods and Material The regression analysis involves estimation of the demand function for the most widely used smokeless tobacco product in Bangladesh, zarda. Statistical analysis used The descriptive analysis looks at the characteristics of the price distribution of cigarette, bidi, zarda, and gul using the univariate Epanechnikov kernel density estimation. Results It estimates the price elasticity of lower price brands of zarda (the most commonly used smokeless tobacco product in Bangladesh) at -0.64 and of higher-priced brands at -0.39, and the cross-price elasticity of zarda with respect to cigarettes at 0.35. Conclusions The tax increase on smokeless tobacco products needs to be greater than the tax increase on smoked tobacco products to bridge the wide price differential between the two types of products that currently encourages downward substitution and discourages quitting behaviour. Finally, a specific
McClave-Regan, Annette K; Berkowitz, Judy
Marketing and advertising of smokeless tobacco products towards cigarette smokers has increased recently. Because the use of multiple tobacco products is a growing public health concern, the present work assesses the use of smokeless tobacco among cigarette smokers, a behaviour termed as 'dual use', as well as attitudes and beliefs on their 'dual use' of tobacco. Data were used from the 2008 Consumer Styles survey, a nationally representative, mail-in survey of consumers in the USA (n=10,108). 'Dual use' was more common among cigarette smokers who were young, white men living in the Midwest or South. The majority of 'dual users' reported using smokeless tobacco in places where they could not smoke (67.7%) and did not believe smokeless tobacco would help in quitting smoking (75.1%). 'Dual users' reported planning to quit within the next 6 months less often than adults who smoke cigarettes exclusively and close to half (42.3%) never plan to quit smoking. Tobacco use is attributed to a number of diseases and deaths worldwide, and cessation of tobacco use can reduce these health risks. The prevalent use of smokeless tobacco in places with smoking restrictions and lack of planning to quit by 'dual users' suggest the need to promote cessation among these users.
Lee, Youn O; Hebert, Christine J; Nonnemaker, James M; Kim, Annice E
Noncigarette tobacco products are increasingly popular. Researchers need to understand multiple tobacco product use to assess the effects of these products on population health. We estimate national prevalence and examine risk factors for multiple product use. We calculated prevalence estimates of current use patterns involving cigarettes, cigars, electronic cigarettes, hookah, smokeless tobacco, and snus using data from the 2012 RTI National Adult Tobacco Survey (N=3627), a random-digit-dial telephone survey of adults aged 18 and over. Associations between use patterns (exclusive single product and multiple products) and demographic characteristics were examined using Pearson chi-square tests and logistic regression. 32.1% of adults currently use 1 or more tobacco products; 14.9% use cigarettes exclusively, and 6.6% use one noncigarette product exclusively, 6.9% use cigarettes with another product (dual use), 1.3% use two noncigarette products, and 2.4% use three or more products (polytobacco use). Smokers who are young adult, male, never married, reside in the West, and made prior quit attempts were at risk for multiple product use. Over 10% of U.S. adults use multiple tobacco products. A better understanding of multiple product use involving combustible products, like cigars and hookah, is needed. Multiple product use may be associated with past quit attempts. Copyright © 2014 Elsevier Inc. All rights reserved.
Feirman, Shari P; Donaldson, Elisabeth A; Parascandola, Mark; Snyder, Kimberly; Tworek, Cindy
Changes to the U.S. smokeless tobacco landscape in recent years include a change to health warnings on packages, the implementation of bans in some stadiums, and the launch of a federal youth prevention campaign. It is unclear whether such changes have impacted consumer beliefs about smokeless tobacco. This study examines relative harm perceptions of smokeless tobacco compared to cigarettes among adults and assesses changes in smokeless tobacco harm perceptions over time. We analyzed data from three cycles (2012, 2014, 2015) of the Health Information National Trends Survey (HINTS). Using 2015 data, we assessed bivariate associations between smokeless tobacco harm perceptions and tobacco use, beliefs, information seeking, and demographics. Using 2012, 2014, and 2015 data, we assessed whether smokeless tobacco harm perceptions changed over time within demographic groups using chi-square tests. We then used a weighted multinomial logistic regression to assess the association between smokeless tobacco perceptions and survey year, adjusting for covariates. When asked whether smokeless tobacco products are less harmful than cigarettes, the majority of respondents across cycles said "no." The percent of respondents who selected this response option decreased over time. Findings showed significant differences in relative harm perceptions of smokeless tobacco versus cigarettes for specific demographic subgroups. Among subgroups, these shifts did not occur with a discernible pattern. Understanding factors associated with perceptions of smokeless tobacco can inform tobacco control efforts. Additional monitoring of these trends may provide researchers with a deeper understanding of how and why smokeless tobacco harm perceptions change. Published by Elsevier Ltd.
Agaku, Israel; Akinyele, Adisa O; Omaduvie, Uyoyo T
Smokeless and cigarette tobacco use is becoming increasingly popular among Nigerian adolescents. This study aimed to evaluate predictors of intention to quit tobacco use among adolescents that currently use tobacco products in Nigeria. A total of 536 male and female high school students in senior classes in Benue State, Nigeria were enrolled into the cross-sectional study. The survey instrument was adapted from the Global Youth Tobacco Survey (GYTS) questionnaire. Among adolescents with tobacco habits, 80.5% of smokeless tobacco users and 82.8% of cigarette smokers intended to quit tobacco use within 12 months. After adjustment, significant predictors of intention to quit cigarette smoking were parents' smoking status (Pperception that smoking made one comfortable at social events (Ptobacco use, significant predictors after adjustment were parents' smokeless use status, (P=0.03) perception that smokeless tobacco use made one more comfortable at social events (P=0.04) and perception of harm from smokeless use (P=0.02). This study demonstrates that the intention to quit smokeless and cigarette tobacco use is significantly predicted by perception about the societal acceptance of tobacco use at social events, parents and peers' tobacco use status as well as the perception of harm from use of tobacco products. Providing social support may increase quit attempts among youth smokers.
Full Text Available BackgroundIn the past, studies have compared smokeless tobacco and non-tobacco users for the risk of various chronic diseases. The differences in the risk of chronic diseases between smokeless tobacco user and smokers have not been explored. The objective of this study is to estimate the risk of chronic diseases among smokeless tobacco users compared to smokers.MethodsThe data were used from the Study on Global Ageing and Adult Health (SAGE Wave-1, conducted in 2007–2008 in India. The study sample is the respondents who reported consuming any form of tobacco in last 1 month. The total sample size was 4,038 respondents. The odds ratio of chronic morbidities was estimated taking smokers as the reference category.ResultsThe odds ratios for (self-reported diabetes, asthma, and hypertension were not significant for smokeless tobacco user compared to smoked tobacco users. The odds ratio of chronic lung diseases (CLDs was significantly lower among smokeless tobacco users compared to smoked tobacco users. The odds ratio of hypertension (measured combined with low education and belonging to lowest wealth quintiles were not significant for smokeless tobacco users compared to smoked tobacco users. Duration of the use of smokeless tobacco and quantity of use was found to have no significant relation with risk of chronic diseases as compared to smoking.ConclusionThis study did not find the significantly higher risk of chronic morbidities except for CLD for smokeless tobacco users compared to smoked tobacco users. The study suggests that the use of any form of tobacco may have a similar risk of chronic diseases.
Dabelsteen, S; Christensen, S; Gron, B
To investigate the effect of smokeless tobacco (ST) on (1) HGF, KGF and GM-CSF expression by buccal fibroblasts and (2) on keratinocyte and fibroblast proliferation. Buccal fibroblasts were stimulated with different concentrations of ST extracts in a double dilution from 0.50% w/v to 0.03% w/v. S....... Keratinocytes and fibroblasts showed no increase in proliferation after stimulation with increased concentrations of ST. The results suggest that HGF and KGF may play an important role as a paracrine growth factor in epithelial hyperplasia in ST lesions....
Pakhale, Smita; Samet, Jonathan; Folan, Patricia; Leone, Frank; White, Alexander
On November 10, 2015, the U.S. Food and Drug Administration approved, for the first time, the sale of smokeless tobacco products authorized under the new premarket tobacco application pathway. This Food and Drug Administration regulatory decision draws attention to the growing worldwide use of smokeless tobacco products in general. Use of these tobacco products is particularly popular in low- and middle-income countries of Asia. Due to aggressive and strategic marketing to children, young adults, and current smokers, rates of smokeless tobacco use in men of all ages are on the rise in United States and elsewhere. The tobacco industry also continues to market these products to current cigarette smokers for use in the growing number of "smoke-free environments." Smokeless tobacco products are associated with cancers of the upper aerodigestive tract, particularly the oral cavity, esophagus, and pancreas; cardiovascular diseases; small-for-gestational-age infants; premature births; increased risk of apnea; and stillbirth. There is no convincing evidence regarding the efficacy of smokeless tobacco, including snus, to promote smoking cessation. Rather, studies from Europe and the United States demonstrate that smokeless tobacco use may facilitate regular cigarette smoking by acting as a gateway drug, especially for children. Caution is warranted before proposing smokeless tobacco as a harm-reduction strategy, in part because of the potential for further promoting smokeless tobacco in low- and middle-income countries where use is already widespread. Continued vigilance through comprehensive surveillance is warranted. We strongly recommend the use of graphic warning labels as a "no regrets" strategy for all smokeless tobacco products marketed globally.
Bolinder, G; Alfredsson, L; Englund, A; de Faire, U
Little is known about the risks of cardiovascular disease associated with the use of smokeless tobacco, which produces blood nicotine levels similar to those caused by cigarette smoking. Male Swedish construction industry employees (n = 135,036) who attended a health examination were followed by studying cause-specific mortality during a 12-year period. The study population comprised 6297 smokeless tobacco users, 14,983 smokers of fewer than 15 cigarettes per day, 13,518 smokers of 15 or more cigarettes per day, 17,437 ex-smokers, 50,255 "other" tobacco users, and 32,546 nonusers. The age-adjusted relative risk of dying from cardiovascular disease was 1.4 for smokeless tobacco users and 1.9 for smokers of 15 or more cigarettes per day, compared with nonusers. Among men aged 35 through 54 years at the start of follow-up, the relative risk was 2.1 for smokeless tobacco users and 3.2 for smokers. When data were adjusted for body mass index, blood pressure, and history of heart symptoms, the results were essentially unchanged. Cancer mortality was not raised in smokeless tobacco users. Both smokeless tobacco users and smokers face a higher risk of dying from cardiovascular disease than nonusers. Although the risk is lower for smokeless tobacco users than for smokers, the excess risk gives cause for preventive actions.
Murukutla, Nandita; Turk, Tahir; Prasad, C V S; Saradhi, Ranjana; Kaur, Jagdish; Gupta, Shefali; Mullin, Sandra; Ram, Faujdar; Gupta, Prakash C; Wakefield, Melanie
Smokeless tobacco consumption in India is a significant source of morbidity and mortality. In order to educate smokeless tobacco users about the health harms of smokeless tobacco and to denormalise tobacco usage and encourage quitting, a national television and radio mass media campaign targeted at smokeless tobacco users was aired for 6 weeks during November and December 2009. The campaign was evaluated with a nationally representative household survey of smokeless tobacco users (n = 2898). The effect of campaign awareness was assessed with logistic regression analysis. The campaign affected smokeless tobacco users as intended: 63% of smokeless-only users and 72% of dual users (ie, those who consumed both smoking and smokeless forms) recalled the campaign advertisement, primarily through television delivery. The vast majority (over 70%) of those aware of the campaign said that it made them stop and think, was relevant to their lives and provided new information. 75% of smokeless-only users and 77% of dual users said that it made them feel concerned about their habit. Campaign awareness was associated with better knowledge, more negative attitudes towards smokeless tobacco and greater cessation-oriented intentions and behaviours among smokeless tobacco users. Social marketing campaigns that utilise mass media are feasible and efficacious interventions for tobacco control in India. Implications for future mass media tobacco control programming in India are discussed.
Agaku, Israel T; Singh, Tushar; Jones, Sherry Everett; King, Brian A; Jamal, Ahmed; Neff, Linda; Caraballo, Ralph S
Athletes are not a typical at-risk group for smoking combustible tobacco products, because they are generally health conscious and desire to remain fit and optimize athletic performance (1). In contrast, smokeless tobacco use historically has been associated with certain sports, such as baseball (2). Athletes might be more likely to use certain tobacco products, such as smokeless tobacco, if they perceive them to be harmless (3); however, smokeless tobacco use is not safe and is associated with increased risk for pancreatic, esophageal, and oral cancers (4). Tobacco use among youth athletes is of particular concern, because most adult tobacco users first try tobacco before age 18 years (5). To examine prevalence and trends in current (≥1 day during the past 30 days) use of combustible tobacco (cigarettes, cigars) and smokeless tobacco (chewing tobacco, snuff, or dip [moist snuff]) products among athlete and nonathlete high school students, CDC analyzed data from the 2001–2013 National Youth Risk Behavior Surveys. Current use of any tobacco (combustible or smokeless tobacco) significantly declined from 33.9% in 2001 to 22.4% in 2013; however, current smokeless tobacco use significantly increased from 10.0% to 11.1% among athletes, and did not change (5.9%) among nonathletes. Furthermore, in 2013, compared with nonathletes, athletes had significantly higher odds of being current smokeless tobacco users (adjusted odds ratio [AOR] = 1.77, ptobacco users (AOR = 0.80, ptobacco control and prevention measures targeting youth athletes regarding the health risks associated with all forms of tobacco use.
Siddiqi, Kamran; Vidyasagaran, Aishwarya Lakshmi; Readshaw, Anne; Croucher, Ray
Globally, over 300 million people consume diverse smokeless tobacco (ST) products. They are addictive, cause cancer, increased cardiovascular mortality risks and poor pregnancy outcomes. To identify gaps in implementing key ST demand-reduction measures, focused literature reviews were conducted and findings synthesized according to relevant WHO Framework Convention on Tobacco Control (FCTC) Articles. The literature supports implementation of ST demand-reduction measures. For taxation, labelling and packaging, most administrations have weaker policies for ST than cigarettes. Capacity to regulate ST contents and offer cessation support is lacking. There is poor compliance with bans on ST advertising, promotion and sponsorship. The literature on implementation of WHO FCTC for ST is limited. Although strengths of ST demand-control activities are currently identifiable from available literature, full implementation of FCTC is lacking. A wider evidence-based response to WHO FCTC is proposed, particularly for countries facing the greatest disease burdens.
Boyle, Raymond G; St Claire, Ann W; Kinney, Ann M; D'Silva, Joanne; Carusi, Charles
Cigarette smokers are being encouraged to use smokeless tobacco (SLT) in locations where smoking is banned. We examined state-wide data from Minnesota to measure changes over time in the use of SLT and concurrent use of cigarettes and SLT. The Minnesota Adult Tobacco Survey was conducted four times between 1999 and 2010 and has provided state-wide estimates of cigarette smoking, SLT use and concurrent use of SLT by smokers. The prevalence of SLT was essentially unchanged through 2007, then increased significantly between 2007 and 2010 (3.1% versus 4.3%, P cigarette smokers who reported using SLT was stable then increased between 2007 and 2010 (4.4% versus 9.6%, P alternative products as they adjust to recent public policies restricting smoking in public places. The findings are suggestive that some Minnesota smokers are switching to concurrent use of cigarettes and SLT. Future surveillance reports will be necessary to confirm the results.
Gupta, Rajeev; Gupta, Nishant; Khedar, R S
Smoking is an important cardiovascular risk factor, however, use of smokeless tobacco has not been well studied. Smokeless tobacco use is high in countries of South and Southeast Asia, Africa and Northern Europe. Meta-analyses of prospective studies of smokeless tobacco users in Europe reported a relative risk for fatal coronary heart disease of 1.13 (confidence intervals 1.06-1.21) and fatal stroke of 1.40 (1.28-1.54) while in Asian countries it was 1.26 (1.12-1.40). Case-control studies reported significantly greater risk for acute coronary events in smokeless tobacco users (odds ratio 2.23, 1.41-3.52), which was lower than smokers (2.89, 2.11-3.96), and subjects who both chewed and smoked, had the greatest risk (4.09, 2.98-5.61). There is a greater prevalence of hypertension and metabolic syndrome in users of smokeless tobacco. Smokeless tobacco use leads to accelerated atherothrombosis similar to smoking. There is an urgent need for public health and clinical interventions to reduce smokeless tobacco addiction. Copyright © 2013 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.
Smyth, Eoghan M; Kulkarni, Prachi; Claye, Emma; Stanfill, Stephen; Tyx, Robert; Maddox, Cynthia; Mongodin, Emmanuel F; Sapkota, Amy R
Smokeless tobacco products contain numerous chemical compounds, including known human carcinogens. Other smokeless tobacco constituents, including bacteria, may also contribute to adverse health effects among smokeless tobacco users. However, there is a lack of data regarding the microbial constituents of smokeless tobacco. Our goal was to characterize the bacterial microbiota of different smokeless tobacco products and evaluate differences across product types and brands. DNA was extracted from 15 brands of smokeless tobacco products (including dry snuff, moist snuff, snus, and Swedish snus) and 6 handmade products (e.g., toombak) using an enzymatic and mechanical lysis approach. Bacterial community profiling was performed using PCR amplification of the V1-V2 hypervariable region of the 16S rRNA gene, followed by 454 pyrosequencing of the resulting amplicons and sequence analysis using the QIIME package. Total viable counts were also determined to estimate the number of viable bacteria present in each product. Average total viable counts ranged from 0 to 9.35 × 107 CFU g-1. Analysis of the 16S rRNA gene sequences revealed high bacterial diversity across the majority of products tested: dry snuff products where characterized by the highest diversity indices compared to other products. The most dominant bacterial phyla across all products were Firmicutes, Proteobacteria, Actinobacteria, and Bacteroidetes. Significant differences in both bacterial community composition and in silico predicted gene content were observed between smokeless tobacco product types and between brands of specific smokeless tobacco products. These data are useful in order to comprehensively address potential health risks associated with the use of smokeless tobacco products.
Sharma, Priyamvada; Murthy, Pratima; Shivhare, Parul
A variety of smoked and smokeless tobacco products with varying nicotine content are accessible in India. Nicotine quantity in tobacco products has direct bearing on tobacco dependence. Our objective was to estimate nicotine content in various types of smoked and smokeless products. Disclosure for essential health warning was also checked. Liquid-liquid extraction was used for nicotine extraction and high-performance thin layer chromatography technique was applied for quantification of nicotine in seventy-one smoked and smokeless tobacco products. Significant variation in nicotine content was observed across products. In smoked tobacco, nicotine content varied from 1.01 to 13.0 mg/rod, while in smokeless tobacco products it ranged from 0.8 mg/g to 50.0 mg/g. Moisture content varied from 9% to 21%. This work lists a range of smoked and smokeless tobacco products available in this region. We report a wide variability in nicotine quantity across smoked and smokeless tobacco products. Such variation in nicotine content may have important implications for tobacco cessation interventions and policies.
Klein, E.G.; Ferketich, A.K.; Abdel-Rasoul, M.; Kwan, M.P.; Kenda, L.; Wewers, M.E.
Introduction: Smokeless tobacco (ST) use is increasingly prevalent among poor and vulnerable groups, especially rural males. Access to tobacco products, as well as marketing messages, is associated with tobacco usage. In June 2010, the Tobacco Control Act (TCA) marked the beginning of federal
Full Text Available Abstract Background Use of smokeless tobacco is common in South Asia. Tobacco is a major preventable cause of morbidity and mortality. Doctors make one of the best avenues to influence patients' tobacco use. However, medical students addicted to tobacco are likely to retain this habit as physicians and are unlikely to counsel patients against using tobacco. With this background, this study was conducted with the objective of determining the prevalence of smokeless tobacco among Pakistani medical students. Methods A cross sectional study was carried out in three medical colleges of Pakistan – one from the north and two from the southern region. 1025 students selected by convenient sampling completed a peer reviewed, pre-tested, self-administered questionnaire. Questions were asked regarding lifetime use (at least once or twice in their life, current use (at least once is the last 30 days, and established use (more than 100 times in their life of smokeless tobacco. Chi square and logistic regression analyses were used. Results Two hundred and twenty (21.5% students had used tobacco in some form (smoked or smokeless in their lifetime. Sixty six (6.4% students were lifetime users of smokeless tobacco. Thirteen (1.3% were daily users while 18 (1.8% fulfilled the criterion for established users. Niswar was the most commonly used form of smokeless tobacco followed by paan and nass. Most naswar users belonged to NWFP while most paan users studied in Karachi. On univariate analysis, lifetime use of smokeless tobacco showed significant associations with the use of cigarettes, student gender (M > F, student residence (boarders > day scholars and location of the College (NWFP > Karachi. Multivariate analysis showed independent association of lifetime use of smokeless tobacco with concomitant cigarette smoking, student gender and location of the medical college. Conclusion The use of smokeless tobacco among medical students cannot be ignored. The
Lee Peter N
Full Text Available Abstract Background Interest is rising in smokeless tobacco as a safer alternative to smoking, but published reviews on smokeless tobacco and cancer are limited. We review North American and European studies and compare effects of smokeless tobacco and smoking. Methods We obtained papers from MEDLINE searches, published reviews and secondary references describing epidemiological cohort and case-control studies relating any form of cancer to smokeless tobacco use. For each study, details were abstracted on design, smokeless tobacco exposure, cancers studied, analysis methods and adjustment for smoking and other factors. For each cancer, relative risks or odds ratios with 95% confidence intervals were tabulated. Overall, and also for USA and Scandinavia separately, meta-analyses were conducted using all available estimates, smoking-adjusted estimates, or estimates for never smokers. For seven cancers, smoking-attributable deaths in US men in 2005 were compared with deaths attributable to introducing smokeless tobacco into a population of never-smoking men. Results Eighty-nine studies were identified; 62 US and 18 Scandinavian. Forty-six (52% controlled for smoking. Random-effects meta-analysis estimates for most sites showed little association. Smoking-adjusted estimates were only significant for oropharyngeal cancer (1.36, CI 1.04–1.77, n = 19 and prostate cancer (1.29, 1.07–1.55, n = 4. The oropharyngeal association disappeared for estimates published since 1990 (1.00, 0.83–1.20, n = 14, for Scandinavia (0.97, 0.68–1.37, n = 7, and for alcohol-adjusted estimates (1.07, 0.84–1.37, n = 10. Any effect of current US products or Scandinavian snuff seems very limited. The prostate cancer data are inadequate for a clear conclusion. Some meta-analyses suggest a possible effect for oesophagus, pancreas, larynx and kidney cancer, but other cancers show no effect of smokeless tobacco. Any possible effects are not evident in Scandinavia. Of 142
Gupta, Prakash C; Ray, Cecily S; Sinha, Dhirendra N; Singh, Poonam K
Smokeless tobacco use is on the upswing in some parts of the world, including parts of SEAR. It is therefore important to monitor this problem and understand the possible consequences on public health. Material for this review was obtained from documents and data of the World Health Organization, co-authors, colleagues, and searches on key words in PubMed and on Google. Smokeless tobacco use in SEAR, as betel quid with tobacco, declined with increased marketing of cigarettes from the early twentieth century. Smokeless tobacco use began to increase in the 1970s in South Asia, with the marketing of new products made from areca nut and tobacco and convenient packaging. As a consequence, oral precancerous conditions and cancer incidence in young adults have increased significantly. Thailand's successful policies in reducing betel quid use through school health education from the 1920s and in preventing imports of smokeless tobacco products from 1992 are worth emulating by many SEAR countries. India, the largest manufacturing country of smokeless tobacco in the Region, is considering ways to regulate its production. Best practices require the simultaneous control of smokeless and smoking forms of tobacco. Governments in SEAR would do well to adopt strong measures now to control this problem.
Creath, Curtis J.; And Others
Survey of high school football players (n=1,116) found that, compared to nonusers, adolescent athletes who tried smokeless tobacco were more likely to be white; to use cigarettes, alcohol, and cigars; and to have family users. Initial use was highest before age 14. Differences were found between snuff users and users of chewing tobacco. (Author/NB)
Rahman, Muhammad Aziz; Mahmood, Mohammad Afzal; Spurrier, Nicola; Rahman, Mahmudur; Choudhury, Sohel Reza; Leeder, Stephen
Despite scientific evidence about the harmful effects of smokeless tobacco (SLT), it is widely used in Bangladesh. This study explored perceptions about health effects of SLT use. Semistructured interviews were conducted with 1812 nonsmoking adults. About 40% of the participants were current SLT users or had used SLT in the past. Family members' influence was the main factor for initiation. The participants believed that people continued using SLT because of addiction (52%) and as a part of their lifestyle (23%). The majority of participants (77%) did not mention any benefit, but SLT users considered it to be a remedy for toothache (P < .05). Almost all participants mentioned that SLT was harmful and causes heart disease, cancer, and tuberculosis. Doctors' advice was the common motivating factor to quit. Health promotion interventions should highlight the adverse effects of SLT use, which outweigh the perceived benefits, and should consider addressing the role of family in SLT initiation and use. © 2012 APJPH.
Bonaguro, John A.; And Others
A sample of more than 1,000 fourth- through twelfth-grade students was administered a questionnaire designed to determine smokeless tobacco usage of respondents and their friends. Results are presented. (MT)
Weitkunat, Rolf; Sanders, Edward; Lee, Peter N
Smokeless tobacco is often referred to as a major contributor to oral cancer. In some regions, especially Southeast Asia, the risk is difficult to quantify due to the variety of products, compositions...
Mohammad Shakhawat Hossain
Full Text Available OBJECTIVE: To estimate the prevalence and identify correlates of smokeless tobacco consumption among married rural women with a history of at least one pregnancy in Madaripur, Bangladesh. MATERIALS AND METHODS: We conducted a cross-sectional survey using an interviewer administered, pre-tested, semi-structured questionnaire. All women living in the study area, aged 18 years and above with at least one pregnancy in their lifetime, who were on the electoral roll and agreed to participate were included in the study. Information on socio-demographic characteristics and smokeless tobacco consumption was collected. Smokeless tobacco consumption was categorized as 'Current', 'Ever but not current' and 'Never'. Associations between smokeless tobacco consumption and the explanatory variables were estimated using simple and multiple binary logistic regression. RESULTS: 8074 women participated (response rate 99.9%. The prevalence of 'Current consumption', 'Ever consumption but not current', and 'Never consumption' was 25%, 44% and 31%, respectively. The mean age at first use was 31.5 years. 87% of current consumers reported using either Shadapata or Hakimpuree Jarda. Current consumption was associated with age, level of education, religion, occupation, being an income earner, marital status, and age at first use of smokeless tobacco. After adjustment for demographic variables, current consumption was associated with being over 25 years of age, a lower level of education, being an income earner, being Muslim, and being divorced, separated or widowed. CONCLUSION: The prevalence of smokeless tobacco consumption is high among rural women in Bangladesh and the age of onset is considerably older than that for smoking. Smokeless tobacco consumption is likely to be producing a considerable burden of non-communicable disease in Bangladesh. Smokeless tobacco control strategies should be implemented.
Zohaib Khan; Justus Tönnies; Steffen Müller
Introduction. Smokeless tobacco is considered one of the major risk factors for oral cancer. It is estimated that over 90% of the global smokeless tobacco use burden is in South Asia. This paper aims to systematically review publications reporting epidemiological observational studies published in South Asia from 1984 till 2013. Methods. An electronic search in “Medline” and “ISI Web of Knowledge” yielded 734 publications out of which 21 were included in this review. All publications were ass...
Niaz, Kamal; Maqbool, Faheem; Khan, Fazlullah; Bahadar, Haji; Ismail Hassan, Fatima; Abdollahi, Mohammad
Smokeless tobacco consumption, which is widespread throughout the world, leads to oral submucous fibrosis (OSMF), which is a long-lasting and devastating condition of the oral cavity with the potential for malignancy. In this review, we mainly focus on the consumption of smokeless tobacco, such as paan and gutkha, and the role of these substances in the induction of OSMF and ultimately oral cancer. The list of articles to be examined was established using citation discovery tools provided by ...
Yang, Fei; Pedersen, Nancy L; Ye, Weimin; Liu, Zhiwei; Norberg, Margareta; Forsgren, Lars; Trolle Lagerros, Ylva; Bellocco, Rino; Alfredsson, Lars; Knutsson, Anders; Jansson, Jan-Håkan; Wennberg, Patrik; Galanti, Maria Rosaria; Lager, Anton C J; Araghi, Marzieh; Lundberg, Michael; Magnusson, Cecilia; Wirdefeldt, Karin
Cigarette smoking is associated with a lower risk of Parkinson's disease. It is unclear what constituent of tobacco smoke may lower the risk. Use of Swedish moist smokeless tobacco (snus) can serve as a model to disentangle what constituent of tobacco smoke may lower the risk. The aim of this study was to determine whether snus use was associated with a lower risk of Parkinson's disease. Individual participant data were collected from seven prospective cohort studies, including 348 601 men. We used survival analysis with multivariable Cox regression to estimate study-specific relative risk of Parkinson's disease due to snus use, and random-effects models to pool estimates in a meta-analysis. The primary analyses were restricted to never-smokers to eliminate the potential confounding effect of tobacco smoking. During a mean follow-up time of 16.1 years, 1199 incident Parkinson's disease cases were identified. Among men who never smoked, ever-snus users had about 60% lower Parkinson's disease risk compared with never-snus users [pooled hazard ratio (HR) 0.41, 95% confidence interval (CI) 0.28-0.61]. The inverse association between snus use and Parkinson's disease risk was more pronounced in current (pooled HR 0.38, 95% CI 0.23-0.63), moderate-heavy amount (pooled HR 0.41, 95% CI 0.19-0.90) and long-term snus users (pooled HR 0.44, 95% CI 0.24-0.83). Non-smoking men who used snus had a substantially lower risk of Parkinson's disease. Results also indicated an inverse dose-response relationship between snus use and Parkinson's disease risk. Our findings suggest that nicotine or other components of tobacco leaves may influence the development of Parkinson's disease.
Rodu, Brad; Jansson, Christer
Smokeless tobacco has been associated with oral cancer for many decades. The purpose of this article is to review research relevant to this association, including epidemiologic studies, studies of putative carcinogens such as tobacco-specific nitrosamines (TSNAs) and other contaminants, and possible cancer inhibitors. Epidemiologic studies addressing this issue primarily consist of case-control studies. They show that the use of chewing tobacco and moist snuff is associated with very low risks for cancers of the oral cavity and related structures (relative risks [RR] from 0.6 to 1.7). The use of dry snuff is associated with higher RRs, ranging from 4 to 13, while the RRs from smokeless tobacco, unspecified as to type, are intermediate (RR = 1.5 to 2.8). With regard to TSNAs, historical levels in American moist snuff products were higher than those in their Swedish counterparts, but levels in contemporary products are uniformly low. TSNA levels in chewing tobacco have always been low, but levels in dry snuff have been higher, including some very high levels in current products. In general, smokeless tobacco users are not exposed to significant levels of cadmium, lead, benzo(a)pyrene, polonium-210, and formaldehyde, when compared with concentrations of these compounds in foods. Finally, low oral cancer risk from smokeless tobacco use may be influenced by the presence of cancer inhibitors, mainly anti-oxidants, in smokeless tobacco products.
Klein, Elizabeth G; Quisenberry, Amanda J; Shoben, Abigail B; Cooper, Sarah; Ferketich, Amy K; Berman, Micah; Peters, Ellen; Wewers, Mary Ellen
Little research has examined the impacts of graphic health warnings on the users of smokeless tobacco products. A convenience sample of past-month, male smokeless tobacco users (n = 142; 100% male) was randomly assigned to view a smokeless tobacco advertisement with a graphic health warning (GHW) or a text-only warning. Eye-tracking equipment measured viewing time, or dwell time, in milliseconds. Following the advertisement exposure, participants self-reported smokeless tobacco craving and recalled any content in the health warning message (unaided recall). Linear and logistic regression analyses evaluated the proportion of time viewing the GHW, craving, and GHW recall. Participants who viewed a GHW spent a significantly greater proportion of their ad viewing time on GHWs (2.87 seconds or 30%), compared to those viewing a text-only warning (2.05 seconds or 24%). Although there were no significant differences by condition in total advertisement viewing duration, those participants viewing a GHW had increased recall of health warning messages compared to the text-only warning (76% had any warning message recall compared to 53%; p < .05). Self-reported craving after advertisement exposure was lower in the GHW compared to text-only condition, but the difference was not statistically significant (a rating of 4.4 vs. 5.3 on a 10-point scale; p = .08). GHWs attracted greater attention and greater recall of health warning messages compared to text-only warnings among rural male smokeless tobacco users. Among a sample of rural smokeless tobacco users, GHWs attracted more attention and recall of health warning messages compared to text-only warnings when viewed within smokeless tobacco advertising. These findings provide additional empirical support that GHWs are an effective tobacco control tool for all tobacco products and advertisements.
Nemeth, Julianna M; Liu, Sherry T; Klein, Elizabeth G; Ferketich, Amy K; Kwan, Mei-Po; Wewers, Mary Ellen
The burden of smokeless tobacco (ST) use disproportionally impacts males in rural Ohio Appalachia. The purpose of this study was to describe the cultural factors contributing to this disparity and to articulate the way in which culture, through interpersonal factors (i.e. social norms and social networks) and community factors (i.e. marketing and availability), impacts ST initiation and use of ST among boys and men in Ohio Appalachia. Fifteen focus groups and 23 individual qualitative interviews were conducted with adult (n = 63) and adolescent (n = 53) residents in Ohio Appalachian counties to ascertain factors associated with ST use and the impact of ST marketing. Transcriptions were independently coded according to questions and themes. ST use appears to be a rite of passage in the development of masculine identity in Ohio Appalachian culture. Interpersonal factors had the greatest influence on initiation and continued use of ST. Ohio Appalachian boys either emulated current ST users or were actively encouraged to use ST through male family and peer networks. Users perceived their acceptance into the male social network as predicated on ST use. Community factors, including ST advertisement and access to ST, reinforced and normalized underlying cultural values. In addition to policy aimed at reducing tobacco marketing and access, interventions designed to reduce ST use in Ohio Appalachia should incorporate efforts to (1) shift the perception of cultural norms regarding ST use and (2) address male social networks as vehicles in ST initiation.
Smith, Matthew Lee; Colwell, Brian; Forté, Chanese A; Pulczinski, Jairus C; McKyer, E Lisako J
Adolescent tobacco use is influenced by intrapersonal (e.g., impulse control) and external factors, such as behaviors of friends and peers. The relationships of these factors to smokeless tobacco (ST) use are not yet fully understood. This is especially true as it pertains to the simultaneous examination of psychological and normative perceptions. Using constructs of the Biopsychosocial Model, this study investigates factors associated with lifetime ST use among middle and high school students. Data were analyzed from 938 Indiana middle and high school students. Binary sequential logistic regression was performed to examine the relationship of personal characteristics and psychosocial measures to adolescent lifetime ST use. Approximately 9 % reported having ever used ST, among which 78.6 % were male. Females and younger students were less likely to have used ST in their lifetime, whereas participants with a sibling smoker and those who compared their life to the lives of others were more likely to report lifetime ST usage. In the presence of psychological and normative variables, sex, age, and comparing one's life to others remained significant. Additionally, participants who perceived higher friend approval of substance use were significantly more likely to report lifetime ST use. Understanding the normative perceptions of adolescents may lend insight into the drivers of ST use adolescent subgroups and, which may enable community and school officials to tailor interventions to prevent ST initiation and promote cessation.
Raymond G. Boyle
Full Text Available Cigarette smokers are being encouraged to use smokeless tobacco (SLT in locations where smoking is banned. We examined state-wide data from Minnesota to measure changes over time in the use of SLT and concurrent use of cigarettes and SLT. The Minnesota Adult Tobacco Survey was conducted four times between 1999 and 2010 and has provided state-wide estimates of cigarette smoking, SLT use and concurrent use of SLT by smokers. The prevalence of SLT was essentially unchanged through 2007, then increased significantly between 2007 and 2010 (3.1% versus 4.3%, P<0.05. Similarly, the prevalence of cigarette smokers who reported using SLT was stable then increased between 2007 and 2010 (4.4% versus 9.6%, P<0.05. The finding of higher SLT use by smokers could indicate that smokers in Minnesota are in an experimental phase of testing alternative products as they adjust to recent public policies restricting smoking in public places. The findings are suggestive that some Minnesota smokers are switching to concurrent use of cigarettes and SLT. Future surveillance reports will be necessary to confirm the results.
Curry, Laurel E; Pederson, Linda L; Stryker, Jo Ellen
Concerns about secondhand smoke, increasing indoor smoking bans, and health concerns regarding cigarettes are contributing to the development of new smokeless tobacco (ST) products by the tobacco industry and the repositioning of traditional ST products. The objective of this research was to systematically document the changing advertising strategies and themes of the ST industry. Using descriptive content analysis, this study analyzed 17 nationally circulated magazines for ST advertisements (ads) from 1998-1999 and 2005-2006, recording both magazine and advertisement characteristics (e.g., themes, selling proposition, people portrayed, and setting/surroundings.) Ninety-five unique ads were found during the two time periods-occurring with total frequency of 290 ad placements in 816 issues. One hundred ninety-one ads were found in the 2005-2006 sample, while 99 were found in the 1998-1999 magazines. Significant differences in ST ads were identified between time periods and magazine types. A greater percentage of ads were found in the latter time period, and the average number of ads per issue increased (0.24 in 1998-1999 and 0.49 in 2005-2006, p advertise in men's magazines with themes appealing to men and "traditional" ST users, the ST industry appears to be simultaneously changing its message placement and content in order to include readers of general adult magazines who may not currently use ST.
Wang, Teresa W; Kenemer, Brandon; Tynan, Michael A; Singh, Tushar; King, Brian
Combustible and smokeless tobacco use causes adverse health outcomes, including cardiovascular disease and multiple types of cancer (1,2). Standard approaches for measuring tobacco use include self-reported surveys of use and consumption estimates based on tobacco excise tax data (3,4). To provide the most recently available tobacco consumption estimates in the United States, CDC used federal excise tax data to estimate total and per capita consumption during 2000-2015 for combustible tobacco (cigarettes, roll-your-own tobacco, pipe tobacco, small cigars, and large cigars) and smokeless tobacco (chewing tobacco and dry snuff). During this period, total combustible tobacco consumption decreased 33.5%, or 43.7% per capita. Although total cigarette consumption decreased 38.7%, cigarettes remained the most commonly used combustible tobacco product. Total noncigarette combustible tobacco (i.e., cigars, roll-your-own, and pipe tobacco) consumption increased 117.1%, or 83.8% per capita during 2000-2015. Total consumption of smokeless tobacco increased 23.1%, or 4.2% per capita. Notably, total cigarette consumption was 267.0 billion cigarettes in 2015 compared with 262.7 billion in 2014. These findings indicate that although cigarette smoking declined overall during 2000-2015, and each year from 2000 to 2014, the number of cigarettes consumed in 2015 was higher than in 2014, and the first time annual cigarette consumption was higher than the previous year since 1973. Moreover, the consumption of other combustible and smokeless tobacco products remains substantial. Implementation of proven tobacco prevention interventions (5) is warranted to further reduce tobacco use in the United States.
Widome, Rachel; Brock, Betsy; Klein, Elizabeth G; Forster, Jean L
We aimed to describe the prevalence, in-store location, and neighborhood predictors of point-of-sale smokeless tobacco advertising. In 2007, we conducted assessments of smokeless tobacco advertising at the point of sale in 484 establishments, which held tobacco licenses and sold tobacco products in a Midwest metropolitan area. Associations between store characteristics, neighborhood characteristics (based on U.S. 2000 census block groups), and smokeless tobacco advertising were calculated. Advertisements for smokeless tobacco were found in 21% (n = 103) of stores. Approximately, 12% (n = 58) of stores had ads within 6 feet of the counter, 3% (n = 14) had ads less than 3 feet from the ground, and 2% (n = 9) had advertisement less than 1 foot from candy or snacks. The racial/ethnic composition and number of households on public assistance within the block group in which a store was situated were related to the amount of smokeless advertising in stores. For instance, having a higher proportion of the population identifying as White was associated with more advertising. Gas stations/convenience stores had more advertising than any other store types. Chain stores had double the amount of advertising as independent stores (p point of sale.
Popova, Lucy; Neilands, Torsten B.; Ling, Pamela M.
Introduction Tobacco manufacturers’ aggressive promotion of new smokeless tobacco products such as snus warrants a timely and effective public health response. This study tested potential counter-marketing messages to discourage current and former smokers from becoming dual users of smokeless tobacco and cigarettes. Methods In a pretest – post-test experiment, 1,836 adult current and recently former smokers from a national sample were randomized to view one of six anti-smokeless tobacco ads followed by a snus ad, to view a control ad followed by a snus ad; or to view two control ads. Perceived effectiveness of ads and actual changes in attitudes and openness to snus were compared across groups using analyses of variance. Results Some ads that were perceived as most effective did not change attitudes or openness to trying snus, and conversely, some ads not perceived as effective changed attitudes and openness to snus. Ads portraying the negative health effects of smokeless tobacco were perceived as most effective, but ads with anti-tobacco industry themes significantly decreased favorable attitudes toward snus. Responses to ads were different for smokers who had ever used smokeless tobacco: for this group health effects and humorous/testimonial ads were effective. Conclusions Measures of perceived effectiveness of anti-tobacco ads need to be augmented with measures of actual effectiveness to assess counter-marketing messages. Some of the developed ads, such as ads with anti-industry themes, were effective for the overall population of smokers whereas humorous/testimonial and health effects ads were particularly effective in changing attitudes of past users of smokeless tobacco. PMID:23467655
Israel Agaku; Akinyele, Adisa O.; Uyoyo T Omaduvie
Background: Smokeless and cigarette tobacco use is becoming increasingly popular among Nigerian adolescents. This study aimed to evaluate predictors of intention to quit tobacco use among adolescents that currently use tobacco products in Nigeria. Materials and Methods: A total of 536 male and female high school students in senior classes in Benue State, Nigeria were enrolled into the cross-sectional study. The survey instrument was adapted from the Global Youth Tobacco Survey (GYTS) question...
Muula Adamson S; Rudatsikira Emmanuel; Siziya Seter
Abstract Background Tobacco use is a leading cause of global morbidity and mortality. Much of the epidemiologic research on tobacco focuses on smoking, especially cigarette smoking, but little attention on smokeless tobacco (SLT). Methods Using data from the Republic of Congo Global Youth Tobacco Survey (GYTS) of 2006, we estimated the prevalence of SLT use among in-school adolescents. We also assessed the association between SLT use and cigarette smoking as well as the traditional factors wh...
Timberlake, David S; Zell, Jason A
Some tobacco researchers have argued that the European Union should remove its ban on a form of low-nitrosamine smokeless tobacco referred to as Swedish 'snus'. This argument has developed in to an international debate over the use of smokeless tobacco as a measure of harm reduction for smokers. Leading authorities in the USA have firmly stated that there is no safe tobacco - a message which does not allow for any discussion of comparative tobacco risks. This commentary is intended to review the origin of the controversy over Swedish 'snus', to examine briefly the meta-analysis on cancer risks by Peter Lee and Jan Hamling (published in July in BMC Medicine) and to discuss the anticipated direction of the debate on tobacco-harm reduction in the USA. We anticipate that much of the debate will shift from the discussion of epidemiologic data to the discussion of the marketing, health communication and economics of smokeless tobacco. While the Food and Drug Administration's newly approved authority over tobacco will undoubtedly affect the smokeless products, it may not be the sole determinant of harm reduction's fate in the USA. See associated research article by Lee and Hamling: http://www.biomedcentral.com/1741-7015/7/36.
Timberlake David S
Full Text Available Abstract Some tobacco researchers have argued that the European Union should remove its ban on a form of low-nitrosamine smokeless tobacco referred to as Swedish 'snus'. This argument has developed in to an international debate over the use of smokeless tobacco as a measure of harm reduction for smokers. Leading authorities in the USA have firmly stated that there is no safe tobacco - a message which does not allow for any discussion of comparative tobacco risks. This commentary is intended to review the origin of the controversy over Swedish 'snus', to examine briefly the meta-analysis on cancer risks by Peter Lee and Jan Hamling (published in July in BMC Medicine and to discuss the anticipated direction of the debate on tobacco-harm reduction in the USA. We anticipate that much of the debate will shift from the discussion of epidemiologic data to the discussion of the marketing, health communication and economics of smokeless tobacco. While the Food and Drug Administration's newly approved authority over tobacco will undoubtedly affect the smokeless products, it may not be the sole determinant of harm reduction's fate in the USA. See associated research article by Lee and Hamling: http://www.biomedcentral.com/1741-7015/7/36
This PSA helps retailers understand new federal regulations surrounding the sale of unpackaged cigarettes and smokeless tobacco. Created: 10/28/2010 by The CDC Division of News and Electronic Media and the FDA Center for Tobacco Products. Date Released: 10/28/2010.
Cinelli, Bethann; Rose-Colley, Mary
A survey of 1,368 Pennsylvania college students found that a total of 23.9 percent used tobacco products (14 percent cigarettes and 10 percent smokeless tobacco). Data support the need for prevention and intervention programs beginning at the elementary level and continuing through college. (SM)
Edwards, Steven W; And Others
A study of 25 male college students (both athletes and nonathletes) who where either regular smokeless tobacco users or nonusers as they performed perceptual-motor tasks revealed significant differences in favor of athletes over nonathletes in terms of reaction time. Tobacco-using subjects showed significant increases in heart rate. (Author/CB)
Schensul, Jean J; Nair, Saritha; Bilgi, Sameena; Cromley, Ellen; Kadam, Vaishali; Mello, Sunitha D; Donta, Balaiah
To examine the role of accessibility, product availability, promotions and social norms promotion, factors contributing to the use of smokeless tobacco (ST) products in a typical low-income community of Mumbai community using Geographic Information System (GIS), observational and interview methodologies and to assess implementation of Cigatettes and other Tobacco Products Act (COTPA) legislation. In India, the third largest producer of tobacco in the world, smokeless tobacco products are used by men, women and children. New forms of highly addictive packaged smokeless tobacco products such as gutkha are inexpensive and rates of use are higher in low-income urban communities. These products are known to increase rates of oral cancer and to affect reproductive health and fetal development. The study used a mixed methods approach combining ethnographic and GIS mapping, observation and key informant interviews. Accessibility was defined as density, clustering and distance of residents and schools to tobacco outlets. Observation and interview data with shop owners and community residents produced an archive of products, information on shop histories and income and normative statements. Spatial analysis showed high density of outlets with variations across subcommunities. All residents can reach tobacco outlets within 30-100 feet of their homes. Normative statements from 55 respondents indicate acceptance of men's, women's and children's use, and selling smokeless tobacco is reported to be an important form of income generation for some households. Multilevel tobacco control and prevention strategies including tobacco education, community norms change, licensing and surveillance and alternative income generation strategies are needed to reduce accessibility and availability of smokeless tobacco use.
Gartner, Coral E; Hall, Wayne D
In Australia, 2.9 million people continue to smoke daily, and tobacco still accounts for 8% of disease burden. Tobacco harm-reduction strategies, such as the use of Swedish snus, have been suggested as a way to further reduce this disease burden. In Australia, the most dangerous tobacco products (cigarettes) are the least regulated, while oral tobacco products, including snus, cannot be sold legally. Recent epidemiological modelling indicates that there are only small differences in life expectancy between smokers who quit and those who switch to snus. There is a case on public health and ethical grounds for allowing inveterate smokers who want to reduce their health risks to access snus. At a minimum, the recent increase in tax on smokeless tobacco should be reversed, and the ban on the commercial importation and supply of low nitrosamine smokeless tobacco should be reconsidered in light of the epidemiological evidence on its potential to reduce tobacco-related disease in smokers.
Bromberg, Julie E; Augustson, Erik M; Backinger, Cathy L
Videos of smokeless tobacco (ST) on YouTube are abundant and easily accessible, yet no studies have examined the content of ST videos. This study assesses the overall portrayal, genre, and messages of ST YouTube videos. In August 2010, researchers identified the top 20 search results on YouTube by "relevance" and "view count" for the following search terms: "ST," "chewing tobacco," "snus," and "Skoal." After eliminating videos that were not about ST (n = 26), non-English (n = 14), or duplicate (n = 42), a final sample of 78 unique videos was coded for overall portrayal, genre, and various content measures. Among the 78 unique videos, 15.4% were anti-ST, while 74.4% were pro-ST. Researchers were unable to determine the portrayal of ST in the remaining 10.3% of videos because they involved excessive or "sensationalized" use of the ST, which could be interpreted either positively or negatively, depending on the viewer. The most common ST genre was positive video diaries (or "vlogs"), which made up almost one third of the videos (29.5%), followed by promotional advertisements (20.5%) and anti-ST public service announcements (12.8%). While YouTube is intended for user-generated content, 23.1% of the videos were created by professional organizations. These results demonstrate that ST videos on YouTube are overwhelmingly pro-ST. More research is needed to determine who is viewing these ST YouTube videos and how they may affect people's knowledge, attitudes, and behaviors regarding ST use.
Rudatsikira, Emmanuel; Muula, Adamson S; Siziya, Seter
Tobacco use is a leading cause of global morbidity and mortality. Much of the epidemiologic research on tobacco focuses on smoking, especially cigarette smoking, but little attention on smokeless tobacco (SLT). Using data from the Republic of Congo Global Youth Tobacco Survey (GYTS) of 2006, we estimated the prevalence of SLT use among in-school adolescents. We also assessed the association between SLT use and cigarette smoking as well as the traditional factors which are associated with cigarette smoking among adolescents (e.g. age, sex, parental or peer smoking). Unadjusted odds ratios (OR) and adjusted odds ratios (AOR) together with their 95% confidence intervals (CI) were used to measure magnitudes of associations. Of the 3,034 respondents, 18.0% (18.0% males and 18.1% females) reported having used smokeless tobacco (chewing tobacco, sniff or dip) in the last 30 days. In multivariate analysis, no significant associations were observed between age and sex on one hand and current smokeless tobacco use on the other. Cigarette smokers were more than six times likely to report current use of smokeless tobacco (AOR = 6.65; 95% CI [4.84, 9.14]). Having parents or friends smokers was positively associated with using smokeless tobacco (AOR = 1.98; 95% CI [1.51, 2.59] for parents who smoked cigarettes, AOR = 1.82; 95% CI [1.41, 2.69] for some friends who smoked cigarettes, and AOR = 2.02; 95% CI [1.49, 2.47] for most or all friends who smoked cigarettes). Respondents who reported have seen tobacco advertisement on TV, billboards and in newspapers/magazines were 1.95 times more likely to report current use of smokeless tobacco (AOR = 1.95; 95% CI [1.34, 3.08]). Perception that smoking was harmful to health was negatively associated with current use of smokeless tobacco (AOR = 0.60; 95% CI [0.46, 0.78]). Prevention programs aimed to reduce teen [cigarette] smoking must also be designed to reduce other forms of tobacco use. The teenagers environment at home, at school and
Muula Adamson S
Full Text Available Abstract Background Tobacco use is a leading cause of global morbidity and mortality. Much of the epidemiologic research on tobacco focuses on smoking, especially cigarette smoking, but little attention on smokeless tobacco (SLT. Methods Using data from the Republic of Congo Global Youth Tobacco Survey (GYTS of 2006, we estimated the prevalence of SLT use among in-school adolescents. We also assessed the association between SLT use and cigarette smoking as well as the traditional factors which are associated with cigarette smoking among adolescents (e.g. age, sex, parental or peer smoking. Unadjusted odds ratios (OR and adjusted odds ratios (AOR together with their 95% confidence intervals (CI were used to measure magnitudes of associations. Results Of the 3,034 respondents, 18.0% (18.0% males and 18.1% females reported having used smokeless tobacco (chewing tobacco, sniff or dip in the last 30 days. In multivariate analysis, no significant associations were observed between age and sex on one hand and current smokeless tobacco use on the other. Cigarette smokers were more than six times likely to report current use of smokeless tobacco (AOR = 6.65; 95% CI [4.84, 9.14]. Having parents or friends smokers was positively associated with using smokeless tobacco (AOR = 1.98; 95% CI [1.51, 2.59] for parents who smoked cigarettes, AOR = 1.82; 95% CI [1.41, 2.69] for some friends who smoked cigarettes, and AOR = 2.02; 95% CI [1.49, 2.47] for most or all friends who smoked cigarettes. Respondents who reported have seen tobacco advertisement on TV, billboards and in newspapers/magazines were 1.95 times more likely to report current use of smokeless tobacco (AOR = 1.95; 95% CI [1.34, 3.08]. Perception that smoking was harmful to health was negatively associated with current use of smokeless tobacco (AOR = 0.60; 95% CI [0.46, 0.78]. Conclusions Prevention programs aimed to reduce teen [cigarette] smoking must also be designed to reduce other forms of
Sun, Jinchun; Jin, Jinshan; Beger, Richard D.; Cerniglia, Carl E.; Yang, Maocheng; Chen, Huizhong
The association between exposure to smokeless tobacco products (STP) and oral diseases is partially due to the physiological and pathological changes in the composition of the oral microbiome and its metabolic profile. However, it is not clear how STPs affect the physiology and ecology of oral microbiota. A UPLC/QTof-MS-based metabolomics study was employed to analyze metabolic alterations in oral bacterium, Capnocytophaga sputigena as a result of smokeless tobacco exposure and to assess the capability of the bacterium to metabolize nicotine. Pathway analysis of the metabolome profiles indicated that smokeless tobacco extracts caused oxidative stress in the bacterium. The metabolomics data also showed that the argininenitric oxide pathway was perturbed by the smokeless tobacco treatment. Results also showed that LC/MS was useful in identifying STP constituents and additives, including caffeine and many flavoring compounds. No significant changes in levels of nicotine and its major metabolites were found when C. sputigena was cultured in a nutrient rich medium, although hydroxylnicotine and cotinine N-oxide were detected in the bacterial metabolites suggesting that nicotine metabolism might be present as a minor degradation pathway in the bacterium. Study results provide new insights regarding the physiological and toxicological effects of smokeless tobacco on oral bacterium C. sputigena and associated oral health as well as measuring the ability of the oral bacterium to metabolize nicotine. PMID:27480511
Ebbert, Jon O; Severson, Herbert H; Croghan, Ivana T; Danaher, Brian G; Schroeder, Darrell R
Long-term smokeless tobacco (ST) use is associated with cardiovascular disease and cancer, but not all ST users want to quit. Previous studies have evaluated the effectiveness of nicotine lozenges and tobacco-free snuff for reducing ST use among ST users not ready to quit, but no comparative effectiveness trials of these two products have been conducted. We conducted a multicenter, randomized clinical pilot study evaluating the comparative effectiveness of the 4-mg nicotine lozenge and tobacco-free snuff for reducing ST use and increasing tobacco abstinence among ST users with no intention of quitting in the next 30 days. Participants received 8 weeks of treatment and behavioral counseling on tobacco reduction strategies with follow-up to 26 weeks. We randomized 81 participants (40 nicotine lozenges, 41 tobacco-free snuff). No significant differences in reduction were observed between the two groups at weeks 8, 12, and 26. No significant differences were observed between groups in nicotine withdrawal or tobacco craving. However, both groups significantly reduced (ptobacco-free snuff both appear to be effective and comparable for reducing ST use among ST users not ready to quit in the next 30 days. Copyright © 2013 Elsevier Ltd. All rights reserved.
Heavner, Karyn K; Rosenberg, Zale; Tenorio, Francis; Phillips, Carl V
Tobacco retailers are potential public health partners for tobacco harm reduction (THR). THR is the substitution of highly reduced-risk nicotine products, such as smokeless tobacco (ST) or pharmaceutical nicotine, for cigarettes. The introduction of a Swedish-style ST product, du Maurier snus (dMS) (Imperial Tobacco Canada Limited), which was marketed as a THR product, provided a unique opportunity to assess retailers' knowledge. This study examined retailers' knowledge of THR and compliance with recommendations regarding tobacco sales to young adults. Male researchers, who may have looked younger than 18 years old, visited 60 stores in Edmonton that sold dMS. The researchers asked the retailers questions about dMS and its health risks relative to those from other tobacco products. They also attempted to purchase dMS to ascertain whether retailers would ask for identification to verify that they were at least 18 years old. Overall, the retailers were only moderately knowledgeable about THR and the differences between dMS and other tobacco products. About half of the retailers correctly indicated that snus is safer than cigarettes; half of whom knew it is safer because it is smoke-free. Fifty percent incorrectly believed that snus causes oral cancer. Less than fifty percent indicated that dMS differs from chewing tobacco because it is in pouches and is used without spitting or chewing (making it more promising for THR). Most (90%) of the retailers asked the researchers for identification when selling dMS. Tobacco retailers are potentially important sources of information about THR, particularly since there are restrictions on the promotion of all tobacco products (regardless of the actual health risks) in Canada. This study found that many retailers in Edmonton do not know the relative health risks of different tobacco products and are therefore unable to pass on accurate information to smokers.
Full Text Available Background. The current study describes concurrent use of cigarettes and smokeless tobacco (CiST among males and females and evaluates factors associated with CiST use. Methods. Cross-sectional data were drawn from the 2010 Behavioral Risk Factor Surveillance System (BRFSS. Weighted stratified analyses were performed to find associations between CiST use and sociodemographic factors by gender. CiST users were compared to three different tobacco use groups: nonusers, exclusive smokers, and exclusive ST users. Results. Younger age and heavy alcohol consumption were consistently associated with increased odds of CiST use among both males and females, and regardless of comparison group. Among males, education was inversely related to CiST use, and these findings were consistent in all three comparisons. Among women, those unable to work or out of work were more likely to be CiST users, which was consistent across comparisons. American Indian females had higher odds of CiST use than White females when nontobacco users or smokers were the comparison group. Conclusion. This study identified sociodemographic characteristics associated with CiST use, and differences in these associations among women and men. Additionally, this study highlights the need to carefully consider what comparison groups should be used to examine factors associated with CiST use.
Mushtaq, Nasir; Williams, Mary B.; Beebe, Laura A.
Background. The current study describes concurrent use of cigarettes and smokeless tobacco (CiST) among males and females and evaluates factors associated with CiST use. Methods. Cross-sectional data were drawn from the 2010 Behavioral Risk Factor Surveillance System (BRFSS). Weighted stratified analyses were performed to find associations between CiST use and sociodemographic factors by gender. CiST users were compared to three different tobacco use groups: nonusers, exclusive smokers, and exclusive ST users. Results. Younger age and heavy alcohol consumption were consistently associated with increased odds of CiST use among both males and females, and regardless of comparison group. Among males, education was inversely related to CiST use, and these findings were consistent in all three comparisons. Among women, those unable to work or out of work were more likely to be CiST users, which was consistent across comparisons. American Indian females had higher odds of CiST use than White females when nontobacco users or smokers were the comparison group. Conclusion. This study identified sociodemographic characteristics associated with CiST use, and differences in these associations among women and men. Additionally, this study highlights the need to carefully consider what comparison groups should be used to examine factors associated with CiST use. PMID:22666280
Congress of the U.S., Washington, DC. Senate Committee on Labor and Human Resources.
This document summarizes the Comprehensive Smokeless Tobacco and Health Education Act of 1985 bill. A summary of the impact of the bill is included which notes the following: (1) programs to inform the public of the dangers of smokeless tobacco are to be established; (2) smokeless tobacco products will carry one of three warning statements; and…
Public Health Service (DHHS), Rockville, MD.
This report on the health consequences of smokeless tobacco contains an "Introduction, Overview, and Conclusions" section and four major chapters. Chapter 1 defines the various forms of smokeless tobacco that are used in the United States and examines data pertaining to trends in prevalence and patterns of use. Methodological…
Gupta, Prakash Chandra; Subramoney, Sreevidya
Maternal cigarette smoking has been causally associated with an increased risk for stillbirth. Preliminary reports suggest an increased risk for stillbirth with smokeless tobacco use during pregnancy. We conducted a population-based prospective cohort study to investigate this association by using a house-to-house approach to recruit 1,217 women who were between 3 and 7 months' gestation. Of these, 96% were contacted after delivery to determine the pregnancy outcome. Demographic and maternal variables which were apparently associated either with stillbirth or with smokeless tobacco use (OR >or= 1.5) were included as potential confounders. Stillbirth was defined as any delivery of a dead fetus after 20 completed weeks of gestation. We used time-to-event methods to analyze the risk of stillbirth. Overall occurrence of stillbirth among singleton deliveries in this population was 4.1%. Smokeless tobacco use was reported by 17% of women; 8.9% of smokeless tobacco users had a stillbirth compared with 3.1% among nonusers (life-table adjusted hazard ratio = 3.1; 95% confidence interval = 1.7-5.6). After adjustment by the Cox proportional hazards procedure for age, educational and socioeconomic background, working status of mother, parity, prenatal care variables, and place of delivery, the risk for stillbirth in users was 2.6 (95% confidence interval-1.4-4.8). Most women used mishri (a pyrolyzed tobacco product often used as dentifrice), and there was a dose-response relationship between the daily frequency of use and stillbirth risk. The risk of stillbirth associated with smokeless tobacco use was greater in earlier gestational periods. Smokeless tobacco use during pregnancy increases stillbirth risk, with a risk at least as great as that associated with maternal cigarette smoking.
Kalkhoran, Sara; Grana, Rachel A.; Neilands, Torsten B.; Ling, Pamela M.
Objectives To evaluate predictors of dual use of cigarettes with smokeless tobacco or e-cigarettes. Methods Adult smokers (N = 1324) completed online cross-sectional surveys. Logistic regression evaluated predictors of dual use and cigarette quit attempts. Results Smokeless tobacco dual use was associated with past attempts to quit smoking by switching to smokeless products. E-cigarette dual use was associated with using stop-smoking medication and strong anti-tobacco industry attitudes. Ever use of stop-smoking medication was associated with quit attempts among dual e-cigarette users and cigarette-only users. Conclusions Dual users are more likely than cigarette-only users to endorse certain cessation-related attitudes and behaviors. This may provide an opportunity for clinicians or others to discuss evidence-based strategies for smoking cessation. PMID:25564840
Stepanov, Irina; Villalta, Peter W; Knezevich, Aleksandar; Jensen, Joni; Hatsukami, Dorothy; Hecht, Stephen S
Smokeless tobacco contains 28 known carcinogens and causes precancerous oral lesions and oral and pancreatic cancer. A recent study conducted by our research team identified eight different polycyclic aromatic hydrocarbons (PAHs) in U.S. moist snuff, encouraging further investigations of this group of toxicants and carcinogens in smokeless tobacco products. In this study, we developed a gas chromatography-mass spectrometry method that allows simultaneous analysis of 23 various PAHs in smokeless tobacco after a simple two-step extraction and purification procedure. The method produced coefficients of variation under 10% for most PAHs. The limits of quantitation for different PAHs varied between 0.3 and 11 ng/g tobacco, starting with a 300 mg sample. The recovery of the stable isotope-labeled internal standards averaged 87%. The method was applied to analysis of 23 moist snuff samples that included various flavors of the most popular U.S. moist snuff brands, as well as 17 samples representing the currently marketed brands of spit-free tobacco pouches, a relatively new type of smokeless tobacco. The sum of all detected PAHs in conventional moist snuff averaged 11.6 (+/-3.7) microg/g dry weight; 20% of this amount was comprised of carcinogenic PAHs. The levels of PAHs in new spit-free tobacco products were much lower than those in moist snuff; the sum of all detected PAHs averaged 1.3 (+/-0.28) microg/g dry weight. Our findings render PAHs one of the most prevalent groups of carcinogens in smokeless tobacco. Urgent measures are required from the U.S. tobacco industry to modify manufacturing processes so that the levels of these toxicants and carcinogens in U.S. moist snuff are greatly reduced.
Smokeless tobacco consumption, which is widespread throughout the world, leads to oral submucous fibrosis (OSMF), which is a long-lasting and devastating condition of the oral cavity with the potential for malignancy. In this review, we mainly focus on the consumption of smokeless tobacco, such as paan and gutkha, and the role of these substances in the induction of OSMF and ultimately oral cancer. The list of articles to be examined was established using citation discovery tools provided by PubMed, Scopus, and Google Scholar. The continuous chewing of paan and swallowing of gutkha trigger progressive fibrosis in submucosal tissue. Generally, OSMF occurs due to multiple risk factors, especially smokeless tobacco and its components, such as betel quid, areca nuts, and slaked lime, which are used in paan and gutkha. The incidence of oral cancer is higher in women than in men in South Asian countries. Human oral epithelium cells experience carcinogenic and genotoxic effects from the slaked lime present in the betel quid, with or without areca nut. Products such as 3-(methylnitrosamino)-proprionitrile, nitrosamines, and nicotine initiate the production of reactive oxygen species in smokeless tobacco, eventually leading to fibroblast, DNA, and RNA damage with carcinogenic effects in the mouth of tobacco consumers. The metabolic activation of nitrosamine in tobacco by cytochrome P450 enzymes may lead to the formation of N-nitrosonornicotine, a major carcinogen, and micronuclei, which are an indicator of genotoxicity. These effects lead to further DNA damage and, eventually, oral cancer. PMID:28292008
Niaz, Kamal; Maqbool, Faheem; Khan, Fazlullah; Bahadar, Haji; Ismail Hassan, Fatima; Abdollahi, Mohammad
Smokeless tobacco consumption, which is widespread throughout the world, leads to oral submucous fibrosis (OSMF), which is a long-lasting and devastating condition of the oral cavity with the potential for malignancy. In this review, we mainly focus on the consumption of smokeless tobacco, such as paan and gutkha, and the role of these substances in the induction of OSMF and ultimately oral cancer. The list of articles to be examined was established using citation discovery tools provided by PubMed, Scopus, and Google Scholar. The continuous chewing of paan and swallowing of gutkha trigger progressive fibrosis in submucosal tissue. Generally, OSMF occurs due to multiple risk factors, especially smokeless tobacco and its components, such as betel quid, areca nuts, and slaked lime, which are used in paan and gutkha. The incidence of oral cancer is higher in women than in men in South Asian countries. Human oral epithelium cells experience carcinogenic and genotoxic effects from the slaked lime present in the betel quid, with or without areca nut. Products such as 3-(methylnitrosamino)-proprionitrile, nitrosamines, and nicotine initiate the production of reactive oxygen species in smokeless tobacco, eventually leading to fibroblast, DNA, and RNA damage with carcinogenic effects in the mouth of tobacco consumers. The metabolic activation of nitrosamine in tobacco by cytochrome P450 enzymes may lead to the formation of N-nitrosonornicotine, a major carcinogen, and micronuclei, which are an indicator of genotoxicity. These effects lead to further DNA damage and, eventually, oral cancer.
McAdam, K; Kimpton, H; Porter, A; Liu, C; Faizi, A; Mola, M; McAughey, J; Rodu, B
There is considerable interest in the chemical composition of smokeless tobacco products (STPs), owing to health concerns associated with their use. Previous studies have documented levels of 210Po, 210Pb and uranium in STP samples. Here, the levels of 13 α-particle and 15 β-radiation emitting radionuclides have been measured in a broad and representative range of contemporary STPs commercially available in the United States and Sweden. For each radionuclide, the level of radioactivity and calculated mass per gram of STP are reported. The results indicate that, among 34 Swedish snus and 44 US STPs, a more complex radionuclide content exists than previously reported for these products. Of the 28 radionuclides examined, 13 were detected and quantified in one or more STPs. The most frequently identified radionuclides in these STPs were 40K, 14C, 210Po and 226Ra. Over half the STPs also contained 228Th, and an additional 8 radionuclides were identified in a small number of STPs. The presence of 14C, 3H and 230Th are reported in tobacco for the first time. The activity of β-emitters was much greater than those of α-emitters, and the β-emitter 40K was present in the STPs with both the greatest radioactivity and mass concentrations. Since the three radionuclides included in the FDA's HPHC list were either not detected (235U), identified in only three of 78 samples (238U), and/or had activity levels over fifty times lower than that of 40K (210Po, 238U), there may be a rationale for reconsidering the radionuclides currently included in the FDA HPHC list, particularly with respect to 40K. Using a model of the physical and biological compartments which must be considered to estimate the exposure of STP users to radionuclides, we conclude that exposure from α-emitters may be minimal to STP users, but 40K in particular may expose the oral cavities of STP users to β-radiation. Although a more comprehensive picture of the radioisotope content of STPs has emerged from this
Vijayaraghavan, Athreya; Aswath, Nalini
Palm prints formed once does not change throughout life and is not influenced by environment. Palmar Dermatoglyphics can indicate the development of potentially malignant and malignant lesions and help in identifying persons at high risk of developing Oral submucous fibrosis (OSMF) and Oral squamous cell carcinoma (OSSC). To analyze the qualitative [finger ridge pattern and presence or absence of hypothenar pattern] and quantitative [mean ATD angle and total AB ridge count] variations in Palmar Dermatoglyphics in patients suffering from OSMF and OSCC. A prospective comparative study among 40 patients (Group I--10 samples of smokeless tobacco users with OSMF, Group II--10 samples of smokeless tobacco users with OSCC, Group III--10 samples of smokeless tobacco users without OSMF or OSCC and Group IV--10 samples without smokeless tobacco habit without OSMF and OSCC as controls) were selected. The palm prints were recorded using an HP inkjet scanner. The patients were asked to place the palm gently on the scanner with the fingers wide apart from each other. The images of the palm prints were edited and qualitative and quantitative analysis were done. Statistical analysis such as Kruskal Wallis, Post Hoc and Analysis of Varience were done. A highly significant difference among the finger ridge, hypothenar pattern and mean ATD angle (PCancer patients. Palmar Dermatoglyphics can predict the probable occurrence of OSMF and OSCC in smokelees tobacco users.
Popova, Lucy; Neilands, Torsten B; Ling, Pamela M
Tobacco manufacturers' aggressive promotion of new smokeless tobacco products such as snus warrants a timely and effective public health response. This study tested potential countermarketing messages to discourage current and former smokers from becoming dual users of smokeless tobacco and cigarettes. In a pretest-post-test experiment, 1836 adult current and recently former smokers from a national sample were randomised to view one of six antismokeless tobacco ads followed by a snus ad, to view a control ad followed by a snus ad; or to view two control ads. Perceived effectiveness of ads and actual changes in attitudes and openness to snus were compared across groups using analyses of variance. Some ads that were perceived as most effective did not change attitudes or openness to trying snus, and conversely, some ads not perceived as effective changed attitudes and openness to snus. Ads portraying the negative health effects of smokeless tobacco were perceived as most effective, but ads with antitobacco industry themes significantly decreased favourable attitudes toward snus. Responses to ads were different for smokers who had ever used smokeless tobacco: for this group health effects and humorous/testimonial ads were effective. Measures of perceived effectiveness of antitobacco ads need to be augmented with measures of actual effectiveness to assess countermarketing messages. Some of the developed ads, such as ads with anti-industry themes, were effective for the overall population of smokers whereas humorous/testimonial and health effects ads were particularly effective in changing attitudes of past users of smokeless tobacco. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Alcalá, Héctor E; von Ehrenstein, Ondine S; Tomiyama, A Janet
Adverse childhood experiences (ACEs) have been linked to increased use of tobacco products later in life. However, studies to date have ignored smokeless tobacco products. To address this, data from the 2011 Behavioral Risk Factor Surveillance System, which interviewed adults 18 years and over (N = 102,716) were analyzed. Logistic regression models were fit to estimate odds ratios of ever smoking, current smoking and current smokeless tobacco use in relation to ACEs. Results showed that less than 4 % of respondents currently used smokeless tobacco products, while 44.95 and 18.57 % reported ever and current smoking, respectively. Physical abuse (OR 1.40; 95 % CI 1.14, 1.72), emotional abuse (OR 1.41; 95 % CI 1.19, 1.67), sexual abuse (OR 0.70; 95 % CI 0.51, 0.95), living with a drug user (OR 1.50; 95 % CI 1.17, 1.93), living with someone who was jailed (OR 1.50; 95 % CI 1.11, 2.02) and having parents who were separated or divorced (OR 1.31; 95 % CI 1.09, 1.57) were associated with smokeless tobacco use in unadjusted models. After accounting for confounders, physical abuse (OR 1.43; 95 % CI 1.16, 1.78), emotional abuse (OR 1.32; 95 % CI 1.10, 1.57), living with a problem drinker (OR 1.30; 95 % CI 1.08, 1.58), living with a drug user (OR 1.31; 95 % CI 1.00, 1.72) and living with adults who treated each other violently (OR 1.30; 95 % CI 1.05, 1.62) were associated with smokeless tobacco use. Living with someone who was mentally ill (OR 0.70; 95 % CI 0.53, 0.92) was associated with smokeless tobacco use after accounting for confounders and all ACEs. Results indicated that some childhood adversities are associated with use of smokeless tobacco products. Special attention is needed to prevent tobacco use of different types among those experiencing ACEs.
The Food and Drug Administration (FDA) is reissuing a final rule restricting the sale, distribution, and use of cigarettes and smokeless tobacco. As required by the Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act), FDA is issuing a final rule that is identical to the provisions of the final rule on cigarettes and smokeless tobacco published by FDA in 1996, with certain required exceptions. The rule prohibits the sale of cigarettes and smokeless tobacco to individuals under the age of 18 and imposes specific marketing, labeling, and advertising requirements. Elsewhere in this issue of the Federal Register, FDA is issuing an advance notice of proposed rulemaking to obtain information related to the regulation of outdoor advertising of cigarettes and smokeless tobacco.
Singh, J K; Acharya, D; Kadel, R; Adhikari, S; Lombard, D; Koirala, S; Paudel, R
Tobacco use among women during pregnancy leading to poor maternal and child health outcomes has been well documented. However, factors influencing use of smokeless tobacco in Nepal has not yet been well established. This study aims at exploring the factors related to smokeless tobacco use among pregnant women in rural southern Terai of Nepal. A community-based cross-sectional study was performed at 52 wards within 6 Village Development Committee in Dhanusha district of Nepal. A total of 426 expectant mothers in their second trimester were selected using a multistage cluster sampling method. Descriptive and regression analyses were done to explore the factors that influence smokeless tobacco use. In a total of 426 pregnant mothers, one in five used tobacco in any form. Among the users, 13.4% used smokeless tobacco. Pregnant mothers who were smoking tobacco (AOR 6.01; 95% CI (1.88-19.23), having alcohol consumption (AOR 3.86; 95% CI (1.23-12.08), stressed (AOR 5.04; 95% CI (1.81-14.03), non-vegetarian (AOR 3.31;(1.84-13.03), not attending regular mothers' group meetings (AOR 4.63; (1.41-15.19), and not-exposed to mass media (AOR 5.02; (1.89-13.33) were significantly associated with smokeless tobacco use. Similarly, mothers of age group 20-34 years, dalit, aadibasi and janajati, hill origin, no education and primary education were more likely to use smokeless tobacco than their counterparts. Factors such as smoking tobacco, alcohol consumption, stress, and poor education were found to be significantly associated with smokeless tobacco use among pregnant women in southern Terai of Nepal. This requires an immediate attention develop an effective strategy to prevent and control smokeless tobacco use among pregnant women in southern Terai of Nepal.
Full Text Available Abstract Background Smokeless tobacco is often referred to as a major contributor to oral cancer. In some regions, especially Southeast Asia, the risk is difficult to quantify due to the variety of products, compositions (including non-tobacco ingredients and usage practices involved. In Western populations, the evidence of an increased risk in smokeless tobacco users seems unclear, previous reviews having reached somewhat differing conclusions. We report a detailed quantitative review of the evidence in American and European smokeless tobacco users, and compare our findings with previous reviews and meta-analyses. Methods Following literature review a meta-analysis was conducted of 32 epidemiological studies published between 1920 and 2005 including tests for homogeneity and publication bias. Results Based on 38 heterogeneous study-specific estimates of the odds ratio or relative risk for smokeless tobacco use, the random-effects estimate was 1.87 (95% confidence interval 1.40–2.48. The increase was mainly evident in studies conducted before 1980. No increase was seen in studies in Scandinavia. Restricting attention to the seven estimates adjusted for smoking and alcohol eliminated both heterogeneity and excess risk (1.02; 0.82–1.28. Estimates also varied by sex (higher in females and by study design (higher in case-control studies with hospital controls but more clearly in studies where estimates were unadjusted, even for age. The pattern of estimates suggests some publication bias. Based on limited data specific to never smokers, the random-effects estimate was 1.94 (0.88–4.28, the eight individual estimates being heterogeneous and based on few exposed cases. Conclusion Smokeless tobacco, as used in America or Europe, carries at most a minor increased risk of oral cancer. However, elevated risks in specific populations or from specific products cannot definitely be excluded.
Weitkunat, Rolf; Sanders, Edward; Lee, Peter N
Smokeless tobacco is often referred to as a major contributor to oral cancer. In some regions, especially Southeast Asia, the risk is difficult to quantify due to the variety of products, compositions (including non-tobacco ingredients) and usage practices involved. In Western populations, the evidence of an increased risk in smokeless tobacco users seems unclear, previous reviews having reached somewhat differing conclusions. We report a detailed quantitative review of the evidence in American and European smokeless tobacco users, and compare our findings with previous reviews and meta-analyses. Following literature review a meta-analysis was conducted of 32 epidemiological studies published between 1920 and 2005 including tests for homogeneity and publication bias. Based on 38 heterogeneous study-specific estimates of the odds ratio or relative risk for smokeless tobacco use, the random-effects estimate was 1.87 (95% confidence interval 1.40-2.48). The increase was mainly evident in studies conducted before 1980. No increase was seen in studies in Scandinavia. Restricting attention to the seven estimates adjusted for smoking and alcohol eliminated both heterogeneity and excess risk (1.02; 0.82-1.28). Estimates also varied by sex (higher in females) and by study design (higher in case-control studies with hospital controls) but more clearly in studies where estimates were unadjusted, even for age. The pattern of estimates suggests some publication bias. Based on limited data specific to never smokers, the random-effects estimate was 1.94 (0.88-4.28), the eight individual estimates being heterogeneous and based on few exposed cases. Smokeless tobacco, as used in America or Europe, carries at most a minor increased risk of oral cancer. However, elevated risks in specific populations or from specific products cannot definitely be excluded.
Danaher, Brian G.; Severson, Herbert H.; Zhu, Shu-Hong; Andrews, Judy A.; Cummins, Sharon E.; Lichtenstein, Edward; Tedeschi, Gary J.; Hudkins, Coleen; Widdop, Chris; Crowley, Ryann; Seeley, John R.
Background Use of smokeless tobacco (moist snuff and chewing tobacco) is a significant public health problem but smokeless tobacco users have few resources to help them quit. Web programs and telephone-based programs (Quitlines) have been shown to be effective for smoking cessation. We evaluate the effectiveness of a Web program, a Quitline, and the combination of the two for smokeless users recruited via the Web. Objectives To test whether offering both a Web and Quitline intervention for smokeless tobacco users results in significantly better long-term tobacco abstinence outcomes than offering either intervention alone; to test whether the offer of Web or Quitline results in better outcome than a self-help manual only Control condition; and to report the usage and satisfaction of the interventions when offered alone or combined. Methods Smokeless tobacco users (N= 1,683) wanting to quit were recruited online and randomly offered one of four treatment conditions in a 2×2 design: Web Only, Quitline Only, Web + Quitline, and Control (printed self-help guide). Point-prevalence all tobacco abstinence was assessed at 3- and 6-months post enrollment. Results 69% of participants completed both the 3- and 6-month assessments. There was no significant additive or synergistic effect of combining the two interventions for Complete Case or the more rigorous Intent To Treat (ITT) analyses. Significant simple effects were detected, individually the interventions were more efficacious than the control in achieving repeated 7-day point prevalence all tobacco abstinence: Web (ITT, OR = 1.41, 95% CI = 1.03, 1.94, p = .033) and Quitline (ITT: OR = 1.54, 95% CI = 1.13, 2.11, p = .007). Participants were more likely to complete a Quitline call when offered only the Quitline intervention (OR = 0.71, 95% CI = .054, .093, p = .013), the number of website visits and duration did not differ when offered alone or in combination with Quitline. Rates of program helpfulness (p Web and
Casas, J. Manuel; Bimbela, Alfredo; Corral, Carla V.; Yanez, Isidro; Swaim, Randall C.; Wayman, Jeffrey C.; Bates, Scott
Survey of 1,672 Mexican American students in grades 6-12 in a southern California school district found that smoking and smokeless tobacco use were greater among males than females and increased substantially across grades. Nonmigrant youths and those identifying with traditional Mexican American culture were more likely to consider regular…
Levenson, Phyllis M.; And Others
This study compared undergraduates' cognitive and affective responses to interactive and noninteractive video instruction on smokeless tobacco. The interactive video group demonstrated more accurate and comprehensive recall than the noninteractive and control groups; they were more willing to promote cessation among users; and learner satisfaction…
Marty, Phillip J.; McDermott, Robert J.
This study determined the prevalence and patterns of smokeless tobacco use in a sample of preservice educators at a southern university, and identified factors associated with initiation and reinforcement of the activity. A 26-item survey was completed by 174 persons enrolled in a course required for completion of the teacher education program.…
Sussman, Steve; And Others
Showed videotapes designed to affect personal level judgments of concern and risk in context of smokeless tobacco use to 388 tenth graders, manipulating either message convincingness or perceived probability of consequences portrayed in message. Results suggest that media manipulation of probability of consequences would be more effective than…
Olds, R. Scott
Findings from a survey of 1,830 New York state high school seniors include: smokeless tobacco use (STU) is predominately a rural male behavior; STU declines over timee; cigarette smoking begins before STU; peer influence and taste are cited most often as leading to STU. (IAH)
Glover, Elbert D.; And Others
Presents first part of two-part series reviewing the published literature on smokeless tobacco in the United States and concomitant health effects associated with its use. Delineates the current status of its prevalence, behavioral psychosocial factors associated with use, and review of the negative health effects associated with regular use.…
...\\ Sponsorship expenditures, including sponsorship of sports teams and athletes, were $30.6 million in 2005.\\31... retailer may distribute or cause to be distributed any free samples of smokeless tobacco: (i) To a sports... limited to words only with no music or sound effects. (2) Video formats shall be limited to static black...
Schinke, S P; Gilchrist, L D; Schilling, R F; Senechal, V A
Data from a 2-year study describe tobacco use trends, perceptions, and prevention effects for 1,281 5th and 6th graders enrolled in 12 randomly selected Washington State elementary schools. Youths were pretested, then randomly divided by school into skills, discussion, and control groups. Preventive intervention curriculums for the skills and discussion groups included age-relevant information on smoked and smokeless tobacco use, peer testimonials, debates, games, and homework. Youths in the ...
Benowitz, N L
Smokeless tobacco (ST) delivers nicotine in doses similar to those received in cigarette smoking but does not expose the user to the toxic combustion gases and particles that are responsible for most tobacco-induced disease. This Opinion piece discusses the controversies pertaining to ST and health, the pros and cons of ST in harm reduction, and progress in treatment for those who would like to quit ST use.
Mutti, Seema; Reid, Jessica L.; Gupta, Prakash C.; Pednekar, Mangesh S.; Dhumal, Gauri; Nargis, Nigar; Hussain, AKM Ghulam; Hammond, David
Background: Globally, smokeless tobacco use is disproportionately concentrated in low-income and middle-income countries like India and Bangladesh. Objectives: The current study examined comparative patterns of use and perceptions of harm for different smokeless tobacco products among adults and youth in Navi Mumbai, India, and Dhaka, Bangladesh. Methods: Face-to-face interviews were conducted on tablets with adult (19 years and older) smokeless tobacco users and youth (16–18 years) users and non-users in Navi Mumbai (n = 1002), and Dhaka (n = 1081). Results: A majority (88.9%) of smokeless tobacco users reported daily use. Approximately one-fifth (20.4%) of the sample were mixed-users (used both smoked and smokeless tobacco), of which about half (54.4%) reported that they primarily used smokeless over smoked forms like cigarettes or bidis. The proportion of users planning to quit was higher in India than in Bangladesh (75.7% vs. 49.8%, p smokeless product in India, and pan masala in Bangladesh. Among users in Bangladesh, the most commonly reported reason for using their usual product was the belief that it was “less harmful” than other types. Perceptions of harm also differed with respect to a respondent's usual product. Bangladeshi respondents reported more negative attitudes toward smokeless tobacco compared to Indian respondents. Conclusions: The findings highlight the high daily use of smokeless tobacco, and the high prevalence of false beliefs about its harms. This set of findings reinforces the need to implement effective tobacco control strategies in low and middle-income countries like India and Bangladesh. PMID:27890978
Medline, Embase, Cancerlit, Toxline were searched, followed by the reference lists of identified reviews and articles. Human cohort or case-control studies in peer-reviewed journals or that were publicly available were selected if they specified study location; examined any form of oral cancer as the outcome; and described use of chewing tobacco, orally used moist snuff or unspecified smokeless tobacco as the exposure. Studies in Asian populations and those with insufficient power where risk estimates and confidence intervals were not reported or could not be calculated were excluded. Standard information was abstracted from each study. Whole-population data were used to estimate numbers of never-smokers. Separate figures for males and females were obtained where possible. Estimates were made of effect size and precision since these were not presented in original studies. Separate meta-analyses were conducted for chewing tobacco, for snuff and for overall smokeless tobacco. Sensitivity analyses for smokers/ nonsmokers were carried out. Heterogeneity was investigated and publication bias assessed using a funnel plot. The 32 studies meeting the inclusion criteria provided 38 heterogeneous study-specific estimates of odds or relative risk ratios (see Tables 1, 2). An increase in risk was mainly evident in studies conducted before 1980. No increase was seen in studies in Scandinavia. The pattern of estimates suggests some publication bias. Smokeless tobacco, as used in America or Europe, carries at most a minor increased risk of oral cancer, but elevated risks in specific populations or from specific products cannot definitely be excluded.
... BUREAU, DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO IMPORTATION OF TOBACCO PRODUCTS, CIGARETTE PAPERS... tobacco” or “snuff.” As an alternative, packages of chewing tobacco may be designated “Tax Class C,” and... contained therein. As an alternative, the shipping cases containing packages of chewing tobacco or snuff may...
... BUREAU, DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO REMOVAL OF TOBACCO PRODUCTS AND CIGARETTE PAPERS..., the designation “chewing tobacco” or “snuff.” As an alternative, packages of chewing tobacco may be... product contained therein. As an alternative, the shipping cases containing packages of chewing tobacco or...
... BUREAU, DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO MANUFACTURE OF TOBACCO PRODUCTS, CIGARETTE PAPERS..., the designation “chewing tobacco” or “snuff.” As an alternative, packages of chewing tobacco may be... product contained therein. As an alternative, the shipping cases containing packages of chewing tobacco or...
Ammann, Jeffrey R.; Lovejoy, Katherine S.; Walters, Matthew J.; Holman, Matthew R.
This investigation provides an updated survey measuring the levels of N′-nitrosonornicotine (NNN) and water content of a select number of smokeless tobacco products sold in the United States in 2015. A total of 34 smokeless tobacco products were collected and analyzed for NNN and water content using LC-MS/MS and GC-TCD, respectively. Smokeless tobacco products were chosen to obtain a representative sample of the different types of products on the U.S. market. These smokeless products represent 12 of the 25 top-selling smokeless tobacco products according to 2013 Nielsen net sales data while five of the smokeless tobacco products are of lower selling smokeless tobacco products. The NNN levels and the water content of the smokeless tobacco products were determined and compared to previous studies. Although the range of NNN levels found was broad for the examined smokeless tobacco products (0.64–12.0 µg/g dry weight), dry snuff had the highest levels of NNN observed (>5 µg/g dry weight). We observed a general decrease in NNN levels for the same six moist snuff products that were analyzed in 2004 compared to our current 2015 study. The water content of the smokeless tobacco products surveyed ranged from 3.92 to 54.8%. PMID:27192054
Ammann, Jeffrey R; Lovejoy, Katherine S; Walters, Matthew J; Holman, Matthew R
This investigation provides an updated survey measuring the levels of N'-nitrosonornicotine (NNN) and water content of a select number of smokeless tobacco products sold in the United States in 2015. A total of 34 smokeless tobacco products were collected and analyzed for NNN and water content using LC-MS/MS and GC-TCD, respectively. Smokeless tobacco products were chosen to obtain a representative sample of the different types of products on the U.S. market. These smokeless products represent 12 of the 25 top-selling smokeless tobacco products according to 2013 Nielsen net sales data while five of the smokeless tobacco products are of lower selling smokeless tobacco products. The NNN levels and the water content of the smokeless tobacco products were determined and compared to previous studies. Although the range of NNN levels found was broad for the examined smokeless tobacco products (0.64-12.0 μg/g dry weight), dry snuff had the highest levels of NNN observed (>5 μg/g dry weight). We observed a general decrease in NNN levels for the same six moist snuff products that were analyzed in 2004 compared to our current 2015 study. The water content of the smokeless tobacco products surveyed ranged from 3.92 to 54.8%.
Mallery, Susan R; Tong, Meng; Michaels, Gregory C; Kiyani, Amber R; Hecht, Stephen S
In 2007, the International Agency for Research on Cancer presented compelling evidence that linked smokeless tobacco use to the development of human oral cancer. Although these findings imply vigorous local carcinogen metabolism, little is known about levels and distribution of phase I, II, and III (drug egress) enzymes in human oral mucosa. In this study here, we integrated clinical data, and imaging and histopathologic analyses of an oral squamous cell carcinoma that arose at the site of smokeless tobacco quid placement in a patient. Immunoblot and immunohistochemical (IHC) analyses were used to identify tumor and normal human oral mucosal smokeless tobacco-associated metabolic activation and detoxification enzymes. Human oral epithelium contains every known phase I enzyme associated with nitrosamine oxidative bioactivation with approximately 2-fold interdonor differences in protein levels. Previous studies have confirmed approximately 3.5-fold interdonor variations in intraepithelial phase II enzymes. Unlike the superficially located enzymes in nonreplicating esophageal surface epithelium, IHC studies confirmed that oral mucosal nitrosamine metabolizing enzymes reside in the basilar and suprabasilar region, which notably is the site of ongoing keratinocyte DNA replication. Clearly, variations in product composition, nitrosamine metabolism, and exposure duration will modulate clinical outcomes. The data presented here form a coherent picture consistent with the abundant experimental data that link tobacco-specific nitrosamines to human oral cancer. ©2013 AACR.
Schulz, Malte; Reichart, Peter A; Ramseier, Christoph A; Bornstein, Michael M
Due to migration of different ethnic groups, mainly from Africa and Asia, into Switzerland, many traditional products and habits that have not been seen before were also introduced. Smokeless tobacco (ST)--as one of those habits--is a product of increased use in Switzerland, although no sound epidemiological data are presently available. Numerous studies from North-America, Sweden, Asia and Africa could verify the carcinogenic potency of smokeless tobacco and its effects in the developement of oral cancer and different systemic disorders. For dental professionals and their team it is important to detect ST-associated lesions, and to tell the patients about the potential harmful sequelae of ST products. The present review focusses on the different types of RT products and their effects on oral health.
Popova, Lucy; Ling, Pamela M
Graphic warning labels are a tobacco control best practice that is mandated in the US for cigarettes under the 2009 Family Smoking Prevention and Tobacco Control Act. However, smokeless tobacco products are not required to carry graphic warning labels, and as of September 2014, electronic cigarettes in the US carry no warning labels and are aggressively marketed, including with "reduced harm" or "FDA Approved" messages. In this online experiment, 483 US adult non-users of tobacco were randomized to view print advertisements for moist snuff, snus, and e-cigarettes with either warning labels (current warning label, graphic warning label) or "endorsements" (a "lower risk" label proposed by a tobacco company, an "FDA Approved" label) or control (tobacco advertisement with no label, advertisement for a non-tobacco consumer products). Main outcome measures included changes in perceived harm, positive attitudes towards, openness to using, and interest in a free sample of moist snuff, snus, and e-cigarettes. The graphic warning label increased perceived harm of moist snuff and e-cigarettes. "Lower risk" and "FDA Approved" labels decreased perceived harm of moist snuff and snus respectively. Current warning label and graphic warning label significantly lowered positive attitudes towards e-cigarettes. In this sample of non-users of tobacco, 15% were interested in a free sample of alternative tobacco products (predominantly e-cigarettes). Proportion of participants interested in a free sample did not differ significantly across the conditions, but those interested in a free sample had significantly lower perceptions of harm of corresponding tobacco products. Regulatory agencies should not allow "lower risk" warning labels, which have similar effects to the "FDA Approved" label, which is prohibited, and should consider implementing graphic warning labels for smokeless tobacco products and e-cigarettes.
Zitomer, Nicholas; Rybak, Michael E; Li, Zhong; Walters, Matthew J; Holman, Matthew R
This work developed a UHPLC-MS/MS method for the detection and quantitation of aflatoxins in smokeless tobacco products, which was then used to determine aflatoxin B1 concentrations in 32 smokeless tobacco products commercially available in the United States. Smokeless tobacco products were dried, milled, and amended with (13)C17-labeled internal standards, extracted in water/methanol solution in the presence of a surfactant, isolated through use of immunoaffinity column chromatography, and reconstituted in mobile phase prior to UHPLC-MS/MS analysis. The method was capable of baseline separation of aflatoxins B1, B2, G1, and G2 in a 2.5 min run by use of a fused core C18 column and a water/methanol gradient. MS/MS transition (m/z) 313.3 → 241.2 was used for aflatoxin B1 quantitation, with 313.3 → 285.1 used for confirmation. The limit of detection (LOD) for aflatoxin B1 was 0.007 parts per billion (ppb). Method imprecision for aflatoxin B1 (expressed as coefficient of variation) ranged from 5.5 to 9.4%. Spike recoveries were 105-111%. Aflatoxin B1 concentrations in the smokeless tobacco products analyzed ranged from
Sajid, Faiza; Bano, Samina
Dipping tobacco, traditionally referred to as moist snuff, is a type of finely ground, moistened smokeless tobacco product. Naswar is stuffed in the floor of the mouth under the lower lip, or inside the cheek, for extended periods of time. Tobacco use causes dyslipidemia and also induces oxidative stress, leading to alteration in levels of antioxidant enzymes. Dyslipidemia and oxidative stress in turn play a vital role in the development of cardiovascular disease (CVD). Studies conducted on smokeless tobacco products reveal contradictory findings regarding its effects on lipid profile and antioxidant enzymes. As use of Naswar is quite common in Pakistan, the current study aimed to evaluate levels of the antioxidant enzymes viz glutathione per oxidase (GPx) and super oxide dismutase (SOD), alongside lipid profile parameters such as total cholesterol, triglycerides, High density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) to assess the risk of adverse cardiovascular events in Naswar users.90 Healthy males aged 16-43 years, who consumed Naswar daily, were selected for the study, alongside 68 age-matched non-tobacco users as controls. Both GPx and SOD levels as well as serum HDL-C were significantly reduced (Pcardiovascular disease.
Mushtaq, Nasir; Beebe, Laura A; Vesely, Sara K; Neas, Barbara R
Unlike various research studies conducted to address dependence among smokers, only a few studies have examined smokeless tobacco (ST) dependence. The Fagerström Tolerance Questionnaire (FTQ) and Fagerström Test for Nicotine Dependence (FTND) based scales are the most widely used measures of nicotine dependence for both ST users and smokers. These scales were initially developed to measure physical dependence and tolerance and not to assess other salient dimensions of dependence such as craving, compulsion, or withdrawal, as defined by DSM-IV and ICD-10. The aim of this study is to develop and validate a multidimensional scale that has better content coverage, factor structure, and psychometric properties to measure dependence among ST users. 100 adult male smokeless tobacco users were recruited through email distribution lists and community referral. Participants completed three different nicotine dependence questionnaires and provided information related to their tobacco use and demographic characteristics. They also provided a saliva sample for cotinine measurement. In order to develop the new ST scale, subscales and items were selected based on correlation and factor analysis of the modified WISDM-68. Reliability and validity of the new scale, Oklahoma Scale for Smokeless Tobacco Dependence (OSSTD) were also assessed. The new ST scale identified seven latent constructs including 23 items to measure ST dependence. Internal consistency as measured by Cronbach's coefficient (α=0.925) indicated better reliability of OSSTD than FTND-ST. Concurrent validity of OSSTD as evaluated by comparing it with dependence diagnosis and FTND-ST was affirmative. There was a significant correlation between the OSSTD total score and the cotinine levels and tobacco use characteristics among study participants. OSSTD possesses better psychometric properties and provides an effective and efficient tool to measure ST dependence as a multidimensional construct. Copyright © 2013
Miļuna Sintija; Dagnija Rostoka; Ingus Skadińš; Aigars Reinis; Viktorija Priedīte; Rudīte Koka; Didzis Lauva; Juta Kroiča
.... Comparison of the microbiome of saliva and tooth biofilm in snus tobacco users with that in people who never use snus showed that, the number and diversity of periodontal pathogenic microorganism...
Vidyasagaran, Aishwarya L; Siddiqi, Kamran; Kanaan, Mona
Objective The purpose of this study was to assess the risk of ischaemic heart disease (IHD) and stroke (non-fatal and fatal) among adult ever-users of smokeless tobacco (ST). Design The study design involved a systematic review and meta-analysis of observational studies. Methods Data sources for the review included key electronic databases and reference lists. Studies were included based on design (cohort or case-control), exposure (exclusive use of ST or adjusted for smoking), and outcome (non-fatal and fatal IHD and stroke). Data extraction included reported measures of association (risk ratios (RRs) or odds ratios (ORs)) between ever-use of ST (current or past) and cardiovascular disease (CVD) outcomes among non-smokers, and other study characteristics. The Newcastle-Ottawa scale was used to assess study quality. Summary measures were estimated using random effects models. Results Twenty studies were included in the meta-analyses. Overall, significantly increased risk of IHD deaths (1.15, 95% confidence interval (CI: 1.01-1.30) and stroke deaths (1.39, 95% CI: 1.29-1.49) was found among ever-users of ST. We did not find an overall significant increased risk for IHD (1.14, 95% CI: 0.92-1.42) or stroke (1.01, 95% CI: 0.90-1.13). But geographical variations were marked for IHD, with significant positive association in Asian studies (1.40, 95% CI: 1.01-1.95), and the INTERHEART study, where ST data was mainly reported from Asia (2.23, 95% CI: 1.41-3.53). European studies did not show an increased risk for non-fatal CVD. Conclusion An association was found between ever use of ST and risk of fatal IHD and stroke, consistent with previous reviews. ST consumption also appears to significantly increase risk of non-fatal IHD among users in Asia, but not in Europe.
Morrell, Holly E. R.; Cohen, Lee M.; Bacchi, Donna; West, Joel
Cigarette smoking and smokeless tobacco (SLT) use are associated with numerous health hazards and economic costs, and rates of tobacco use have recently increased among young adults. In this study, the authors compared predictors of smoking and SLT use among college students (N = 21,410) from 13 Texas universities using a Web-based survey. Results…
Murukutla, Nandita; Yan, Hongjin; Wang, Shuo; Negi, Nalin Singh; Kotov, Alexey; Mullin, Sandra; Goodchild, Mark
Tobacco control mass media campaigns are cost-effective in reducing tobacco consumption in high-income countries, but similar evidence from low-income countries is limited. An evaluation of a 2009 smokeless tobacco control mass media campaign in India provided an opportunity to test its cost-effectiveness. Campaign evaluation data from a nationally representative household survey of 2898 smokeless tobacco users were compared with campaign costs in a standard cost-effectiveness methodology. Costs and effects of the Surgeon campaign were compared with the status quo to calculate the cost per campaign-attributable benefit, including quit attempts, permanent quits and tobacco-related deaths averted. Sensitivity analyses at varied CIs and tobacco-related mortality risk were conducted. The Surgeon campaign was found to be highly cost-effective. It successfully generated 17 259 148 additional quit attempts, 431 479 permanent quits and 120 814 deaths averted. The cost per benefit was US$0.06 per quit attempt, US$2.6 per permanent quit and US$9.2 per death averted. The campaign continued to be cost-effective in sensitivity analyses. This study suggests that tobacco control mass media campaigns can be cost-effective and economically justified in low-income and middle-income countries. It holds significant policy implications, calling for sustained investment in evidence-based mass media campaigns as part of a comprehensive tobacco control strategy. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
The existence of an indoor smoke-free home rule is associated with lower use of cigar and smokeless tobacco. This study aims to use a longitudinal sample to examine the association between smoke-free home rules and the cessation and uptake of these two types of tobacco products. The Tobacco Use Supplement of the Current Population Survey surveyed 28,153 adults in May 2010 and then followed them up 12months later. Data from these two surveys and multiple logistic regressions were used to examine the association between overtime smoke-free home rule status and the use of cigar and smokeless tobacco. Among respondents who used cigar in 2010, having an indoor smoke-free home rules consistently (AOR=2.41, 95% CI=1.52-3.83) and adopting one during the 12-month period (AOR=1.92, 95% CI=1.01-3.68) increased the likelihood of not using cigar in 2011, compared to not having or forgoing a home rule over time. Among adults who had never used cigar by 2010, those having a rule consistently (AOR=0.47, 95% CI=0.38-0.71) were less likely to initiate cigar use. Having a smoke-free home rule consistently was also associated with lower likelihood of start using smokeless tobacco (AOR=0.52, 95% CI=0.35-0.78). Nevertheless, there is no evidence indicating that the adoption of a rule is correlated with the cessation of smokeless tobacco. The establishment of indoor smoke-free home rules may help reduce cigar use and prevent the uptake of cigar and smokeless tobacco. Such findings call for research using experimental design to further examine the impact of home rules on the use of cigar and smokeless tobacco. Copyright © 2017 Elsevier Ltd. All rights reserved.
Awan, Kamran Habib; Patil, Shankargouda
Smokeless tobacco (SLT) is associated with many heath hazards including oral cancer. Its use is more common in South Asian countries. The current paper aims to systematically review the South Asian studies to assess the association of SLT and oral cancer. Detailed automated literature searches of PubMed, Medline, EMBASE and ISI Web of Science from January 1980 to July 2015 were conducted using the key words "oral cancer", "oral precancer", "oral premalignant lesions", "oral squamous cell carcinoma", "smokeless tobacco", "betel quid", "areca nut", "Gutkha" in various combinations. Letters to the editor, review articles, and case-reports were excluded. Atotal of 21 studies were included. Three studies were of cohort design while the remaining were of case-control design. Nine studies reported betel quid as a risk factor for oral cancer, while fifteen studies reported data on other types of chewing tobacco. The odds ratio (OR) for betel quid and risk of oral cancer varied from 3.1 to 15.7 (11.0-22.1); and for chewable tobacco and risk of oral cancer varied from 1.2 (1.0-1.4) to 12.9 (7.5-22.3). Astrong association between different types of SLTand oral cancer was observed. Well-structured programmes should be employed in South Asian region, both in terms of educating the general public about the health hazards of SLTas well as providing cessation assistance.
Buzzell, George A; Das, Babita; Cruz-Cano, Raul; Nkongho, Lizette E; Kidanu, Azieb W; Kim, Hyoshin; Clark, Pamela I; McDonald, Craig G
Adequate evaluation of novel tobacco products must include investigation of consumers' psychological response to such products. Traditionally, subjective scales of product liking have been used to assess consumer acceptability of tobacco products. However, subjective scales may miss cognitive changes that can only be captured by direct neurophysiological assessment. The present investigation explored the viability of using electroencephalography (EEG), in combination with traditional subjective measures, to assess consumer acceptability of five smokeless tobacco products. Given previous work linking product liking to arousal/attentional (executive function) enhancement, we focused on EEG measures of attention/arousal to objectively characterize cognitive changes associated with tobacco product use. During five separate laboratory visits, smokeless tobacco users used Verve discs, Ariva dissolvables, Skoal snuff, Camel snus, or Nicorette lozenges. The N2 and P3b event-related potential components elicited by an oddball task were used to index attentional changes before/after product usage. Additionally, resting state alpha band EEG activity was analyzed before/after product usage to index cortical arousal. Although analyses of the subjective results provided limited inference, analyses of the electrophysiological measures, particularly the alpha suppression measure, revealed robust differences between products. Skoal elicited significantly enhanced alpha suppression compared to all four other products tested. Additionally, alpha suppression was found to correlate positively with subjective measures of satisfaction and psychological reward, but was unrelated to perceived aversion. The present results provide evidence that electrophysiological measures can yield important insights into consumer acceptability of novel tobacco products and are a valuable complement to subjective measures. This study is the first to employ a combination of electrophysiological measures
Azam, Mohammad Nurul; Shahjahan, Mohammad; Yeasmin, Mahbuba; Ahmed, Nasar U
Cost, social acceptability and non-stringent regulations pertaining to smokeless tobacco (SLT) product sales have made people choose and continue using SLT. If disaggregated data on smokeless forms and smoked practices of tobacco are reviewed, the incidence of SLT remains static. There is a strong positive correlation of SLT intake with the occurrence of adverse cardiovascular disease, particularly in the low socioeconomic populations. To investigate the prevalence of smokeless tobacco, its initiation influence and risk factors associated with the practice among lower socioeconomic populations of Bangladesh. In this study, we explore the utilization of SLT among lower socioeconomic populations in industrialized zone of Bangladesh. A cross-sectional analysis using both quantitative and categorical approaches was employed. Using systematic random sampling method, four focus group discussions (FGDs) were conducted and 459 participants were interviewed. Multiple logistic regression model was applied to distinguish the significant factors among the SLT users. Almost fifty percent of the respondents initiated SLT usage at the age of 15-24 years and another 22 percent respondents were smoking and using SLT concurrently. The bulk of the women respondents used SLT during their pregnancy. Nearly twenty five percent of the respondents tried to quit the practice of SLT and one-quarter had a plan to quit SLT in the future. More than twenty percent respondents were suffering from dental decay. A noteworthy correlation was found by gender (phospitality, culture are influencing factors for SLT initiation. counselling on tobacco, including SLT, health hazards have to be emphasized through mass media and it is essential for development of relevant policies and communication messages to make people aware of serious health consequences of SLT usages.
Cristine D. Delnevo
Full Text Available As the most preventable cause of death in the world today, understanding tobacco use among one of the fastest growing ethnic/racial groups is warranted. We explore cigarette and smokeless tobacco (SLT use among South Asians in NJ and the Northeast using the Tobacco Use Supplement to the Current Population Survey. Overall, tobacco use rates among South Asians were similar or lower than the population. However, in NJ, South Asian males had the highest SLT rate (2.7% and in the Northeast, White (AOR = 5.8, 95% CI = 3.7–9.4 and South Asian males (AOR = 4.0, 95% CI = 1.5–10.6 had significantly higher odds of current SLT use relative to non-White males. Tobacco use among South Asians was not homogeneous; Pakistanis are overrepresented among cigarette smokers while Indians are overrepresented among SLT users. Given the differential tobacco use among and within South Asian, disaggregating data to understand tobacco use behaviors is necessary to develop effective interventions for tobacco cessation.
Macy, Jonathan T; Li, Jing; Xun, Pengcheng; Presson, Clark C; Chassin, Laurie
Identifying trajectories of tobacco use is critical for understanding its natural history and targeting interventions, but research on trajectories of smokeless tobacco and dual use of smokeless tobacco and cigarettes is very limited. This study identified tobacco use trajectories from adolescence to midlife and tested correlates of trajectory group membership. This study included all male participants in a longitudinal study who reported cigarette smoking or smokeless tobacco use in 1987, 1993, 1999, 2005, or 2011 (N = 2230). Group-based trajectory analyses were conducted with zero-inflated Poisson models. Analysis of covariance was used to test adolescent health beliefs associated with trajectory group membership. Five smoking trajectory groups were identified: (1) consistent abstinence from cigarettes; (2) late onset intermittent, then cessation; (3) early onset regular, then cessation; (4) delayed onset regular, then cessation; and (5) consistent regular. Four smokeless tobacco trajectory groups were identified: (1) early onset, then cessation; (2) consistent abstinence from smokeless tobacco; (3) late onset, escalating; and (4) consistent regular. The proportion of participants in trajectory groups representing dual use was low. Adolescent beliefs favorable to smoking and smokeless tobacco were associated with membership in consistent regular use groups. The prevalence of dual use of cigarettes and smokeless tobacco was low, and there was little evidence to suggest switching between tobacco products. Participants who held more positive beliefs about smoking and smokeless tobacco as adolescents were more likely to be consistent regular users of cigarettes and smokeless tobacco into adulthood. © The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Full Text Available Snus is a tobacco product containing nicotine and is widely used in Sweden. Now it is becoming more and more popular among young athletes and teenagers in Latvia, even though it is forbidden for sale in the European Union. The use of snus is considered to induce various oral illnesses, especially periodontal diseases, diabetes, heart and cardiovascular diseases as well as cancer. Comparison of the microbiome of saliva and tooth biofilm in snus tobacco users with that in people who never use snus showed that, the number and diversity of periodontal pathogenic microorganisms was much higher in samples taken from snus users. The observed features of the oral microbiome, such as the presence of periodontal pathogens and their high concentration, may have adverse effect on periodontal tissues of snus users and their general health in the future.
Colilla, Susan A
A systematic review of the epidemiologic literature on the health effects of smokeless tobacco (ST) and its relevance to the harm reduction model for smoking was undertaken. Published epidemiologic studies, from the US and European countries, meeting defined inclusion criteria and assessing the health effects of smokeless tobacco products were examined. ST use showed evidence of a slightly increased risk for all-cause mortality. Little evidence was found to support a causal relationship between ST use and risk of oral, pancreatic or lung cancer. ST use was not associated with an increased risk of cardiovascular disease or stroke incidence, but evidence suggested ST use was associated with increased mortality from these diseases. Clinical trials evaluating the effectiveness of ST products in smoking cessation have been sparse, and no standardized method for measuring ST dependence has been used, limiting the assessment of their relationship to ST use. Several studies have examined if ST use increases the risk of smoking initiation, but few have modeled this complex behavior appropriately. Overall, epidemiologic studies have not shown strong evidence of elevated tobacco-related disease risks with ST use. More research is necessary to assess the smoking behavioral consequences of ST use prior to its consideration as a harm reduction tool. (c) 2009 Elsevier Inc. All rights reserved.
Borgida, Eugene; Loken, Barbara; Williams, Allison L; Vitriol, Joseph; Stepanov, Irina; Hatsukami, Dorothy
Providing accurate information about the constituents in nicotine-containing products may help tobacco users make informed decisions about product choices. An experimental study examined a novel approach for presenting accurate constituent information about brands and types of smokeless tobacco (SLT) that could be understood by the general public. Participants were recruited through Amazon's Mechanical Turk and presented information online about 2 constituent dimensions of SLT products-nicotine and/or toxicity (for simplicity, "toxicity" in this study refers to carcinogenic constituents) Participants completed measures of knowledge and tobacco health risks at 2 time points: before and after exposure to constituent information. Participants were found to increase their knowledge that toxicity contributes to disease risk and nicotine contributes to addiction, that SLT products vary in their levels of nicotine and toxicity, and that both SLT and cigarette products have higher toxicity than medicinal nicotine replacement therapies (e.g., nicotine lozenges). Study results showed no differences when presenting toxicity information alone versus presenting it in conjunction with nicotine information, and found no misperceptions or confusions about the relative harmfulness of cigarettes, SLT, or nicotine replacement therapy. Providing tobacco constituent information to smokers and nonsmokers will improve their knowledge about the relative toxicity across products and variations within a class of tobacco products without compromising the health risks associated with tobacco use. © The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: email@example.com.
Conrad, Amy K; Hutton, Stephen B; Munnelly, Maureen; Bay, R Curtis
The historically disproportionate use of smokeless tobacco (ST) by baseball players is well documented. Oral mucosal lesions (OML) are associated with ST use. Prevalence of ST use and OMLs was assessed among a sample of Major League Baseball (MLB) and Minor League Baseball (MiLB) athletes, while also assessing behavioral and demographic risk factors. ST-use prevalence and OML developmental risk was higher than natiornal averages. MLB policy intervention has not changed ST-use rates, and increased prevalence of ST use remains.
Betül Bakan; Mustafa Haki Sucaklı; Fuat Özkan; Ökkeş Bilal
Aim: Smoking and smokeless tobacco use are two recognized risk factors for low bone mineral density (BMD) and osteoporosis. Maras powder (MP), a kind of smokeless tobacco, has a lot of addicts in the city of Kahramanmaraş and its surroundings, Turkey. This is the study investigating the effects of MP on BMD and comparing with smoking. Meterial and Methods: A total of 120 healthy male subjects (60 MP users, 60 smoker) from Maras City, Turkey were included in the study. All subjects...
3M ESPE St. Paul, MN Resin Modified Glass Ionomer Fuji II LC silicate glass powder, polyalkenoic acid, HEMA, UDMA GC America Alsip, IL 19...J.E., Amin, S., Desai, D., Idris, A.M., Hoffmann, D., 1995. Improved methodology for the quantitative assessment of tobaccospecific
J S Thakur
Full Text Available Background & objectives: India is a large country with each State having distinct social, cultural and economic characteristics. Tobacco epidemic is not uniform across the country. There are wide variations in tobacco consumption across age, sex, regions and socio-economic classes. This study was conducted to understand the wide inequalities in patterns of smoking and smokeless tobacco consumption across various States of India. Methods: Analysis was conducted on Global Adult Tobacco Survey, India (2009-2010 data. Prevalence of both forms of tobacco use and its association with socio-economic determinants was assessed across States and Union Territories of India. Wealth indices were calculated using socio-economic data of the survey. Concentration index of inequality and one way ANOVA assessed economic inequality in tobacco consumption and variation of tobacco consumption across quintiles. Multiple logistic regression was done for tobacco consumption and wealth index adjusting for age, sex, area, education and occupation. Results: Overall prevalence of smoking and smokeless tobacco consumption was 13.9 per cent (14.6, 13.3 and 25.8 per cent (26.6, 25.0, respectively. Prevalence of current smoking varied from 1.6 per cent (richest quintile in Odisha to 42.2 per cent (poorest quintile in Meghalaya. Prevalence of current smokeless tobacco consumption varied from 1.7 per cent (richest quintile in Jammu and Kashmir to 59.4 per cent (poorest quintile in Mizoram. Decreasing odds of tobacco consumption with increasing wealth was observed in most of the States. Reverse trend of tobacco consumption was observed in Nagaland. Significant difference in odds of smoking and smokeless tobacco consumption with wealth quintiles was observed. Concentration index of inequality was significant for smoking tobacco -0.7 (-0.62 to-0.78 and not significant for smokeless tobacco consumption -0.15 (0.01to-0.33 Interpretation & conclusions: The findings of our analysis
Balbo, Silvia; James-Yi, Sandra; Johnson, Charles S; O'Sullivan, Michael G; Stepanov, Irina; Wang, Mingyao; Bandyopadhyay, Dipankar; Kassie, Fekadu; Carmella, Steven; Upadhyaya, Pramod; Hecht, Stephen S
Currently, smokeless tobacco products are being proposed as an alternative mode of tobacco use associated with less harm. All of these products contain the tobacco-specific carcinogen N'-nitrosonornicotine (NNN). The major form of NNN in tobacco products is (S)-NNN, shown in this study to induce a total of 89 benign and malignant oral cavity tumors in a group of 20 male F-344 rats treated chronically with 14 p.p.m. in the drinking water. The opposite enantiomer (R)-NNN was weakly active, but synergistically enhanced the carcinogenicity of (S)-NNN. Thus, (S)-NNN is identified for the first time as a strong oral cavity carcinogen in smokeless tobacco products and should be significantly reduced or removed from these products without delay in order to prevent debilitating and deadly oral cavity cancer in people who use them.
Coral E Gartner
Full Text Available BACKGROUND TO THE DEBATE: The tobacco control community is divided on whether or not to inform the public that using oral, smokeless tobacco (Swedish snus is less hazardous to health than smoking tobacco. Proponents of "harm reduction" point to the Swedish experience. Snus seems to be widely used as an alternative to cigarettes in Sweden, say these proponents, contributing to the low overall prevalence of smoking and smoking-related disease. Harm reduction proponents thus argue that the health community should actively inform inveterate cigarette smokers of the benefits of switching to snus. However, critics of harm reduction say that snus has its own risks, that no form of tobacco should ever be promoted, and that Sweden's experience is likely to be specific to that culture and not transferable to other settings. Critics also remain deeply suspicious that the tobacco industry will use snus marketing as a "gateway" to promote cigarettes. In the interests of promoting debate, the authors (who are collaborators on a research project on the future of tobacco control have agreed to outline the strongest arguments for and against promoting Swedish snus as a form of harm reduction.
Ganganahalli, Praveen; Pratinidhi, Asha; Patil, Jyotsna; Kakade, Satish V
'Smokeless tobacco' is the term used for the tobacco that is consumed in un-burnt form and it can be used orally or nasally. Cotinine, a nicotine metabolite, is used to quantify exposure to tobacco, which readily gains access to foetal circulation. Cotinine is invariably found in coelomic, amniotic and foetal serum when maternal serum cotinine levels exceed 25ng/ml. To estimate cotinine levels among pregnant women using and not using smokeless tobacco (mishri) and to correlate cotinine level with anthropometry of newborns. A hospital based cohort study was conducted at Krishna Hospital, Karad, District Satara, Maharashtra, India. Pregnant women who were using smokeless tobacco (mishri) during pregnancy were analyzed for cotinine levels in blood by using ELISA kit tech and correlated with anthropometry of newborn babies and compared with non users of tobacco. About 480 gm reduction in Birth weight and 6.5 cm reduction in birth length of babies born to mishri users compared to non users of tobacco and also cotinine levels among users were found significantly negatively correlating with anthropometric measurement of newborn babies. A pro-active effort is essential to educate the women about adverse effects of tobacco in general and on the intrauterine growth of the baby in particular.
Banerjee, Smita C; Ostroff, Jamie S; D'Agostino, Thomas A; Bari, Sehrish; Khera, Mitali; Acharya, Sudha; Gany, Francesca
Gutka and tambaku paan (smokeless tobacco products used by South Asian immigrants) are carcinogenic to humans (and perceived as such), yet, one-fourth of South Asian immigrants report current use. This study examined disengagement beliefs that perpetuate gutka/tambaku paan use among South Asians despite awareness of health risks. Six focus groups were conducted with immigrant South Asian adult gutka/tambaku paan users, in Gujarati, Bengali and Urdu languages in New York, USA. Participants included 39 South Asian adults residing in the New York City Metropolitan area, current (a minimum of weekly gutka or tambaku paan use in the last 12 months) or former (regular use prior to past 12 months) gutka or tambaku paan users and self-reported spoken fluency in Gujarati, Urdu or Bengali languages. Participants identified many health risks associated with gutka/tambaku paan use including locked jaw, high blood pressure and cancer. Five themes of disengagement beliefs emerged: (a) skepticism about the gutka/tambaku paan-cancer link, (b) perceived invulnerability to harm, (c) compensatory beliefs, (d) faith-based rationalization and (e) acknowledgment of addiction. To promote smokeless tobacco cessation among South Asians, interventions to counter disengagement beliefs and heighten the discomfort between the dissonant cognitions represent a promising area warranting further attention.
and Eacute;rica Dorigatti de and Aacute;vila
Full Text Available Objective: To evaluate the changes in the number of Langerhans Cells (LC observed in the epithelium of smokeless tobacco (SLT-induced lesions. Methods: Microscopic sections from biopsies carried out in the buccal mucosa of twenty patients, who were chronic users of smokeless tobacco (SLT, were utilized. For the control group, twenty non-SLT users of SLT with normal mucosa were selected. The sections were studied with routine coloring and were immunostained for S-100, CD1a, Ki-67 and p63. These data were statistically analyzed by the Student's t-test to investigate the differences in the expression of immune markers in normal mucosa and in SLT-induced leukoplakia lesions. Results: There was a significant difference in the immunolabeling of all markers between normal mucosa and SLT-induced lesions (p<0.001. The leukoplakia lesions in chronic SLT users demonstrated a significant increase in the number of Langerhans cells and in the absence of epithelial dysplasia. Conclusion: The increase in the number of these cells represents the initial stage of leukoplakia. [Arch Clin Exp Surg 2012; 1(2.000: 85-93
Tyx, Robert E; Stanfill, Stephen B; Keong, Lisa M; Rivera, Angel J; Satten, Glen A; Watson, Clifford H
The bacterial communities present in smokeless tobacco (ST) products have not previously reported. In this study, we used Next Generation Sequencing to study the bacteria present in U.S.-made dry snuff, moist snuff and Sudanese toombak. Sample diversity and taxonomic abundances were investigated in these products. A total of 33 bacterial families from four phyla, Actinobacteria, Firmicutes, Proteobacteria and Bacteroidetes, were identified. U.S.-produced dry snuff products contained a diverse distribution of all four phyla. Moist snuff products were dominated by Firmicutes. Toombak samples contained mainly Actinobacteria and Firmicutes (Aerococcaceae, Enterococcaceae, and Staphylococcaceae). The program PICRUSt (Phylogenetic Investigation of Communities by Reconstruction of Unobserved States) was used to impute the prevalence of genes encoding selected bacterial toxins, antibiotic resistance genes and other pro-inflammatory molecules. PICRUSt also predicted the presence of specific nitrate reductase genes, whose products can contribute to the formation of carcinogenic nitrosamines. Characterization of microbial community abundances and their associated genomes gives us an indication of the presence or absence of pathways of interest and can be used as a foundation for further investigation into the unique microbiological and chemical environments of smokeless tobacco products.
Full Text Available Introduction: More than one-third of the tobacco consumed in India is of smokeless form. While the smokeless tobacco (ST products have been strongly associated with oral cancer, the association between ST and periodontal disease is less clear. The present study was conducted on industrial workers because in premises, there is a ban on smoking tobacco and hence workers tend to consume more of ST products. Aim: The aim of this study is to assess periodontal status in ST chewers and nonchewers among industrial workers in North Bengaluru. Materials and Methods: A cross-sectional analytical study was conducted on 800 industrial workers (400 ST chewers and 400 nonchewers of North Bengaluru. Information regarding ST habits was obtained using the Global Adult Tobacco Survey questionnaire, followed by clinical examination to assess periodontal status using the community periodontal index and attachment loss. The comparison between chewers and nonchewers was done using Pearson's Chi-square test. Logistic regression analysis was used to estimate the difference of periodontal status and loss of attachment (LOA between chewers and nonchewers. Results: ST chewing habit was observed the maximum (46.5% among age group 25–44 years. Most of male chewers had habit of chewing gutkha followed by khaini, and majority of the female chewers were using khaini followed by betel nut quid. A significantly higher prevalence of bleeding on probing and calculus was found among nonchewers. ST chewers had 2.06 (95% confidence interval [CI]: 1.55–2.75 times more risk of developing periodontal pockets and 2.23 (95% CI: 1.68–2.98 times more risk of having LOA when compared with nonchewers. Conclusions: ST has deleterious effects on the periodontium. Hence, it is one of the important risk factors for periodontal disease.
VanLue, Michael J.; And Others
This study evaluated the effectiveness of a training manual developed for speech-language pathologists for providing education and early detection of oral health problems secondary to smokeless tobacco use. With the addition of a clinical training module, the manual provided a method for expansion of the role of speech-language pathologists in…
Prabhakar, V; Jayakrishnan, G; Nair, S V; Ranganathan, B
The characterization and classification of smokeless tobacco products has been a continuously evolving process. This is based on a number of different parameters like nicotine content, moisture content, amount of heavy metals, pH, and in vitro cytotoxicity assays. Their contexts often vary between countries, research institutions, and legal requirements. The categorisation of these products is quite challenging due to the diffused sample sizes, diverse array of branded products on offer, and the absence of a centralized manufacturing facility. This study aims at a systematic classification of 10 smokeless tobacco product samples from the retail market based on their potential toxicity upon long-term use. The estimation of potential toxicity follows a well-established method that employs the concentration of toxic metals in the different samples. The potential toxicity as well as heavy metal concentrations of the smokeless tobacco products analysed was found to be much higher than acceptable limits. For instance, the levels of lead, cadmium, copper and zinc of 2.5, 1, 4 and 23 ppm, respectively, are well above their recommended limits. The results from the study indicate that chronic use of smokeless tobacco products is a significant health risk, especially in the vulnerable population. Further studies of this nature will help establish a toxicological fingerprint on the diverse class of products that floods the market now.
Balbo, Silvia; James-Yi, Sandra; Johnson, Charles S; O'Sullivan, Michael G; Stepanov, Irina; Wang, Mingyao; Bandyopadhyay, Dipankar; Kassie, Fekadu; Carmella, Steven; Upadhyaya, Pramod; Hecht, Stephen S
..., (S)-NNN is identified for the first time as a strong oral cavity carcinogen in smokeless tobacco products and should be significantly reduced or removed from these products without delay in order to prevent debilitating and deadly oral cavity cancer in people who use them.
Harris, Andrew C; Tally, Laura; Schmidt, Clare E; Muelken, Peter; Stepanov, Irina; Saha, Subhrakanti; Vogel, Rachel Isaksson; LeSage, Mark G
Preclinical models are needed to inform regulation of tobacco products by the Food and Drug Administration (FDA). Typically, animal models of tobacco addiction involve exposure to nicotine alone or nicotine combined with isolated tobacco constituents (e.g. minor alkaloids). The goal of this study was to develop a model using extracts derived from tobacco products that contain a range of tobacco constituents to more closely model product exposure in humans. This study compared the addiction-related effects of nicotine alone and nicotine dose-equivalent concentrations of aqueous smokeless tobacco extracts on intracranial self-stimulation (ICSS) in rats. Extracts were prepared from Kodiak Wintergreen, a conventional product, or Camel Snus, a potential "modified risk tobacco product". Binding affinities of nicotine alone and extracts at various nicotinic acetylcholine receptor (nAChR) subtypes were also compared. Kodiak and Camel Snus extracts contained levels of minor alkaloids within the range of those shown to enhance nicotine's behavioral effects when studied in isolation. Nonetheless, acute injection of both extracts produced reinforcement-enhancing (ICSS threshold-decreasing) effects similar to those of nicotine alone at low to moderate nicotine doses, as well as similar reinforcement-attenuating/aversive (ICSS threshold-increasing) effects at high nicotine doses. Extracts and nicotine alone also had similar binding affinity at all nAChRs studied. Relative nicotine content is the primary pharmacological determinant of the abuse liability of Kodiak and Camel Snus as measured using ICSS. These models may be useful to compare the relative abuse liability of other tobacco products and to model FDA-mandated changes in product performance standards. Copyright © 2015. Published by Elsevier Ireland Ltd.
Mohammad Nurul Azam
Full Text Available Cost, social acceptability and non-stringent regulations pertaining to smokeless tobacco (SLT product sales have made people choose and continue using SLT. If disaggregated data on smokeless forms and smoked practices of tobacco are reviewed, the incidence of SLT remains static. There is a strong positive correlation of SLT intake with the occurrence of adverse cardiovascular disease, particularly in the low socioeconomic populations.To investigate the prevalence of smokeless tobacco, its initiation influence and risk factors associated with the practice among lower socioeconomic populations of Bangladesh. In this study, we explore the utilization of SLT among lower socioeconomic populations in industrialized zone of Bangladesh.A cross-sectional analysis using both quantitative and categorical approaches was employed. Using systematic random sampling method, four focus group discussions (FGDs were conducted and 459 participants were interviewed. Multiple logistic regression model was applied to distinguish the significant factors among the SLT users.Almost fifty percent of the respondents initiated SLT usage at the age of 15-24 years and another 22 percent respondents were smoking and using SLT concurrently. The bulk of the women respondents used SLT during their pregnancy. Nearly twenty five percent of the respondents tried to quit the practice of SLT and one-quarter had a plan to quit SLT in the future. More than twenty percent respondents were suffering from dental decay. A noteworthy correlation was found by gender (p<0.01, sufferings from SLT related disease (p<0.05. The multiple logistic regression analysis suggested that, males were 2.7 times more knowledgeable than that of females (p<0.01 about the adversative health condition of SLT usage. The respondents suffering from SLT related diseases were 3.7 times as more knowledgeable about the effect of the practice of SLT than the respondents without diseases (p<0.01. Regarding the knowledge
Balbo, Silvia; James-Yi, Sandra; Johnson, Charles S.; O’Sullivan, Michael G.; Stepanov, Irina; Wang, Mingyao; Bandyopadhyay, Dipankar; Kassie, Fekadu; Carmella, Steven; Upadhyaya, Pramod; Hecht, Stephen S.
Currently, smokeless tobacco products are being proposed as an alternative mode of tobacco use associated with less harm. All of these products contain the tobacco-specific carcinogen N′-nitrosonornicotine (NNN). The major form of NNN in tobacco products is (S)-NNN, shown in this study to induce a total of 89 benign and malignant oral cavity tumors in a group of 20 male F-344 rats treated chronically with 14 p.p.m. in the drinking water. The opposite enantiomer (R)-NNN was weakly active, but ...
Turk, Tahir; Murukutla, Nandita; Gupta, Shefali; Kaur, Jagdish; Mullin, Sandra; Saradhi, Ranjana; Chaturvedi, Pankaj
The burden of tobacco-related morbidity and mortality in India is substantial, with smokeless tobacco being the predominant form of tobacco use. Use of smokeless tobacco (for example gutkha, paan, khaini, and pan masala) is linked to a host of socioeconomic and cultural factors including gender, regional differences, educational level, and income disparities. Given the scale of the problem, a national social marketing campaign was developed and implemented. The creative approach used testimonials from a surgeon and patients at Tata Memorial Hospital in Mumbai. The communication message approach was designed to reflect the realities of disfiguring, disabling, and fatal cancers caused by smokeless tobacco. Evaluation of the campaign identified significant differences across a range of campaign behavioral predictors by audience segments aware of the campaign versus those who were "campaign unaware". Significant findings were also identified regarding vulnerable groups by gender (female/male) and rural/urban disparities. Findings are discussed in relation to the powerful impact of using graphic, emotive, and testimonial imagery for tobacco control with socially disadvantaged groups.
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Mela, D J
Nicotine and smoking may modify gustatory function or preferences and are associated with altered energy balance; however, there is no information on whether smokeless tobacco (ST) has similar effects. Evaluations of gustatory function (threshold sensitivity, perceived intensity of suprathreshold stimuli, preferences) were conducted on 28 chronic ST users and 30 nonusers after both abstaining and using ST. Subjects also maintained 7-d dietary records that included descriptions of the predominant taste qualities of foods. There were few user vs nonuser differences in gustatory measures. Among nonusers, use of ST reduced perceived intensity of salty, sour, and bitter stimuli. Users reported greater alcohol intakes and lower consumption of carbohydrates, sweet foods, fruits, and grains. Chronic use of ST does not appear to have substantial effects on gustatory function but may be associated with decreased carbohydrate intakes, perhaps related to increased alcohol use and possibly because of reduced consumption of sweet-tasting foods.
Olalekan A Ayo-Yusuf
Full Text Available BACKGROUND: Some smokeless tobacco products (SLT have been shown to be associated with only a fraction of the risks of cigarettes. This study assessed South African smokers' interest in switching to a hypothetical reduced harm SLT product. METHODS: The 2007 South African Social Attitudes Survey was analysed for 678 exclusive cigarette smokers. Respondents were asked about their perceptions about relative harm of snuff compared to cigarettes, and their interest in switching to snuff if informed it was 99% less harmful than cigarettes. RESULTS: About 49.7% of exclusive cigarette smokers believed that snuff was equally as harmful as cigarettes; 12.9% thought snuff was more harmful; 5.7% thought snuff was less harmful; while 31.8% did not know if there was a difference in harm between snuff and cigarettes. Approximately 24.2% of exclusive cigarette smokers indicated interest in switching to snuff, with significantly greater interest observed among those exposed to 100% smoke-free work environment. Interest in switching was highest (34.7% among smokers who believed a priori that using snuff was more harmful than cigarettes, and lowest (14.5% among those who did not know if there was a difference in harm. In a multi-variable adjusted logistic regression model, this latter group remained less likely to be interested in harm reduction switching (adjusted odds ratio = 0.42; 95% CI: 0.19-0.91. CONCLUSION: About a quarter of smokers indicated interest in harm reduction switching to snuff. SLT products have a potential role in reducing the harm from smoking in South Africa, but only if they are not used to circumvent smoke-free laws that have been associated with reduced smoking.
Al-Hebshi, Nezar Noor; Alharbi, Fahd Ali; Mahri, Mohammed; Chen, Tsute
Smokeless tobacco (ST) products vary significantly in their oral carcinogenicity. Much is known about the differences in the chemical, but not the bacterial, constituents of these products. In this study, we explored the composition and function of the bacteriome in ST products from four countries using quantitative polymerase chain reaction (qPCR) and 16S rRNA-based next generation sequencing. The bacterial load (16S rRNA copies/gram) was lowest in Swedish snus (3.4 × 10⁶) and highest in Yemeni shammah (6.6 × 1011). A total of 491 species-level taxa, many of which are potentially novel, belonging to 178 genera and 11 phyla were identified. Species richness and diversity were highest for Swedish snus and lowest for Yemeni shammah. Bacillus, Paenibacillus, and Oceanobacillus spp. were the most abundant in American snuff; species of Pseudomonas, Massilia, Propionibacterium, Puniceispirillum, and Gloeothece predominated in Swedish snus. In Sudanese toombak, Facklamia, Desemzia, Atopostipes, and Lysinibacillus spp. accounted for the majority of the bacteriome. Yemeni shammah exclusively contained Bacillus spp. Functional prediction by phylogenetic investigation of communities by reconstruction of unobserved states (PICRUSt) showed that genes encoding cadmium/zinc and nickel transport systems were enriched in the presumptively "high carcinogenicity" products. The bacteriome of ST products thus differed qualitatively, quantitatively, and functionally. The relevance of these differences, particularly with respect to nickel and cadmium, to oral carcinogenesis warrants further investigation.
Seidenberg, Andrew B; Rodgers, Elizabeth J; Rees, Vaughan W; Connolly, Gregory N
Smokeless tobacco (SLT) use among white adolescent males has increased in recent years, and prevalence of SLT use among adolescent males exceeds that for smoking in several U.S. states. Recent reports have described the presence of cigarette-related content on social media Web sites popular among youth; however, little has been reported on SLT content. The YouTube video search engine was searched for the popular SLT brand Skoal, and the first 50 search results were downloaded. Video statistics data were collected for and content analysis was performed on all videos featuring smokeless use (82%). Access to SLT YouTube videos by youth was also determined by assessing whether YouTube permits youth viewing and creation of SLT videos. Mean number of views for videos analyzed was 15,422, and the most watched video had 124,276 views. Descriptions of SLT flavor/smell and social references/interactions were found in 48.8% and 63.4% of videos, respectively. By contrast, references to drug (nicotine) effects (12.2%) and public health messaging (9.8%) were less common. None of the SLT videos in the sample had restrictions that would block youth viewing. In addition, evidence of self-identified youth creating SLT videos was found for 13% of unique users in the sample. YouTube does not restrict youth from creating or viewing "dip videos." Proactive efforts are needed to ensure that YouTube and other online media do not become influential vehicles for tobacco promotion to youth. Copyright Â© 2012 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
Rogers, John D; Biener, Lois; Clark, Pamela I
This exploratory study was designed to assess the availability, price, and point-of-purchase marketing strategies for new smokeless tobacco products in 4 test market areas. A random sample of 50 gas stations, convenience and food stores, and tobacco shops was selected in each of 4 test market areas. Pairs of observers visited each store, recorded product information, and engaged vendors in conversation about product demand. Snus was available in 64% of the stores, but availability and price differed by brand. Point-of-purchase marketing also varied by brand on a variety of dimensions and all brands appeared to be marketed primarily to smokers. Camel Snus was described by store attendants as having the highest demand and was also the most expensive of the observed products. In light of the number of test market cities and intensity of promotion at retail locations, Camel Snus was the most intensively marketed product. The results appear to reflect differences in marketing strategy by American snus manufacturers. These strategies may help to predict future marketing of snus and other tobacco products and may provide a baseline for later assessments of product acceptance.
Liu, Sherry T; Nemeth, Julianna M; Klein, Elizabeth G; Ferketich, Amy K; Kwan, Mei-Po; Wewers, Mary Ellen
As smokeless tobacco (ST) marketing increases and new products emerge on the market, very little is known about consumer perceptions of ST products. To inform development of future ST counter-marketing approaches, this qualitative study examined consumer perceptions of traditional and novel ST products and packaging. Focus groups and qualitative interviews were held with adolescent (n=23; mean age of 17 years) and adult (n=38; mean age of 29 years) male ST users from rural Ohio counties. Participants were shown a variety of traditional (eg, Copenhagen, Timber Wolf) and novel (eg, Camel Snus, Orbs) ST products and asked about perceptions of these products and their packaging. Transcriptions were coded independently for common themes by two individuals. Adolescents and adults generally had similar beliefs and reactions about ST products. While participants were familiar with a variety of traditional ST products, Copenhagen was the most frequently used product. Perceptions of quality and price of traditional products were closely tied to product taste and packaging material. Colours, design and size of ST packaging appealed to participants and influenced decisions to purchase. Adults believed novel ST products had a weak taste and were targeted at untraditional ST users. While the vast majority was unfamiliar with dissolvable tobacco, adolescents noted that they would be more convenient to use during school than traditional ST. Packaging has a significant role in shaping perceptions of ST and consumer behaviour. Regulation of product packaging such as shape, size and images should be part of comprehensive tobacco control.
Gao, Hong; Prasad, G L; Zacharias, Wolfgang
The aim of this work was to investigate genomic DNA damage in human oral cavity cells after exposure to different tobacco product preparations (TPPs). The oral carcinoma cell line 101A, gingival epithelial cells HGEC, and gingival fibroblasts HGF were exposed to TPM (total particulate matter from 3R4F cigarettes), ST/CAS (2S3 smokeless tobacco extract in complete artificial saliva), and NIC (nicotine). Treatments were for 24 h using TPM at its EC-50 doses, ST/CAS and NIC at doses with equi-nicotine units, and high doses for ST/CAS and NIC. Comet assays showed that TPM, but not ST/CAS or NIC, caused substantial DNA breaks in cells; only the high ST/CAS dose caused weak DNA damage. These results were confirmed by immunofluorescence for γ-H2AX protein. These data revealed that the combusted TPP caused substantial DNA damage in all cell types, whereas the two non-combusted TPPs exerted no or only minimal DNA damage. They support epidemiologic evidence on the relative risk associated with consumption of non-combusted versus combusted tobacco products, and help to understand potential genotoxic effects of such products on oral cavity cells. Copyright © 2014 Elsevier B.V. All rights reserved.
Jonah Sydney Aprioku
Full Text Available This study investigated the effects of 30-day exposure to tobacco smoke (TS, smokeless tobacco (ST, and nicotine on reproductive parameters and oxidative biomarkers in prepubertal and adult male rats. Sperm motility was reduced by 77.5 and 89.0% in TS and ST exposed prepubertal rats and 71.1 and 86.4% in adult rats, respectively. Sperm count was also reduced by 64.7 and 89.9% in prepubertal rats and 64.9 and 47.0% in adult rats, respectively. Nicotine decreased sperm motility (82.2% and count (62.6% in prepubertal rats but caused no effect in adult rats. There were no changes in sperm morphology; testosterone was decreased, while LH and FSH were increased in exposed rats, when compared with control. Malondialdehyde levels in testes of exposed rats were increased, and GSH, SOD, and catalase were altered. Results indicate that subacute exposure of tobacco products alters sperm characteristics in a rank order of ST > TS > nicotine, which may be linked to increase in oxidative stress in the testis.
Kuldeep Singh Shekhawat
Full Text Available Background: Tobacco consumption is highest among labor classes and low socioeconomic status (SES, with inclination toward smokeless tobacco (SLT. Aim: The aim of the study was to determine the prevalence and pattern of SLT consumption with secondary objective to profile various sachets of SLT most commonly sold in the study setting. Setting and Design: A cross-sectional questionnaire study conducted in rural Puducherry. Materials and Methods: A self-interviewed structured questionnaire was administered to 150 participants from two villages. Data on education, occupation, and income were collected with details in the form of tobacco consumed, duration of habit, daily consumption, and brand of SLT among other things. Profiling of sachets was done with manufacturing date, date of expiry, presence and absence of warning signs, and name of the manufacturer as parameter. Statistical Analysis: Descriptive analysis was done for frequency distribution and Chi-square test for proportions. Results: The overall prevalence of SLT was 44% with women consuming more than males. 41–50-year-old were highest users of SLT. More than 50% of the participants were unaware of the “pictorial warnings” and 65% did not know about the presence of “contents” on sachets. Pan masala with tobacco was the most preferred form. Only 5 of the 23 commercial brands of sachets had both “pictorial and readable warnings” printed. Conclusion: The prevalence of STC was high when compared to the general population. Steps need to be taken to address the adverse effects printed on sachets for low SES populations. The printed warnings need to be inspected regularly. Dual tobacco use is a new addition to the existing list of challenges.
Full Text Available European Union (EU legislation bans the sale of snus, a smokeless tobacco (SLT which is considerably less harmful than smoking, in all EU countries other than Sweden. To inform the current review of this legislation, this paper aims to explore transnational tobacco company (TTC interests in SLT and pure nicotine in Europe from the 1970s to the present, comparing them with TTCs' public claims of support for harm reduction.Internal tobacco industry documents (in total 416 documents dating from 1971 to 2009, obtained via searching the online Legacy Tobacco Documents Library, were analysed using a hermeneutic approach. This library comprises documents obtained via litigation in the US and does not include documents from Imperial Tobacco, Japan Tobacco International, or Swedish Match. To help overcome this limitation and provide more recent data, we triangulated our documentary findings with contemporary documentation including TTC investor presentations. The analysis demonstrates that British American Tobacco explored SLT opportunities in Europe from 1971 driven by regulatory threats and health concerns, both likely to impact cigarette sales negatively, and the potential to create a new form of tobacco use among those no longer interested in taking up smoking. Young people were a key target. TTCs did not, however, make SLT investments until 2002, a time when EU cigarette volumes started declining, smoke-free legislation was being introduced, and public health became interested in harm reduction. All TTCs have now invested in snus (and recently in pure nicotine, yet both early and recent snus test markets appear to have failed, and little evidence was found in TTCs' corporate materials that snus is central to their business strategy.There is clear evidence that BAT's early interest in introducing SLT in Europe was based on the potential for creating an alternative form of tobacco use in light of declining cigarette sales and social restrictions on
Peeters, Silvy; Gilmore, Anna B
European Union (EU) legislation bans the sale of snus, a smokeless tobacco (SLT) which is considerably less harmful than smoking, in all EU countries other than Sweden. To inform the current review of this legislation, this paper aims to explore transnational tobacco company (TTC) interests in SLT and pure nicotine in Europe from the 1970s to the present, comparing them with TTCs' public claims of support for harm reduction. Internal tobacco industry documents (in total 416 documents dating from 1971 to 2009), obtained via searching the online Legacy Tobacco Documents Library, were analysed using a hermeneutic approach. This library comprises documents obtained via litigation in the US and does not include documents from Imperial Tobacco, Japan Tobacco International, or Swedish Match. To help overcome this limitation and provide more recent data, we triangulated our documentary findings with contemporary documentation including TTC investor presentations. The analysis demonstrates that British American Tobacco explored SLT opportunities in Europe from 1971 driven by regulatory threats and health concerns, both likely to impact cigarette sales negatively, and the potential to create a new form of tobacco use among those no longer interested in taking up smoking. Young people were a key target. TTCs did not, however, make SLT investments until 2002, a time when EU cigarette volumes started declining, smoke-free legislation was being introduced, and public health became interested in harm reduction. All TTCs have now invested in snus (and recently in pure nicotine), yet both early and recent snus test markets appear to have failed, and little evidence was found in TTCs' corporate materials that snus is central to their business strategy. There is clear evidence that BAT's early interest in introducing SLT in Europe was based on the potential for creating an alternative form of tobacco use in light of declining cigarette sales and social restrictions on smoking, with
Moghbel, Nahid; Ryu, BoMi; Cabot, Peter J; Steadman, Kathryn J
The Aboriginal population of Central Australia use endemic Nicotiana species to make a smokeless tobacco product known usually as pituri or mingkulpa. Nicotiana leaves are masticated with wood ash into a 'quid' that is chewed/sucked for absorption of nicotine. In addition to nicotine, smokeless tobacco products contain a spectrum of biologically active compounds that may contribute to effects on health. The objective of this study was to quantify nicotine, and related alkaloids and tobacco specific nitrosamines (TSNAs), in Nicotiana leaves used in pituri, and compare in vitro toxicity of pure nicotine with Nicotiana leaf extract at the same concentration of nicotine. An aqueous extract of dry leaves of Nicotiana gossei and a reference smokeless tobacco (CORESTA CRP2) were quantified for major pyridine alkaloids and TSNAs using HPLC-UV and LC-MS/MS. A range of extract concentrations and corresponding concentrations of nicotine standard were tested using an MTS assay to measure human lung epithelium cell (A549) survival. Cells treated for 24h with the maximum concentration of 1.5mg/ml of nicotine resulted in 77% viability. In contrast, extracts from N. gossei leaves and CRP2 containing a similar concentration of nicotine (1.3mg/ml) resulted in remarkably lower viability of 1.5 and 6%, respectively. Comparison of cytotoxicity of pure nicotine with that of the extracts revealed that nicotine was not the source of their cytotoxicity. Other biologically active compounds such as the known carcinogens NNK and NNN, derived from nicotine and nornicotine and found to be present in the smokeless tobacco extracts, may be responsible. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Borgerding, M F; Bodnar, J A; Curtin, G M; Swauger, J E
Selected toxicant concentrations and other chemical measures have been determined for 43 U.S. smokeless tobacco products sold in 2006 and 2007. Products evaluated included moist snuff, dry snuff, loose leaf, plug, dissolvable and snus tobacco brands. Reference products available for scientific research purposes and eleven Swedish products were also evaluated and compared to the commercial products studied. Chemical endpoints determined included benzo[a]pyrene (B[a]P), N'-nitrosonornicotine (NNN), N'-nitrosoanatabine (NAT), N'-nitrosoanabasine (NAB), 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), N-Nitrosodimethylamine (NDMA), nitrite, cadmium, lead, arsenic, nickel, chromium, chloride, water, pH and nicotine. Different toxicant profiles were observed for the products studied, with snus tobacco brands generally containing relatively low concentrations of B[a]P and tobacco specific nitrosamines (TSNAs) compared to other moist snuffs. Smokeless tobacco reference product toxicant profiles were similar to corresponding commercial products, with the exception of the TSNA content of the dry snuff reference material. TSNA concentrations observed for all commercial products were lower than historically reported values, likely reflecting changes in product shelf life, tobacco curing practices and, possibly, product blend formulations during the last 20-30 years. The survey results summarized provide a temporal point of comparison with future data anticipated from FDA "harmful and potentially harmful constituents in tobacco products" reporting. Copyright © 2012 Elsevier Inc. All rights reserved.
Vidhubala, E; Pisinger, C; Basumallik, B; Prabhakar, D S
India is the world's third largest consumer of tobacco. There are twice as many users of smokeless tobacco products (STPs) as cigarette smokers. The Government of Tamil Nadu has banned the sale of gutkha and pan masala in 2013. Our aim was to identify the varieties of illegal STP available in Chennai, India. In systematically chosen zones and regions of Chennai city, we randomly identified three kinds of kiosks (n = 18) and asked for "gutkha" and "pan masala," one of each product available. Details of each product were reviewed based on the information printed on the sachets. Totally 65 STPs were collected; 26 distinct products and 23 brands. All products were claimed to be "tobacco" by the shop keepers. Sixty-five percent of the products informed to contain tobacco and 15.4% to contain pan masala. Five sachets did not inform about the content; 30.8% did not have a pictorial warning; a text warning was printed on 80.8%, but only two products had the messages in Tamil; 70% had promotional messages printed, and 57% had their registration numbers printed. The ban on STP is being systematically violated in Chennai. STP are cheap and easily available and due to promotional laudatory messages and lacking information about the content and warning of health damage, the consumers are left with the perception that they buy more or less harmless product. The Indian Government must introduce policies to control production, import, and sale of illicit STP but we also call for a coordinated international solution.
Chande, Milan; Suba, Krishna
The use of supari (areca nut) and smokeless tobacco products are seen as a major risk factor for oral cancer. There are increasing rates of oral cancer across the United Kingdom, along with the increase of the use of these products. This article examines the uses of such products amongst the South Asian Community and explores sensitive issues associated with the cessation of their use. Evidence-based recommendations are provided on how to provide advice and treatment to patients that regularly use these products. A rethink is also suggested on the policy of taxation of such products. CPD/Clinical Relevance: With the rates of oral cancer increasing across the United Kingdom, it is important for us as dental professionals to tackle the use of areca nut and smokeless tobacco products.
Mushtaq, Nasir; Beebe, Laura A
Fagerström Test for Nicotine Dependence (FTND) is the most commonly used measure of dependence among tobacco users. Psychometric properties of FTND have been validated among cigarette smokers, but the reliability and validity of its variant for smokeless tobacco (ST) users (FTND-ST) is not well documented. The objective of the present study is to evaluate reliability, construct validity, and structure model of FTND-ST. Data from 95 exclusive ST users living in Oklahoma were used for this study. Participants completed a self-administered mail survey including FTND-ST and other questionnaires. Measures of internal consistency, Cronbach's coefficient α and item-total correlation were estimated to evaluate reliability of the FTND-ST. To ascertain the factor structure of the scale, confirmatory factor analysis was performed. We examined concurrent and construct validity with correlation and regression analysis. Salivary cotinine concentration was used as a criterion variable. The FTND-ST demonstrated good reliability with acceptable Cronbach's coefficient (α = 0.72) and significant item-total correlations. Study findings showed that FTND-ST had positive significant association with salivary cotinine concentration (r = 0.61, p <.0001) and Tobacco Dependence Screener (r = 0.44, p < .0001). Results of factor analysis support a unidimensional factor structure of FTND-ST. The FTND-ST demonstrated good psychometric properties. The unidimensional structure of the scale indicates that it measures single clearly defined aspect of dependence, physical dependence. Given its good reliability and demonstrated construct validity, FTND-ST is a useful measure of dependence among ST users. Because of the paucity of ST dependence research, there are limited studies evaluating ST dependence measures. Although the FTND was exclusively developed for cigarette smoking, it has been adapted for ST users in the form of FTND-ST. This is the first study to examine reliability, concurrent and
Liu, Min; Jin, Jinshan; Pan, Hongmiao; Feng, Jinhui; Cerniglia, Carl E; Yang, Maocheng; Chen, Huizhong
To evaluate the toxicity of smokeless tobacco products (STPs) on oral bacteria, seven smokeless tobacco aqueous extracts (STAEs) from major brands of STPs and three tobacco-specific N-nitrosamines (TSNAs) were used in a growth and viability test against 38 oral bacterial species or subspecies. All seven STAEs showed concentration-dependent effects on the growth and viability of tested oral bacteria under anaerobic culture conditions, although there were strain-to-strain variations. In the presence of 1 mg/ml STAEs, the growth of 4 strains decreased over 0.32-2.14 log10 fold, while 14 strains demonstrated enhanced growth of 0.3-1.76 log10 fold, and the growth of 21 strains was not significantly affected. In the presence of 10 mg/ml STAEs, the growth of 17 strains was inhibited 0.3-2.11 log10 fold, 18 strains showed enhanced growth of 0.3-0.97 log10 fold, and 4 strains were not significantly affected. In the presence of 50 mg/ml STAEs, the growth of 32 strains was inhibited 0.3-2.96 log10 fold, 8 strains showed enhanced growth of 0.3-1.0 log10 fold, and 2 strains were not significantly affected. All seven STAEs could promote the growth of 4 bacterial strains, including Eubacterium nodatum, Peptostreptococcus micros, Streptococcus anginosus, and Streptococcus constellatus. Exposure to STAEs modulated the viability of some bacterial strains, with 21.1-66.5% decrease for 4 strains at 1 mg/ml, 20.3-85.7% decrease for 10 strains at 10 mg/ml, 20.0-93.3% decrease for 27 strains at 50 mg/ml, and no significant effect for 11 strains at up to 50 mg/ml. STAEs from snuffs inhibited more tested bacterial strains than those from snus indicating that the snuffs may be more toxic to the oral bacteria than snus. For TSNAs, cell growth and viability of 34 tested strains were not significantly affected at up to 100 μg/ml; while the growth of P. micros was enhanced 0.31-0.54 log10 fold; the growth of Veillonella parvula was repressed 0.33-0.36 log10 fold; and the cell
Willis, Daniel; Popovech, Mary; Gany, Francesca; Zelikoff, Judith
The popularity of smokeless tobacco (ST), or noncombusted tobacco, usually placed within the mouth to be chewed, sucked, or swallowed, is growing rapidly and its prevalence of use is rising globally, due (in part) to greater convenience, as allowable cigarette smoking areas are rapidly decreasing, and increased social acceptability. Though data are limited, ST usage has been directly linked to a number of adverse health outcomes. The potential role that immune dysfunction, including dysregulation of immune cells and their components, may play in the progression of these adverse health outcomes is only just beginning to emerge. Evidence suggesting reproductive outcomes, such as perinatal mortality, preterm birth, and reduced sperm viability, also exists in conjunction with ST use. Cardiovascular health may also be impacted by ST use, resulting in increased blood pressure and endothelial dysfunction, both of which may potentially lead to cardiovascular diseases. This review describes the toxicological implications associated with ST use, with emphasis on immune, reproductive, and cardiovascular outcomes. Epidemiological studies are discussed with respect to experimental studies to help develop the relationship between ST and disease pathology. This review also summarizes the gaps in ST knowledge and potential future directions that are needed to more fully delineate the complex systems driving the adverse health outcomes associated with its use.
McAdam, Kevin; Kimpton, Harriet; Essen, Sofia; Davis, Peter; Vas, Carl; Wright, Christopher; Porter, Andrew; Rodu, Brad
Due to the lower health risks associated with the use of certain categories of smokeless tobacco products (STPs) such as Swedish snus, there is interest in the comparative levels of toxic chemical constituents in different types of STPs. A method has been developed and validated for the analysis of hydrazine in STPs. Seventy four commercial STPs from the US and Sweden, representing 80-90% of the 2010 market share for all the major STP categories in these two countries, as well as three reference STPs, were analysed for hydrazine. Aqueous extracts of the STPs were treated with excess pentafluorobenzaldehyde (PFB), which reacted with hydrazine in solution to form decafluorobenzaldehyde azine (DFBA). DFBA was partitioned into hexane and then quantified by gas chromatography-mass spectrometry (GC-MS). The method was validated using five different types of STP, was linear in the range 8-170 ng/mL, and had limits of quantification (LOQ) from 26-53 ng of hydrazine per g of STP (as sold). The method was applied to the analysis of 74 contemporary STPs commercially available in the United States and Sweden, none of which were found to contain hydrazine above the LOQ or LOD. Trace levels of compounds showing chromatographic and mass spectral features consistent with hydrazine were identified at very low levels (sub-limit of detection, tobacco. Our results show that hydrazine is not a prevalent constituent of STPs, and when present is not quantifiable using currently available analytical methodology.
Rickert, W S; Joza, P J; Trivedi, A H; Momin, R A; Wagstaff, W G; Lauterbach, J H
Some health experts are recommending that smokers who refuse to quit or refuse to use nicotine replacement therapy (NRT) such as nicotine-containing chewing gum switch to certain types of smokeless tobacco products (STP) such as Swedish snus. Other health experts disagree citing the uncertainty in the composition of commercially available STP, the lack of governmental regulations to ensure that STP advertised to meet certain standards (i.e., GothiaTek) do actually meet such standards, and the uncertainty that any STP can provide as safe as alternative to smoking as NRT. One reason for uncertainty is the dearth of detailed chemical and toxicological information on contemporary STP. Unlike the situation with cigarettes, there are few standardized methods for analytical and toxicological studies of STP. Consequently, the objective for this work was to characterize several types of STP available on the Canadian market using the modifications of the Official Health Canada chemical and toxicological methods developed for cigarettes. Moist snuff samples tested had TSNA and B[a]P levels somewhat above the GothiaTek standard while samples of Swedish snus, low-moisture snuff, and US-style chewing tobacco did not. Use of in vitro assays to assess STP toxicity was of limited utility in distinguishing product types.
Arain, Sadaf Sadia; Gul Kazi, Tasneem; Afridi, Hassan Imran; Brahman, Kapil Dev; NaEemuliah; Shah, Faheem; Mughal, Moina Akhtar
Extensive investigation has shown that smokeless tobacco (SLT) may cause inflammation of the oral cavity. In this study, the concentration of arsenic (As) was determined in SLT products (gutkha, mainpuri, and dry and moist snuff). Scalp hair samples of males aged 20-30 years who consumed different types of SLT products available in Pakistan were analyzed for As contents. Total As in different SLT products and in scalp hair was determined by electrothermal atomic absorption spectrometry after microwave-assisted extraction. The validity of the methodology was tested by simultaneously analyzing certified reference materials and spike recovery studies. The range of As concentrations in moist snuff, dry snuff, gutkha, and mainpuri were 0.574-1.53, 0.642-1.07, 0.246-0.622, and 0.419-0.874 μg/g, respectively. We estimated that a daily intake of 10 g of all SLT products could contribute 2.0-12.2% of the provisional maximum tolerable daily intake for As in adults. The As concentration in scalp hair of SLT consumers was higher than that of referents who had not consumed any type of tobacco products.
Weitkunat Rolf; Sponsiello-Wang Zheng; Lee Peter N
Abstract Background Recent reviews claiming smokeless tobacco increases pancreatic cancer risk appear not to have considered all available epidemiological evidence; nor were meta-analyses included. We present a systematic review of studies from North America and Europe, since data are lacking from other continents. Risk is also difficult to quantify elsewhere due to the various products, compositions and usage practices involved. Methods Epidemiological studies were identified that related pa...
Hureiki, J; Laqueille, X
Some rituals about a regular consumption of tea, smokeless tobacco (chewing) and milk are described by one of the authors at the time of his anthropological investigation among the Tuaregs of Timbuktu's region (Mali). He carries out some ethnographical and clinical materials which highlight the dependence to these substances and the role of their psychostimulant and anorexigene effects in a society much ritualised. The subject of this article appears original in the literature which approaches more the dependence to coffee than tea, to cigarettes than to chewing tobacco. The observation of daily life of a tuareg encampment shows a ritual consumption of tea at four time a day. The motivations of the Tuaregs are the increase of vigilance and performance with that psychostimulant substance. They describe an intoxication syndrome related to caffeineism, observed among European tourists. The Tuaregs are aware of their addiction to tea and distinguish psychological dependence from physical dependence. The psychological dependence corresponds to a powerful desire to drink tea at ritual moments, while the physical dependence appears at waking-up and when the time of preparing this beverage is too late. The Tuaregs describe also a phenomenon of loss tolerance after an abstinence period. In spite of the maraboutic prohibition to drink tea, which diverts Tuaregs of their religious practice, they defy this ban from the waking-up to take that infusion before the matinal prayer. That addiction appears also in the identity of the Tuaregs who are called "the sons of tea". The consumption of chewing tobacco, mixed with ash, rhythms the daily life. The mean number of chewing is about fifteen by day; every chewing last 30 minutes. The first chewing of the day occurs 15 minutes after waking-up. The Tuaregs use tobacco in order to get relaxation and vigilance. They suggest intoxication symptoms and especially a withdrawal syndrome which appears at the waking-up or after an important
Cullen, Doris; Keithly, Lois; Kane, Kevin; Land, Thomas; Paskowsky, Mark; Chen, Lili; Hayes, Rashelle; Li, Wenjun
Sales of smokeless tobacco products have increased in the USA. More than one in eight males in the 12th grade are current users of smokeless tobacco. Surveillance data examining nicotine levels of smokeless tobacco subsequent to 2006 have not been reported in the literature. Data on nicotine levels and design features (eg, pH, moisture content, leaf cut and flavour) of smokeless tobacco products sold in Massachusetts were obtained from manufacturers between 2003 and 2012. Design features, levels and temporal trends in unionised (free) nicotine and nicotine content of smokeless tobacco products were analysed overall and by manufacturer and product type. The annual total number of moist snuff products increased from 99 in 2003 to 127 in 2012. The annual total number of reported snus products increased from 4 in 2003 to the highest level of 62 in 2011, before decreasing to 26 in 2012. Overall, mean unionised (free) nicotine remained relatively stable (β=0.018 (95% CI -0.014 to 0.050) mg/g dry weight/year) from 2003 to 2012. However, both levels and temporal trends of mean free nicotine varied significantly among manufacturers (p<0.001). Since 2003, the free nicotine content of snus has increased at an overall rate of 0.192 (95% CI 0.138 to 0.246) mg/g dry weight/year, but varied by manufacturer (p<0.001). The number of smokeless tobacco products increased in the Massachusetts market. Further, mean unionised (free) nicotine levels in smokeless tobacco products of several manufacturers continued to rise despite decreasing levels from other manufacturers. The current success in tobacco control is very likely undermined without government surveillance, regulation and widespread public disclosure of nicotine levels in these products. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Full Text Available Abstract Background Recent reviews claiming smokeless tobacco increases pancreatic cancer risk appear not to have considered all available epidemiological evidence; nor were meta-analyses included. We present a systematic review of studies from North America and Europe, since data are lacking from other continents. Risk is also difficult to quantify elsewhere due to the various products, compositions and usage practices involved. Methods Epidemiological studies were identified that related pancreatic cancer to use of snuff, chewing tobacco or unspecified smokeless tobacco. Study details and effect estimates (relative risks or odds ratios were extracted, and combined by meta-analyses. Results Nine North American and two Scandinavian studies were identified. Reporting was limited in four studies, so only seven were included in meta-analyses, some providing results for never smokers, some for the overall population of smokers and non-smokers, and some for both. Giving preference to study-specific estimates for the overall population, if available, and for never smokers otherwise, the random-effects estimate for ever smokeless tobacco use was 1.03 (95% confidence interval 0.71–1.49 based on heterogeneous estimates from seven studies. The estimate varied little by continent, study type, or type of smokeless tobacco. Giving preference to estimates for never smokers, if available, and overall population estimates otherwise, the estimate was 1.14 (0.67–1.93, again based on heterogeneous estimates. Estimates varied (p = 0.014 between cohort studies (1.75, 1.20–2.54 and case-control studies (0.84, 0.36–1.97. The value for cohort studies derived mainly from one study, which reported an increase for never smokers (2.0, 1.2–3.3, but not overall (0.9, 0.7–1.2. This study also contributed to increases seen for snuff use and for European studies, significant only in fixed-effect analyses. The studies have various weaknesses, including few exposed
Sponsiello-Wang, Zheng; Weitkunat, Rolf; Lee, Peter N
Background Recent reviews claiming smokeless tobacco increases pancreatic cancer risk appear not to have considered all available epidemiological evidence; nor were meta-analyses included. We present a systematic review of studies from North America and Europe, since data are lacking from other continents. Risk is also difficult to quantify elsewhere due to the various products, compositions and usage practices involved. Methods Epidemiological studies were identified that related pancreatic cancer to use of snuff, chewing tobacco or unspecified smokeless tobacco. Study details and effect estimates (relative risks or odds ratios) were extracted, and combined by meta-analyses. Results Nine North American and two Scandinavian studies were identified. Reporting was limited in four studies, so only seven were included in meta-analyses, some providing results for never smokers, some for the overall population of smokers and non-smokers, and some for both. Giving preference to study-specific estimates for the overall population, if available, and for never smokers otherwise, the random-effects estimate for ever smokeless tobacco use was 1.03 (95% confidence interval 0.71–1.49) based on heterogeneous estimates from seven studies. The estimate varied little by continent, study type, or type of smokeless tobacco. Giving preference to estimates for never smokers, if available, and overall population estimates otherwise, the estimate was 1.14 (0.67–1.93), again based on heterogeneous estimates. Estimates varied (p = 0.014) between cohort studies (1.75, 1.20–2.54) and case-control studies (0.84, 0.36–1.97). The value for cohort studies derived mainly from one study, which reported an increase for never smokers (2.0, 1.2–3.3), but not overall (0.9, 0.7–1.2). This study also contributed to increases seen for snuff use and for European studies, significant only in fixed-effect analyses. The studies have various weaknesses, including few exposed cases, reliance in
Senkubuge, Flavia; Ayo-Yusuf, Olalekan A; Louwagie, Goedele M C; Okuyemi, Kolawole S
This study sought to determine the sociodemographic and behavioral factors associated with water pipe and smokeless tobacco (SLT) use among a population of medical students in the Pretoria area, South Africa. Undergraduate medical students (N = 722) in their 2nd and 6th year of study in 2 medical schools in South Africa completed a self-administered questionnaire during 2008. Information on ever and current use of water pipe and SLT was obtained along with information on sociodemographic variables, alcohol use, and cigarette smoking status. Multiple logistic regression analysis were used to determine factors associated with current use of water pipe and SLT. The mean age of study participants was 23 years. Of the participants, 53% were female and 55% were self-identified as Black Africans. Of the study participants, 18.6% were current water pipe users, 3.1% were current SLT users, while 17.3% were current cigarette smokers. Factors independently associated with current water pipe use were having an alcohol drinking-problem (odds ratio [OR] = 2.43; 95% CI = 1.48-3.40), currently smoking cigarettes (3.40; 2.04-5.67), and reporting exposure to smoking in places other than home (2.51; 1.29-4.90). Compared with Black students, White medical students were more likely to have smoked a water pipe in the past month (3.14; 1.74-5.70) but less likely to have ever used SLT (0.37; 0.19-0.73). These findings suggest that the use of alternative tobacco products is common among South African medical students and may form part of a pattern of risk-taking behavior. Furthermore, there appear to be cultural differences in the use of certain tobacco products.
Wackowski, Olivia A; Lewis, M Jane; Delnevo, Cristine D; Ling, Pamela M
Research attention on smokeless tobacco (SLT) has focused on SLT use, health risks, harm-reduction potential, and risk perceptions, but few studies have examined mediated communications about SLT. This study aims to contribute to the literature by providing the first description of SLT coverage in the news, an important communication channel given its ability to educate and shape public opinion about tobacco issues. A content analysis was conducted on SLT-related news and opinion articles between 2006 and 2010 from top circulating national and state newspapers and select news wires. Articles were coded for the main SLT topic, SLT risk references, and slant of opinion articles. SLT was discussed in news/feature articles (n = 677) in terms of business (28%), new products, product regulation and harm reduction (19%), prevention/cessation (11.4%), taxation (10.2%), profiles/trends in use (9%), bans (8.1%), and tobacco industry promotional activities (4.9%). Health risk references (i.e., addictiveness, carcinogenicity, and specific health effects including oral cancer) were found in 40% of articles, though frequency differed by article topic. Although the majority of opinion articles (n = 176) conveyed an anti-SLT slant (64%), 25.6% were pro-SLT. SLT topics of both national and local importance are covered in the news. Public health professionals can participate in SLT coverage by sending in press releases about new study findings, events, or resources and by submitting opinion pieces to share views or respond to previous coverage. Research on SLT news should continue given its potential to shape the public's SLT knowledge and opinions.
Liu, Sherry T.; Nemeth, Julianna M.; Klein, Elizabeth G.; Ferketich, Amy K.; Kwan, Mei-Po; Wewers, Mary Ellen
Objective As smokeless tobacco (ST) marketing increases and new products emerge on the market, very little is known about consumer perceptions of ST products. To inform development of future ST counter-marketing approaches, this qualitative study examined consumer perceptions of traditional and novel ST products and packaging. Methods Focus groups and qualitative interviews were held with adolescent (n=23; mean age of 17 years) and adult (n=38; mean age of 29 years) male ST users from rural Ohio counties. Participants were shown a variety of traditional (e.g., Copenhagen®, Timber Wolf®) and novel (e.g., Camel Snus®, Orbs®) ST products and asked about perceptions of these products and their packaging. Transcriptions were coded independently for common themes by two individuals. Findings Adolescents and adults generally had similar beliefs and reactions about ST products. While participants were familiar with a variety of traditional ST products, Copenhagen® was the most frequently used product. Perceptions of quality and price of traditional products were closely tied to product taste and packaging material. Colors, design, and size of ST packaging appealed to participants and influenced decisions to purchase. Adults believed novel ST products had a weak taste and were targeted to untraditional ST users. While the vast majority was unfamiliar with dissolvable tobacco, adolescents noted that they would be more convenient to use during school than traditional ST. Conclusions Packaging has a significant role in shaping perceptions of ST and consumer behavior. Regulation of product packaging such as shape, size, and images should be part of comprehensive tobacco control. PMID:23047885
Merne, Marina; Rautava, Jaana; Ruutu, Merja; Syrjänen, Stina
The scope of this work was to study synergism between human papillomavirus (HPV) infection and tobacco in vitro, both known to be independent risk factors for oral cancer. HPV-positive and HPV-negative oral keratinocytes and oral HPV-negative fibroblasts were exposed to smokeless tobacco extract (STE) prepared from the Scandinavian (STE1) and US-type (STE2) snuff. Cell cycle profiles were determined with flow cytometry, and HPV E6/E7 mRNA expression in HPV-positive cells was assayed using RT-qPCR. The exposure of HPV-positive keratinocytes with STE2 increased the number of aneuploid cells from 27% to 80% of which 44% were in S-phase, while none of the diploid cells were in S-phase. The changes after STE1 exposure were less than seen after STE2: from 27% to 31% of which 34% were in S-phase. STE had no effect on HPV16 E6/E7 expression in HPV-positive keratinocytes. In oral spontaneously transformed, HPV-negative keratinocytes, the number of aneuploid cells at G2-M stage increased after STE1 and STE2 exposure from 3% to 9% and 7%, respectively. In HPV-negative oral fibroblasts, the number of cells at G2-M phase increased from 11% to 21% after STE1 and 29% after STE2 exposure. The effect of STE varied in the cell lines studied. STE2 increased significantly the proportion of aneuploid cells in HPV-positive oral keratinocytes, but not HPV16 E6/E7 expression. This indicates that tobacco products may enhance the effects of HPV 16 and the risk of DNA aneuploidy increasing risk to malignant transformation. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Abu S Abdullah
Full Text Available Although smokeless tobacco (SLT use is prevalent in South Asian countries including Bangladesh, information about the pattern and correlates of SLT use is scarce. This study described the pattern and predictors of SLT use among Bangladeshi adults.The data for this study were derived from the International Tobacco Control Policy Evaluation Bangladesh (ITC BD Survey, a prospective cohort survey of a nationally representative sample of smokers and non-smokers, conducted during November 2011 and May 2012. The study included 5522 adults aged 15 or above. We used multiple logistic regression models to identify predictors of SLT use.Of the respondents (N = 5522, 20% were SLT users. In general, SLT use was significantly higher among women, the illiterate and residents of the Dhaka slums or non-tribal/non-border areas outside Dhaka; SLT use increased with age. Several attitudinal factors were also associated with SLT use. Multivariable logistic regression analyses revealed several predictors of SLT use: being female (OR = 1.96, 95% confidence interval, CI: 1.18-3.24, an increasing age, being a resident of a Dhaka slum (OR = 5.86; 95% CI: 3.73-9.21 or non-tribal/non-border areas outside Dhaka (OR = 3.42; 95% CI: 1.94-6.03, being illiterate (OR = 3.37; 95% CI: 1.99-5.71, holding positive opinion towards societal approval of SLT use (OR = 5.84; 95% CI: 3.38-10.09, holding positive opinion towards SLT use by women (OR = 2.63; 95% CI: 1.53-4.54, believing that SLT is addictive (OR = 2.96; 95% CI: 1.51-5.81, and believing SLT is less harmful than bidi (OR = 2.22; 95% CI: 1.36-3.62.The findings suggest that coordinated efforts of governmental and non-governmental organizations, targeting both smoked tobacco and SLT use reduction and cessation, could be modified to reach each level of population including those who are marginalized, female, less educated and elderly. As most tobacco control programs in Bangladesh target mainly
Abdullah, Abu S.; Driezen, Pete; Ruthbah, Ummul H.; Nargis, Nigar; Quah, Anne C. K.; Fong, Geoffrey T.
Background Although smokeless tobacco (SLT) use is prevalent in South Asian countries including Bangladesh, information about the pattern and correlates of SLT use is scarce. This study described the pattern and predictors of SLT use among Bangladeshi adults. Methods The data for this study were derived from the International Tobacco Control Policy Evaluation Bangladesh (ITC BD) Survey, a prospective cohort survey of a nationally representative sample of smokers and non-smokers, conducted during November 2011 and May 2012. The study included 5522 adults aged 15 or above. We used multiple logistic regression models to identify predictors of SLT use. Results Of the respondents (N = 5522), 20% were SLT users. In general, SLT use was significantly higher among women, the illiterate and residents of the Dhaka slums or non-tribal/non-border areas outside Dhaka; SLT use increased with age. Several attitudinal factors were also associated with SLT use. Multivariable logistic regression analyses revealed several predictors of SLT use: being female (OR = 1.96, 95% confidence interval, CI: 1.18–3.24), an increasing age, being a resident of a Dhaka slum (OR = 5.86; 95% CI: 3.73–9.21) or non-tribal/non-border areas outside Dhaka (OR = 3.42; 95% CI: 1.94–6.03), being illiterate (OR = 3.37; 95% CI: 1.99–5.71), holding positive opinion towards societal approval of SLT use (OR = 5.84; 95% CI: 3.38–10.09), holding positive opinion towards SLT use by women (OR = 2.63; 95% CI: 1.53–4.54), believing that SLT is addictive (OR = 2.96; 95% CI: 1.51–5.81), and believing SLT is less harmful than bidi (OR = 2.22; 95% CI: 1.36–3.62). Conclusion The findings suggest that coordinated efforts of governmental and non-governmental organizations, targeting both smoked tobacco and SLT use reduction and cessation, could be modified to reach each level of population including those who are marginalized, female, less educated and elderly. As most
Correlates of the use of different tobacco cessation methods by smokers and smokeless tobacco users according to their socio-demographic characteristics: Global adult tobacco survey (GATS India 2009-10
Full Text Available Background: Tobacco control has two aspects. One involves preventing non-tobacco users from using tobacco and the second involves tobacco cessation (quitting by existing tobacco users. There are various methods of tobacco cessation. Pharmacotherapy [e.g., nicotine replacement therapy (NRT and medications such as bupropion] and behavioral counselling are some of the internationally approved methods of tobacco cessation. Objective: This paper intends to study how age, gender, residence (rural/urban, education, and occupation influence the use of various tobacco cessation methods by smokers and smokeless tobacco users. Materials and Methods: The study was a cross-sectional secondary data analysis of the Global Adult Tobacco Survey (GATS India 2009-2010. There were 3725 smokers and 6354 smokeless tobacco users included in the study who made attempts to quit in the 12 months prior to the survey by use of different cessation methods (NRT, drugs such as bupropion, counselling, and other methods. Results: A significant association was demonstrated between increasing educational attainment and use of cessation methods for all the methods among smokers. Being employed (Govt. or non-Govt. was positively associated with the use of NRT as a cessation method by smokers. Students and homemakers had higher odds of using pharmacotherapy methods among smokers. A significant association was demonstrated for the gender and age of tobacco users with the use of counselling as a cessation method among smokeless tobacco users. Conclusion: The findings of this study have important implications for tobacco cessation service providers in view of supporting their decision of choosing a particular tobacco cessation method for tobacco users according to certain kinds of sociodemographic characteristics.
Couch, Elizabeth T; Darius, Ellen; Walsh, Margaret M; Chaffee, Benjamin W
Smokeless tobacco (ST) use among US high school males living in rural areas exceeds national levels. Subgroups at heightened risk of ST use have been identified, but less is known regarding ST decision-making within high-risk groups. The study objective was to describe rural adolescent males' perceived ST acceptability, health risks, and social implications and how those perceptions differ between ST users and never-users. Semi-structured individual interviews were conducted with a purposeful sample of 55 male students (32 ST ever-users) at three rural California high schools. Interviews were audio recorded and professionally transcribed. Investigators collaboratively developed a codebook based on thematic content and then independently coded transcripts, reconvening frequently to achieve consensus. Coded text was systematically organized into themes following a general inductive approach. ST users and non-users shared multiple ST-related perceptions, including: that ST is a common, normative way of life in rural "country" culture among certain groups; that ST use conveys oral health risks; and that the decision to use (or not to use) is rooted in personal choice. ST users' and never-users' perceptions differed regarding the immediacy, severity, and inevitability of health risks, particularly relative to cigarette smoking. Other differences included perceived parental permissiveness and the expected social benefits of ST use, such as peer acceptance and conveying maturity. Within this population of rural male adolescents, ST users emphasized the social benefits of ST use, while acknowledging but discounting health risks. Differences and similarities in tobacco perceptions among adolescents living in similar environments may inform effective health communication.
Gordon, Judith S; Akers, Laura; Severson, Herbert H; Danaher, Brian G; Boles, Shawn M
An estimated 22% of Americans currently use smokeless tobacco (ST). Most live in small towns and rural areas that offer few ST cessation resources. Approximately 94 million Americans use the Internet for health-related information, and on-line access is growing among lower-income and less-educated groups. As part of a randomized clinical trial to assess the reach and effectiveness of Web-based programs for delivering an ST cessation intervention, the authors developed and evaluated several methods for overcoming the recruitment challenges associated with Web-based research. This report describes and evaluates these methods. Participants were recruited through: (a) Thematic promotional "releases" to print and broadcast media, (b) Google ads, (c) placement of a link on other Web sites, (d) limited purchase of paid advertising, (e) direct mailings to ST users, and (f) targeted mailings to health care and tobacco control professionals. Combined recruitment activities resulted in more than 23,500 hits on our recruitment website from distinct IP addresses over 15 months, which yielded 2,523 eligible ST users who completed the registration process and enrolled in the study. Self-reports revealed that at least 1,276 (50.6%) of these participants were recruited via mailings, 874 (34.6%) from Google ads or via search engines or links on another Web site, and 373 (14.8%) from all other methods combined. The use of thematic mailings is novel in research settings. Recruitment of study participants went quickly and smoothly. Google ads and mailings to media outlets were the methods that recruited the highest number of participants.
Wolfson, Mark; Suerken, Cynthia K; Egan, Kathleen L; Sutfin, Erin L; Reboussin, Beth A; Wagoner, Kimberly G; Spangler, John
Significant changes in the tobacco industry have led to heightened concern about co-use of cigarettes and smokeless tobacco (SLT) products. The aim of this study was to assess whether male cigarette smokers who also used SLT products, in the first semester of their first year of college, were more or less likely than male cigarette smokers who did not use SLT products to still be smoking by the first semester of their senior year. Using a longitudinal, observational study, we followed a cohort of undergraduate students from 11 four-year universities in North Carolina and Virginia through their college career. Mixed-effects logistic regression analysis was conducted to estimate the likelihood of being a current smoker fall of senior year for male students who used both cigarettes and SLT at baseline, compared to those who only smoked cigarettes, after adjustment for potential confounders (n = 274). At baseline, 67.2% of participants were smoking cigarettes only (no SLT use) and 32.8% were dual users (cigarettes and SLT). A total of 62% were still smoking at senior year. Dual users were 30% more likely to be current smokers senior year compared to cigarette only users, although this difference was not statistically significant. Having at least one friend who smoked cigarettes and heavier cigarette smoking at baseline were significantly related to senior year smoking. Our findings do not support the argument that SLT use may help male college smokers discontinue their smoking habit. In fact, it may contribute to smoking persistence.
Khan, Zohaib; Dreger, Steffen; Shah, Syed Majid Hussain; Pohlabeln, Hermann; Khan, Sheraz; Ullah, Zakir; Rehman, Basheer; Zeeb, Hajo
In the wake of smokeless tobacco (SLT) being advocated as a mean of tobacco harm reduction, it is pertinent to establish individual health risks associated with each SLT product. This case-control study was aimed at assessing the risk of oral cancer associated with a smokeless tobacco product (Naswar). The study was conducted from September 2014 till May 2015 in Khyber Pakhtunkhwa, Pakistan. Exposure and covariate information was collected through a structured questionnaire. Conditional logistic regression was used to calculate odds ratios (OR) along with their 95% confidence intervals (CI). 84 oral cancer cases (62% males) and 174 age- and sex-matched controls were recruited. Ever users of Naswar had more than a 20-fold higher risk of oral cancer compared to never-users (OR 21.2, 95% CI 8.4-53.8). Females had a higher risk of oral cancer with the use of Naswar (OR 29.0, 95% CI 5.4-153.9) as compared to males (OR 21.0, 95% CI 6.1-72.1). Based on this result, 68% (men) and 38% (women) of the oral cancer burden in Pakistan is attributable to Naswar. The risk estimates observed in this study are comparable to risk estimates reported by previous studies on other forms of SLT use and the risk of oral cancer in Pakistan. The exposure-response relationship also supports a strong role of Naswar in the etiology of oral cancer in Pakistan. Although still requiring further validation through independent studies, these findings may be used for smokeless tobacco control in countries where Naswar use is common.
Full Text Available This systematic review and meta-analysis aimed to critically appraised data from comparable studies leading to quantitative assessment of any independent association between use of oral smokeless tobacco in any form, of betel quid without tobacco and of areca nut with incidence of oral cancer in South Asia and the Pacific.Studies (case control and/or cohort were identified by searching Pub Med, CINAHL and Cochrane databases through June 2013 using the keywords oral cancer: chewing tobacco; smokeless tobacco; betel quid; betel quid without tobacco; areca nut; Asia, the Pacific and the reference lists of retrieved articles. A random effects model was used to compute adjusted summary OR(RE for the main effect of these habits along with their corresponding 95% confidence intervals. To quantify the impact of between-study heterogeneity on adjusted main-effect summary OR(RE, Higgins' H and I2 statistics along with their 95% uncertainty intervals were used. Funnel plots and Egger's test were used to evaluate publication bias.Meta-analysis of fifteen case-control studies (4,553 cases; 8,632 controls and four cohort studies (15,342 which met our inclusion criteria showed that chewing tobacco is significantly and independently associated with an increased risk of squamous-cell carcinoma of the oral cavity (adjusted main-effect summary for case- control studies OR(RE = 7.46; 95% CI = 5.86-9.50, P<0.001, (adjusted main-effect summary for cohort studies RR = 5.48; 95% CI = 2.56-11.71, P<0.001. Furthermore, meta-analysis of fifteen case control studies (4,648 cases; 7,847 controls has shown betel quid without tobacco to have an independent positive association with oral cancer, with OR = 2.82 (95% CI = 2.35-3.40, P<0.001. This is presumably due to the carcinogenicity of areca nut. There was no significant publication bias.There is convincing evidence that smokeless (aka chewing tobacco, often used as a component of betel quid, and betel quid without tobacco
Stepanov, Irina; Biener, Lois; Yershova, Katrina; Nyman, Amy L; Bliss, Robin; Parascandola, Mark; Hatsukami, Dorothy K
Analysis of novel smokeless tobacco products purchased in Round I of the New Product Watch (NPW)-a national tobacco monitoring network-demonstrated that some tobacco constituents vary not only across various brands but also regionally and over time within the same product. In this study, we analyzed snus and dissolvable tobacco products that were purchased in Round II of the NPW. We analyzed tobacco-specific N-nitrosamines (TSNA) and nicotine in snus and dissolvable tobacco products that were purchased in various regions of the country during the spring and summer of 2011. The results were compared against the Round I data, across different U.S. regions, and among products. A total of 216 samples were received from different states representing 6 regions of the country. Compared with the previous analyses, TSNA levels increased significantly in Marlboro and Camel Snus and some dissolvable Camel products. The levels of unprotonated nicotine in Marlboro Snus and Camel Snus in this study were not different from Round I but varied significantly by regions; the differences between the highest and the lowest average regional levels were ~3.2-fold in Marlboro Snus ~1.7-fold in Camel Snus. Our results indicate that some novel smokeless tobacco products contain TSNA at the levels found in the conventional moist snuff. Observation of regional variations in unprotonated nicotine content in both Round I and Round II of NPW suggest that manufacturers may tailor the levels of this constituent consistently to different regions. © The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Gupta, Bhawna; Johnson, Newell W
This systematic review and meta-analysis aimed to critically appraised data from comparable studies leading to quantitative assessment of any independent association between use of oral smokeless tobacco in any form, of betel quid without tobacco and of areca nut with incidence of oral cancer in South Asia and the Pacific. Studies (case control and/or cohort) were identified by searching Pub Med, CINAHL and Cochrane databases through June 2013 using the keywords oral cancer: chewing tobacco; smokeless tobacco; betel quid; betel quid without tobacco; areca nut; Asia, the Pacific and the reference lists of retrieved articles. A random effects model was used to compute adjusted summary OR(RE) for the main effect of these habits along with their corresponding 95% confidence intervals. To quantify the impact of between-study heterogeneity on adjusted main-effect summary OR(RE), Higgins' H and I2 statistics along with their 95% uncertainty intervals were used. Funnel plots and Egger's test were used to evaluate publication bias. Meta-analysis of fifteen case-control studies (4,553 cases; 8,632 controls) and four cohort studies (15,342) which met our inclusion criteria showed that chewing tobacco is significantly and independently associated with an increased risk of squamous-cell carcinoma of the oral cavity (adjusted main-effect summary for case- control studies OR(RE) = 7.46; 95% CI = 5.86-9.50, Ptobacco to have an independent positive association with oral cancer, with OR = 2.82 (95% CI = 2.35-3.40, Ptobacco, often used as a component of betel quid, and betel quid without tobacco, are both strong and independent risk factors for oral cancer in these populations. However, studies with better separation of the types of tobacco and the ways in which it is used, and studies with sufficient power to quantify dose-response relationships are still needed.
Dwivedi, Shridhar; Aggarwal, Amitesh; Dev, Munish
There is a general misconception that smokeless tobacco particularly sweetened and flavoured paan masala and gutkas are safe to use. The present study was undertaken with the objective of highlighting the deceptive and aggressive marketing techniques adopted by the manufacturers of smokeless tobacco preparations exploiting cultural, social and religious values. Another object was to highlight the lack of transparency in terms of content, weight, quality control and warning. All empty pouches of the used paan masalas, gutka, khaini or surti in and around a tertiary care hospital at east Delhi were collected. Their constituents were studied as per written declaration by the manufacturers on each packet. Information on net weight, cost, presence and type of warning, and quality assurance on each brand provided on side of the packets was noted. A total of 1136 pouches of 33 brands/varieties were collected. Most of the gutka preparations contained tobacco, betel nut, unknown flavouring agents, undeclared spices and heavy metals. Warning regarding the harmful effect of tobacco was written in 90.9 per cent of brands with 81.8 per cent in English language only in minute font. Contents of the products were mentioned in 84.8 per cent of brands and only 27.3 per cent of those mentioned the net weight of the ingredients. Seemingly 'innocuous' tobacco preparations in the form of paan masalas, gutka, khaini, surti or mouth fresheners contain various harmful substance like tobacco, betel nut, sugar coated fennel, saccharine, heavy metals like silver, unknown flavouring agents and undeclared spices in unknown quantities. Lack of transparency in terms of content, weight, quality control and warning is duping unsuspecting consumers.
Nagarajappa, Sandesh; Prasad, Kakarla V V
The aim of the present study was to compare dental caries and periodontal disease status associated with oral microflora among smokeless tobacco chewers and non-chewers. Forty-two smokeless tobacco chewers and 42 non-chewers (age 20 to 60 years) were assessed for dental caries and periodontal disease status using the Decayed Missing Filled Surface (DMFS) Index, Community Periodontal Index (CPI) and Loss of Attachment (LA) Index. Stimulated saliva and subgingival plaque samples were collected from each subject for performing a culture-based analysis of 20 types of oral microorganisms. Qualitative and semi-quantitative culture-based analysis using MacConkey agar, and aerobic and anaerobic blood agar was carried out to determine the total cultivable microflora. Mutans-Sanguis agar, Pfizer selective Enterococcus agar and Rogosa SL agar were used for the culture of microorganisms associated with dental caries. Mann–Whitney U test and Student t test were employed to compare colony-forming units (CFUs) and caries experience between smokeless tobacco chewers and nonchewers. Z proportionality test was used to compare the periodontal disease status. Caries experience among chewers (26 of 42), that is those subjects who were affected by caries, was significantly less at 61.9% (mean DMFS = 3.5) compared to non-chewers (38 of 42, 90.5%) (mean DMFS = 5.5) (P 5.5 mm on a CPI probe were found among 26.2% of chewers and 19.1% of nonchewers, with no statistically significant differences (P > 0.05). Counts of Lactobacillus species were significantly lower among chewers (median CFU = 0.788 x 10⁵) than among non-chewers (median CFU = 1.52 x 10⁵) (P periodontal disease than non-chewers, but the difference was not significant. These clinical observations suggest a lower ability of Gram-negative bacteria to mediate more periodontal disease in this population.
Kenny, K K; Quigley, N C; Regennitter, F J
In this study an all-male population of 256 U.S. Army basic trainees and 98 armor officer basic course students were surveyed concerning extent of use, knowledge of, and factors contributing to the use of smokeless tobacco (ST). The survey was administered at a dental clinic at Fort Knox, Kentucky. The data were analyzed using the SPSS computer software program. Results showed that more than 17% of this population were either occasional or regular users of ST. Nearly 24% had tried ST and more than 9% were former users. Exactly one-half had not tried ST. A typical user was white, had started ST use at age 14, had used it for 4 years, and was most likely to use snuff or dip. Higher educational level achieved was associated with increased likelihood of ST use. Nearly 22% of college graduates used ST, whereas only 15.3% of high school graduates or those with some college were users. Knowledge about the potential health effects of ST was generally high or moderately high, except for its ability to cause hypertension. This was true for both high school and college graduates, although college graduates were somewhat more informed. Few in this population had a personal attitude of approval toward ST use, and very few perceived that either their parents or their superiors in the military approved of ST use. Perceived attitude of approval was highest from friends and peers. The principle reasons for starting ST use were use by friends and curiosity about taste and effects. Influence from public figures, such as athletes, and from advertising was minimal. Enjoyment of flavor and taste was found to be the main reason for continued ST use. Health professionals were identified by the majority of respondents as the single most important information source on ST. Relatively few (27%), however, stated that their dentist or hygienist had ever discussed ST with them.
Al-Mukhaini, Nawal; Ba-Omar, Taher; Eltayeb, Elsadig; Al-Shihi, Aisha; Al-Riyami, Nafila; Al-Belushi, Jamila; Al-Adawi, Kawthar
Afzal, the common smokeless tobacco product (STP) in Oman, is believed to contain toxins that may impair the function of some organs such as liver and kidney. An aqueous extract from Afzal was added to drinking water to be administrated orally to Wistar albino rats (n=72) young and adult from both genders weighing between 60-80g and 150-240g respectively for 8 weeks. Animals were divided into three groups: control (distilled water instead of Afzal extract), low-dose (3mgnicotine/kgbodyweight/day) and high-dose (6mgnicotine/kgbodyweight/day). The animals were euthanized and their blood, liver and kidney were collected for biochemical and histopathological investigations. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were assayed for the liver function, while blood urea nitrogen (BUN) and creatinine (CRT) were assayed for the kidney function. The results showed a significant increase in the ALT, AST, BUN and CRT levels (P<0.05) in both Afzal-treated groups (low and high doses) compared with the control. Histopathological findings revealed the initial but seem to be serious degenerative alterations of periportal fibrosis in liver and edematous and calcified changes in renal glomerulus among Afzal-treated groups. Additionally, the weight gain of the Afzal-treated groups was lower than the control group. Our findings show that the exposure of Wistar rats to the Afzal extract has the potentials of causing decreased weight gain and dose-dependent functional and structural damage to the biochemical and histological profiles of liver and kidney as well as serious biochemical effects. Copyright © 2017 Elsevier Ltd. All rights reserved.
de Moor, C; Johnston, D A; Werden, D L; Elder, J P; Senn, K; Whitehorse, L
Students attending continuation high schools in San Diego, California were surveyed on their smoking and smokeless tobacco (SLT) use. The students are assigned to continuation high schools because of credit deficiencies, usually resulting from absenteeism, poor grades, and delinquency. Results indicated that smoking was higher than national prevalence rates for these adolescents, with the prevalence of weekly and daily smoking at 50.4% and 43.9%, respectively. Among weekly smokers, 43.7% reported smoking at least half a pack of cigarettes per day. Stepwise logistic regression analysis revealed that Anglo ethnicity, having a friend who smokes, weekly use of marijuana and alcohol, and having adults in the home who smoke were significantly associated with weekly smoking. The prevalence of SLT was very low, with only 5.7% reporting monthly use, 2.9% weekly use, and 1.8% daily use. With respect to monthly SLT use, increased risk was found among males, students whose friends used SLT, weekly alcohol users, students who intended on enrolling in college, and those with an adult in the home who used SLT. Comparison to a population of students attending regular public high schools in the same region showed that the prevalence of daily use of cigarettes, alcohol, marijuana and other illicit substances were 3.9, 2.7, 3.7, and 2.2 times higher, respectively, among the continuation high school students than the public school students. Daily use of SLT among the continuation high school students was, however, only 0.4 times as high as the regular public school students.
Full Text Available Objectives: Afzal is an illegally sold smokeless tobacco product (STP commonly used by youths and teenagers in Oman. The aim of this study was to analyse the composition of Afzal, also commonly known as sweekah, as it is believed to contain many carcinogens and toxic components. In particular, Afzal’s heavy metal content includes cadmium (Cd, chromium (Cr, lead (Pb and nickel (Ni. Methods: This study was conducted between March and June 2013. Three samples of Afzal were first dried and then ground to form a homogenous powder. The powder was digested prior to the heavy metal analysis by inductively coupled plasma-mass spectrometry (ICPMS. Results: Afzal was shown to have high levels of all heavy metals except for Ni and Pb, which were detected in quantities below acceptable international limits. The concentrations of the tested metals were 15.75 μg/g, 1.85 μg/g, 1.62 μg/g and 1.57 μg/g for Cr, Cd, Pb and Ni, respectively. The estimated daily intake of heavy metals from Afzal was below the maximum permissible limit accepted by the Food and Agriculture Organization and World Health Organization, except for Cr and Ni which were found to be dangerously elevated when compared with international standards. Conclusion: The results of this study showed that Afzal contains a number of heavy metals that may cause health problems. Therefore, urgent regulation of the illegal sale of Afzal is needed at the national level in Oman along with a campaign to address public health education and awareness of Afzal and its health risks.
Akhtar, Asma; Afridi, Hasan Imran; Kazi, Tasneem Gul; Talpur, Farah Naz; Arain, Sadaf Sadia; Baig, Jameel Ahmed; Khan, Noman; Khan, Mustafa; Bilal, Muhammad
The pervasive smokeless tobacco (SLT) consumption and diseases related to its use is a hot topic for the public discussion. In this study, concentrations of chromium (Cr) were measured in different SLT products [snuff (dry and moist), mainpuri, and gutkha] offered and used in Pakistan. The current study was also designed to assess the Cr levels in the biological (scalp hair and blood) samples of male and female subjects, age ranged from 25 to 60 years, chewing different SLT products. For comparative purpose, the healthy persons of the same age group, who did not consume any SLT products, were selected as referents. The concentrations of Cr in SLT products and biological samples were measured by electrothermal atomic absorption spectrophotometer after microwave-assisted acid digestion. The validity and accuracy of the methodology were checked by certified reference materials (CRMs). The resulted data indicated that the adult persons, who consumed different SLT products, have 2-3 fold higher levels of Cr in biological samples as compared to referent subjects (p < 0.01). The persons, who chew/sniff different SLT products, have 50-80 and 42-82 % higher levels of Cr in their scalp hair and blood samples as related to referents. The daily intake of Cr is lower as compared to the recommended value of 50-200 μg/day. It was expected that 10 g consumption of various kinds of SLT products (snuff, mainpuri, and gutkha) may subsidize 21.2-220, 17.7-122, and 18.4-273 % of the recommended daily intake of Cr, respectively.
Wackowski, Olivia A; Lewis, M Jane; Delnevo, Cristine D
Smokeless tobacco (SLT) products and their communication have been topics of discussion in harm reduction debates, but little is known about smokers' perceptions of existing SLT risk messages. This study aimed to explore smokers' perceptions of SLT and snus products and news stories with different risk messages about them. We conducted interviews with 30 smokers assigned to read 1 of 3 constructed news stories about SLT and snus with different messages about their risks relative to cigarettes: (1) a 'favourable' version (describing SLT/snus as a 'safer' smoking alternative); (2) a 'cautious' version (describing SLT/snus as having various risks); and (3) a 'mixed' version (both stating SLT risks and potential reduced-risk benefits). Smokers felt somewhat more informed about snus after article reading and largely found quoted sources to be credible. Though some exposed to favourable SLT/snus messages appeared to modify their beliefs about the products' acceptability and risks, many were left unchanged given pre-existing SLT risk perceptions influenced by prior SLT warnings, observed effects in known users, and concerns about SLT's mode of use. Willingness to use/not use snus in the future was also influenced by non-risk-related factors (eg, preference for smoking rituals). Many referenced e-cigarettes as being safer and more attractive smoking alternatives. Exposure to reduced-risk SLT information may have some impact on smokers' SLT perceptions and interest, but this might be limited by a variety of negative SLT beliefs and growth of other smoking alternatives. Future research should explore SLT risk message effects with larger samples and different study designs. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Nawal M. Al-Mukhaini
Full Text Available Objectives: Afzal is a common smokeless tobacco product (STP available illegally in Oman. This study aimed to assess pH and moisture levels and determine cancer-enhancing factors in a randomly selected sample of Afzal. Methods: This study was carried out at the Sultan Qaboos University in Muscat, Oman, between April and December 2013. A package of Afzal was purchased from a single provider and divided into samples. The pH and moisture content of the samples were measured according to the protocols of the Centers for Disease Control and Prevention. Gas chromatography-mass spectrometry was used to analyse nicotine levels and ionexchange chromatography (IC was used to determine concentrations of nitrate, nitrite, chloride, fluoride, bromide, sulphate and phosphate anions. Results: The samples had an alkaline pH of 10.46 with high levels of total (48,770.00 μg per g of STP [μg/g] and unionised (48,590.00 μg/g nicotine. The concentration of nitrate (8,792.20 μg/g was alarmingly high. The chloride concentration (33,170.80 μg/g showed a surge on IC chromatography. The moisture content percentage was 52.00%. Conclusion: The moisture content percentage and chloride concentration of Afzal was consistent with those of other STPs. In contrast, nitrite, sulphate and phosphate concentrations were below reported levels of other STPs. All anion concentrations were below the maximum daily limit set by international health organisations. However, the high concentrations of nitrite, nitrate and nicotine and the elevated alkaline pH observed in the analysed Afzal samples suggest that STP users will face health risks as a result of their use.
Chen, C; Isabelle, L M; Pickworth, W B; Pankow, J F
Nicotine and flavorant compound levels were measured in 10 "mint"-related sub-brands and 8 "wintergreen" sub-brands of smokeless tobacco (SLT). Also analyzed were "mint"-related and "wintergreen" confectionery products. Of the "mint" SLT, "Timberwolf Packs Mint Pouches" contained the highest menthol level (5.3 mg/g); the average for the five most-highly mentholated SLT products was 4.3 mg/g. The average for the most five most-highly mentholated confectionery products was 3.5 mg/g. For hard candy, a reported average of maximum use levels is 2.1 mg/g (Burdock, 2009). Of the "wintergreen" SLT, "Hawken Wintergreen" was found to contain the highest methyl salicylate (MS) level (29.7 mg/g). The average of the five highest SLT MS levels was 23.8 mg/g, i.e., 5x higher than the level found in the confectionery product with the highest MS level (LifeSavers Wint O Green Sugar Free, 4.6 mg/g). For hard candy, a reported average of maximum use levels is 2.0 mg/g (Burdock, 2009). Assuming 23.8 mg/g MS in SLT, SLT use at 15 g/day, 100% bodily absorption of the MS, and 60 kg body weight, the average daily intake would be 6.0 mg/kg-day, i.e., 12x the acceptable daily intake (ADI) of 0.5 mg/kg-day established for this compound by a joint FAO/WHO committee. Copyright 2009 Elsevier Ltd. All rights reserved.
Gupta, Bhawna; Johnson, Newell W.
Aim This systematic review and meta-analysis aimed to critically appraised data from comparable studies leading to quantitative assessment of any independent association between use of oral smokeless tobacco in any form, of betel quid without tobacco and of areca nut with incidence of oral cancer in South Asia and the Pacific. Methods Studies (case control and/or cohort) were identified by searching Pub Med, CINAHL and Cochrane databases through June 2013 using the keywords oral cancer: chewing tobacco; smokeless tobacco; betel quid; betel quid without tobacco; areca nut; Asia, the Pacific and the reference lists of retrieved articles. A random effects model was used to compute adjusted summary ORRE for the main effect of these habits along with their corresponding 95% confidence intervals. To quantify the impact of between-study heterogeneity on adjusted main-effect summary ORRE, Higgins' H and I2 statistics along with their 95% uncertainty intervals were used. Funnel plots and Egger's test were used to evaluate publication bias. Results Meta-analysis of fifteen case–control studies (4,553 cases; 8,632 controls) and four cohort studies (15,342) which met our inclusion criteria showed that chewing tobacco is significantly and independently associated with an increased risk of squamous-cell carcinoma of the oral cavity (adjusted main-effect summary for case- control studies ORRE = 7.46; 95% CI = 5.86–9.50, Poral cancer, with OR = 2.82 (95% CI = 2.35–3.40, Poral cancer in these populations. However, studies with better separation of the types of tobacco and the ways in which it is used, and studies with sufficient power to quantify dose-response relationships are still needed. PMID:25411778
Agaku, Israel T; Alpert, Hillel R
Regulatory imbalances exist in the treatment of cigarettes and non-cigarette tobacco products in the USA. We assessed whether declines in cigarette consumption during 2002-2012 were offset by increased use of non-cigarette tobacco products-cigars, pipes, roll-your-own (RYO) and smokeless tobacco. Industry-reported taxable removals (actual sales) were converted into packs for cigarettes and cigarette pack equivalents (CPEs) for loose tobacco (RYO plus pipe tobacco) and moist snuff. Cigars were not converted to CPEs because of their heterogeneity in size/tobacco content. Per capita sales were calculated for the US adult population aged ≥18 years based on the US Census Bureau data. Self-reported data on current (past 30-day) tobacco use among US adults aged ≥18 years were from the National Survey on Drug Use and Health (NSDUH). Joinpoint and logistic regression were used to assess linear trends during 2002-2012. During 2002-2012, cigarette sales declined from 96.91 to 59.85 cigarette packs per capita; increases occurred for sale of cigars (30.51-57.42 cigars per capita), loose tobacco (2.50-5.63 CPEs per capita) and moist snuff (10.64-14.58 CPEs per capita; all psmokeless tobacco use (3.5-3.7%; all ptobacco consumption is a public health concern because all tobacco products are harmful. Eliminating imbalances in tax structure and regulations between cigarettes and non-cigarette tobacco products may help reduce aggregate tobacco consumption. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Lv, Fang; Guo, Junwei; Yu, Fei; Zhang, Tingting; Zhang, Shimin; Cui, Huapeng; Liu, Xianjun; Chen, Li; Liu, Leiyu; Liu, Shaofeng; Xie, Fuwei
A method was developed for the determination of nine volatile N-nitrosamines in tobacco and smokeless tobacco products. The targets are N-nitrosodimethylamine, N-nitrosopyrrolidine, N-nitrosopiperidine, N-nitrosomorpholine, N-nitrosoethylmethylamine, N-nitrosodiethylamine, N-nitrosodipropylamine, N-nitrosobuylmethylmine, and N-nitrosodibutylamine. The samples were treated by dispersive solid-phase extraction using 1 g of primary secondary amine and 0.5 g of carbon and then analyzed by gas chromatography with tandem mass spectrometry with an electron impact ion source. The recoveries for the targets ranged from 84 to 118%, with tobacco matrix. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.
Full Text Available Abstract Anti-harm-reduction advocates sometimes resort to pseudo-analogies to ridicule harm reduction. Those opposed to the use of smokeless tobacco as an alternative to smoking sometimes suggest that the substitution would be like jumping from a 3 story building rather than 10 story, or like shooting yourself in the foot rather than the head. These metaphors are grossly inappropriate for several reasons, notably including the fact that they are misleading about the actual risk levels. Based on the available literature on mortality from falls, we estimate that smoking presents a mortality risk similar to a fall of about 4 stories, while mortality risk from smokeless tobacco is no worse than that from an almost certainly non-fatal fall from less than 2 stories. Other metaphors are similarly misleading. These metaphors, like other false and misleading anti-harm-reduction statements are inherently unethical attempts to prevent people from learning accurate health information. Moreover, they implicitly provide bad advice about health behavior priorities and are intended to persuade people to stick with a behavior that is more dangerous than an available alternative. Finally, the metaphors exhibit a flippant tone that seems inappropriate for a serious discussion of health science.
Anand, P S; Kamath, K P; Bansal, A; Dwivedi, S; Anil, S
The effects of tobacco smoking on the prevalence and severity of periodontal disease have been well documented. However, very few studies have assessed the effects of oral smokeless tobacco (ST) on the periodontium. Considering the widespread use of ST products globally, the effects of such products on the periodontal tissues may be important. The present study was performed to compare retrospectively the patterns of periodontal destruction among oral ST users and never-users with periodontitis. Data from 149 patients with periodontitis (60 ST users and 89 never-users) were compared for mean scores of probing depth, recession (REC) and clinical attachment loss (CAL) and the mean percentage of sites with different ranges of probing depth, REC and CAL. For full-mouth scores, mean REC and CAL were significantly higher in ST users than in never-users (p oral cavity. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Phillips Carl V
Full Text Available Abstract Background Although smokeless tobacco (ST use has played a major role in the low smoking prevalence among Swedish men, there is little information at the population level about ST as a smoking cessation aid in the U.S. Methods We used the 2000 National Health Interview Survey to derive population estimates for the number of smokers who had tried twelve methods in their most recent quit attempt, and for the numbers and proportions who were former or current smokers at the time of the survey. Results An estimated 359,000 men switched to smokeless tobacco in their most recent quit attempt. This method had the highest proportion of successes among those attempting it (73%, representing 261,000 successful quitters (switchers. In comparison, the nicotine patch was used by an estimated 2.9 million men in their most recent quit attempt, and almost one million (35% were former smokers at the time of the survey. Of the 964,000 men using nicotine gum, about 323,000 (34% became former smokers. Of the 98,000 men who used the nicotine inhaler, 27,000 quit successfully (28%. None of the estimated 14,000 men who tried the nicotine nasal spray became former smokers. Forty-two percent of switchers also reported quitting smoking all at once, which was higher than among former smokers who used medications (8–19%. Although 40% of switchers quit smoking less than 5 years before the survey, 21% quit over 20 years earlier. Forty-six percent of switchers were current ST users at the time of the survey. Conclusion Switching to ST compares very favorably with pharmaceutical nicotine as a quit-smoking aid among American men, despite the fact that few smokers know that the switch provides almost all of the health benefits of complete tobacco abstinence. The results of this study show that tobacco harm reduction is a viable cessation option for American smokers.
Awan, K H; Hussain, Q A; Patil, Shankargouda; Maralingannavar, Mahesh
Tobacco and tobacco-related products have been attributed to be causative factors for oral cancer. Newer, chewable, and commercially available smokeless tobacco (ST) products, such as gutka pose further threat in this direction. The aim of the study was to evaluate the risk of oral cancer associated with gutka and other ST products. A case-control study of 134 cases and 134 controls, over a period of 6 months (July-December 2014), was carried out at the Baqai University, Karachi, Pakistan. An interview-based questionnaire was used to collect data on sociodemographic characteristics, oral hygiene practices and type, duration, and frequency of use of tobacco-related products. Data were analyzed using the Pearson's chi-square (χ2) test with the level of significance set as p tobacco-related products [odds ratio (OR) 5.54; 95% CI 2.83-10.83; p < 0.001)]. Participants who consumed other ST products also showed 2 to 4 times higher odds ratio of developing oral cancer than compared to those who did not consume these products. The study provided strong evidence that gutka and other ST products are independent risk factors for oral cancer. This study highlights the strong association of different types of ST and oral cancer. This results in identification of high-risk groups for targeted screening for potential oral cancer lesions.
Mohammad Perwaiz Iqbal
Full Text Available BACKGROUND: Smokeless tobacco (ST use is highly prevalent in the South Asian populations. While there have been a number of reports on association of ST consumption with cancer, very few studies have been conducted to investigate its relationship with cardiovascular disease. Hyperhomocysteinemia is a well-recognized risk factor for cardiovascular disease; however, its association with ST use has never been investigated. The objective of this study was to evaluate the relationship of ST use with hyperhomocysteinemia in an urban Pakistani population. METHODOLOGY/PRINCIPAL FINDINGS: In a cross-sectional study for assessment of risks of hyperhomocysteinemia, 872 healthy adults (355 males and 517 females of age range 18-60 years were recruited from a low-income population in Karachi, Pakistan. A detailed questionnaire was administered which included information about smoking, non-smoking, use of ST alone (chewing as well as sniffing and use of ST with betel nuts. Fasting serum/plasma levels of homocysteine, folate, vitamin B12 and pyridoxal phosphate (PLP; a coenzymic form of vitamin B6 were analyzed. In this population, 43.4% males and 15.5% females were found to be regular users of ST products. Laborers and vendors were the major ST consumers. Smoking was not found to be associated with plasma/serum concentrations of homocysteine, folate, vitamin B12 and PLP. However, homocysteine concentrations in the group which consumed ST alone and the group which consumed ST along with betel nut were significantly higher compared to the non-user group (17.7±7.5 µmol/L, 25.48 µmol/L vs. 11.95 µmol/L, respectively; p15 µmol/L was 11-fold higher in the ST-consumer group compared to the non-user group, [OR (95%CI = 11.34 (7.58-16.96; p<0.001], when the model was adjusted for age, gender, folate and vitamin B12 status. CONCLUSION: This study shows a positive association between ST consumption and hyperhomocysteinemia in a low-income urban Pakistani
Singh, A; Singh, S P
The present study evaluates the potential of smokeless tobacco to modify the chemopreventive efficacy of minor dietary constituents, including garlic, mace or black mustard, via modulating the competing pathways of hepatic detoxication system and antioxidant defense mechanism in murine system. Garlic (100 mg/kg b.w. per day) by gavage and mace (1% w/w) or black mustard (1% w/w) in diet induced a significant increase in the levels of glutathione-S-transferase (GST), acid-soluble sulfhydryl (-SH), cytochrome b5 (Cyt.b5) and cytochrome P-450 (Cyt.P-450) in murine liver. The hepatic levels of GST and -SH were significantly depressed whereas microsomal Cyt.b5, Cyt.P-450 and MDA levels were elevated in groups treated with smokeless tobacco (50 or 100 mg/kg b.w. per day). The data revealed the inhibitory potential of smokeless tobacco on garlic-induced hepatic GST/GSH system besides the significant augmentation by smokeless tobacco on garlic or mace or black mustard-induced microsomal cytochromes. The possible implications of modulation in competing bioactivation and detoxication pathways in the process of chemical carcinogenesis are discussed.
Full Text Available Aim: Smoking and smokeless tobacco use are two recognized risk factors for low bone mineral density (BMD and osteoporosis. Maras powder (MP, a kind of smokeless tobacco, has a lot of addicts in the city of Kahramanmaraş and its surroundings, Turkey. This is the study investigating the effects of MP on BMD and comparing with smoking. Meterial and Methods: A total of 120 healthy male subjects (60 MP users, 60 smoker from Maras City, Turkey were included in the study. All subjects information on demographics, health history, alcohol and tobacco use and medication use were obtained by an interviewer-administered questionnaire. Subjects who had any pathology that might affect BMD, were excluded from the study. Measurements of bone mineral density were obtained by phalangeal radiographic absorptiometry of the nondominant hand. BMD values (g/cm2 of MP users were compared with those of smokers. Results: The mean duration of MP use and the mean age of MP users were 30.6±14.4 years and 64.4±9.8 years, respectively. The mean duration of smoking and the mean age of smokers were 33.7±11.0 years and 61.6±10.4 years, respectively. The mean phalangeal BMD in MP users (0.31±0.04 g/cm2 was signi cantly lower than that in the smokers (0.33±0.03 g/cm2, p=0.004. Conclusion: In MP user males, BMD is lower compared to the smoker males. If our results are supported by other studies, it may be claimed that MP use is a very strong risk factor for low BMD value compared to cigarette smoking. (Turkish Journal of Osteoporosis 2013;19: 12-6
Stepanov, Irina; Biener, Lois; Knezevich, Aleksandar; Nyman, Amy L; Bliss, Robin; Jensen, Joni; Hecht, Stephen S; Hatsukami, Dorothy K
Information on chemical composition of the new oral "spitless" smokeless tobacco products is scarce, and it is not clear whether there is some variability as a function of purchase place or time due to either unintended or intended manufacturing variations or other conditions. We analyzed tobacco-specific N-nitrosamines (TSNA) and nicotine in Marlboro Snus, Camel Snus, and dissolvable Camel products Orbs, Sticks, and Strips that were purchased in various regions of the country during the summer of 2010. A total of 117 samples were received from different states representing six regions of the country. Levels of unprotonated nicotine in Marlboro Snus and Camel Snus varied significantly by regions, with the differences between the highest and the lowest average regional levels being relatively small in Marlboro Snus (∼1.3-fold) and large in Camel Snus (∼3-fold). Some regional variations in TSNA levels were also observed. Overall, Camel Snus had significantly higher TSNA levels than Marlboro Snus, and Camel Strips had the lowest TSNA levels among all novel products analyzed here. The amount of unprotonated nicotine in the dissolvable Camel products was comparable to the levels found in Marlboro Snus. Our study demonstrates some regional variations in the levels of nicotine and TSNA in Marlboro and Camel novel smokeless tobacco products. Continued monitoring of this category of products is needed as the existing products are being test marketed and modified, and new products are being introduced. This information is particularly important given its relevance to Food and Drug Administration regulation of tobacco products.
Gupta, Ruchika; Gupta, Sanjay; Sharma, Shashi; Sinha, Dhirendra N; Mehrotra, Ravi
Use of smokeless tobacco (SLT) products has been linked to multiple adverse effects, especially precancer and cancer of oral cavity. However, the association of SLT use with risk of coronary heart disease (CHD) is shrouded with controversy due to conflicting results in the literature. The present meta-analysis aimed to evaluate the risk of CHD among adult ever-users of SLT products along with subgroup analysis. The analysis included studies retrieved from a systematic literature search for published articles assessing risk of CHD with SLT use. Two authors independently extracted risk estimates and study characteristics of the included studies. Summary relative risks were estimated using the random-effect model. Twenty studies from four WHO regions were included in the analysis. The summary risk of CHD in SLT users was not significantly positive (1.05, 95% CI 0.96-1.15) although a higher risk of fatal CHD was seen (1.10, 95% CI 1.00-1.20). The risk was significant for users in European Region (1.30, 95% CI 1.14-1.47). The results remained unchanged even after strict adjustment for smoking. Product-wise analysis revealed a significant positive association of fatal CHD with snus/ snuff use (1.37, 95% CI 1.14-1.61). The SLT-attributable fraction of fatal CHD was calculated to be 0.3%, highest being for European region (5%). A significant positive association was detected between SLT use and risk of fatal CHD, especially for European users and those consuming snus/ snuff. In view of the positive association even after strict adjustment for smoking, these results underscore the need for inclusion of cessation efforts for smokeless tobacco in addition to smoking for control of fatal cardiovascular diseases. The present meta-analysis demonstrates a global perspective of association between coronary heart disease (CHD) and use of smokeless tobacco (SLT), especially for fatal cardiac events, even with strict adjustment for smoking. There appears to be some difference in this
Motgi, Anagha A; Chavan, Mahesh S; Diwan, Nikhil N; Chowdhery, Asha; Channe, Pallavi P; Shete, Mrinal V
Early detection of cytological damages may help in reduction of morbidity and mortality in patients with oral cancer. (1) The primary aim of this study is to assess the cytogenic damage in the form of micronuclei (MN) in patients with smokeless and smoked tobacco using habit. (2) The secondary aim of this study is to compare the MN score in patients using tobacco and patients with no tobacco habit. (3) To find out incidence of MN according to duration and frequency of tobacco usage. This is a clinical study. A total of 100 patients each with the habit of smokeless tobacco (SLT) chewing, smoked tobacco usage and with no habit were included in the study. Epithelial cell smears were prepared and slides were stained with Papanicolaou stain. Scoring of at least 1000 cells was done and a MN frequency score was assigned for exfoliated oral mucosal cells. Analysis of variance and post hoc tests were used. The difference between the total number of cells with MN was not appreciable between the smokeless and smoked tobacco groups, though the total number of MN was higher in subjects using SLT. Total number of cells with MN and the total number of MN were significantly lower in non-tobacco users when compared with tobacco users. There was very weak positive correlation between the total number of MN as per the duration and frequency of the tobacco habit. The use of smokeless and smoked tobacco are associated with cytotoxic and genotoxic effects. SLT seems to cause more damaging effects than the smoked form.
Kostygina, Ganna; England, Lucinda; Ling, Pamela
Tobacco companies have begun to acquire pharmaceutical subsidiaries and recently started to market nicotine replacement therapies, such as Zonnic nicotine gum, in convenience stores. Conversely, tobacco companies are producing tobacco products such as tobacco chewing gum and lozenges that resemble pharmaceutical nicotine replacement products, including a nicotine pouch product that resembles snus pouches. This convergence of nicotine and tobacco product marketing has implications for regulation and tobacco cessation.
Klosky, James L.; Hum, Ashley M.; Zhang, Nan; Ali, Khatidja S.; Srivastava, D. Kumar; Klesges, Robert C.; Emmons, Karen M.; Ness, Kirsten K.; Stovall, Marilyn; Robison, Leslie L.; Hudson, Melissa M.
Cancer survivors experience treatment-related complications that can be exacerbated by tobacco use. This study reports the prevalence of smokeless (ST) and dual tobacco (DT) use, compares these rates to the US population, and examines tobacco risk factors among males surviving childhood cancer. Data from the Childhood Cancer Survivor Study (CCSS) 2007 survey were used (N = 3378). Standardized incidence ratios (SIR) were obtained by comparing CCSS data to the National Survey on Drug Use and Health. Logistic regression was used to evaluate associations between risk factors and tobacco use. Among male survivors, 8.3% and 2.3% were current ST and DT users, respectively. Survivors were less likely than population males to report ST (SIR = 0.64, 95% CI = 0.57 – 0.72) or DT (SIR = 0.37, CI = 0.29 – 0.46) use; however, non-white survivors aged 35–49 years were more likely to use ST (SIR = 2.32, CI = 1.27 – 3.90). ST use was associated (p < 0.05) with younger age at diagnosis, lower education, being married or divorced/separated, and not living in the Northeastern US, while history of cardiovascular- and/or pulmonary-toxic treatment was protective. DT use was associated with younger age at diagnosis, lower education, divorce/separation, and high psychological distress. Having active heart or circulatory conditions was protective. Although ST/DT use is generally low among childhood cancer survivors, these findings suggest that tobacco use screening should be expanded to include ST use and that ST-specific education and cessation interventions should be provided to users. Screening and intervening for ST/DT use in childhood cancer survivors will reduce tobacco-related morbidity and mortality. PMID:23580700
Kahraman, Hasan; Sucaklı, Mustafa Haki; Atilla, Nurhan; Arpağ, Hüseyin; Bozkuş, Fulsen; Köksal, Nurhan
The aim of this study was to evaluate whether smokeless tobacco (Maras powder) use increased among smokers working at smoke-free workplaces or not. In Kahramanmaraş city, 242 male workers who were current or former smokers, working at strictly smoke-free workplaces were included in this study. A total of 21 questions, including the Fagerstrom Test for Nicotine Dependence, were asked. All the participants were male with a mean age of 29.33±6.66 years, and the age range was 17-55 years. Current smokers were 90 (37.2%) and former smokers were 152 (62.8%). Former smokers were asked the reason why they quit smoking; the predominant reasons were the health hazards of smoking and the financial burden of cigarettes. The quitting rate was significantly higher among married participants (p=0.023). Maras powder users were 184 (76%), users who never smoked were 54 (22.3%), and former users were 4 (1.7%). We asked the Maras powder users if they had been using it before the smoking bans, and 96 workers (51.1%) answered "no." The question "Did the use of Maras powder increase with smoking bans"? was asked, and 118 workers (62.8%) answered "yes." The level of education among Maras powder users was significantly lower than non-users (p=0.001). Working in smoke-free workplaces is associated with increased rates of quitting smoking and also with increased use of Maras powder, a local form of oral smokeless tobacco.
Donaldson, Elisabeth A.; King, Brian A.
Introduction Among young people, curiosity about tobacco products is a primary reason for tobacco experimentation and is a risk factor for future use. We examined whether curiosity about and ever-use of tobacco products among US middle and high school students changed from 2012 to 2014. Methods Data came from the 2012 and 2014 National Youth Tobacco Surveys, nationally representative surveys of US students in grades 6 through 12. For cigarettes, cigars, smokeless tobacco, and e-cigarettes (2014 only), students were classified as ever-users or never-users of each product. Among never-users, curiosity about using each product was assessed by asking participants if they had “definitely,” “probably,” “probably not,” or “definitely not” been curious about using the product. Results From 2012 to 2014, there were declines in ever-use of cigarettes (26% to 22%; P = .005) and cigars (21% to 18%; P = .003) overall and among students who were Hispanic (cigarettes, P = .001; cigars, P = .001) or black (cigarettes, P = .004; cigars, P = .01). The proportion of never-users reporting they were “definitely not” curious increased for cigarettes (51% to 54%; P = .01) and cigars (60% to 63%; P = .03). Ever-use and curiosity about smokeless tobacco did not change significantly from 2012 to 2014. In 2014, the proportion of young people who were “definitely” or “probably” curious never-users of each product was as follows: cigarettes, 11.4%; e-cigarettes, 10.8%; cigars, 10.3%; and smokeless tobacco, 4.4%. Conclusion The proportion of US students who are never users and are not curious about cigarettes and cigars increased. However, many young people remain curious about tobacco products, including e-cigarettes. Understanding factors driving curiosity can inform tobacco use prevention for youth. PMID:27657506
Alsanosy, Rashad Mohammed
Shammah is a traditional form of chewing tobacco [smokeless tobacco, (ST)] that is commonly used in the Middle East especially in Saudi Arabia (KSA), Yemen and Sudan. The Substance Abuse Research Centre (SARC) at Jazan University noted that no adequate research and information on the prevalence of shammah use in the province of Jazan, and KSA as well, has been provided in the scientific literature. An intensive systematic review of online databases was performed, including AMED (The Allied and Complementary Medicine Database), Biological Abstracts, Cochrane Collection Plus, Dentistry and Oral Sciences Source, E-Journals Database, EBSCO Discovery Service, MEDLINE, PEMSoft, PEP Archive, PsycARTICLES, scopus, Sciencedirect and Google Scholar. Shammah is a mixture of powdered tobacco, lime, ash, black pepper, oils and flavorings. ST in KSA is placed in the buccal or lower labial vestibule of the mouth. The user (or dipper) spits out insoluble debris. The importation of ST products is prohibited in KSA. Accessible information on legislative action to control the use of ST in KSA appeared in 1990. The actual percentage use may be higher, than reported since shammah is illegal in KSA and there may be some reluctance to admit to its use. This review paper is an initial step in a funded research project by SARC to understand the pattern of use of shammah and provide adequate epidemiological data. One goal of this review is to generate further data for public health education.
Full Text Available The use of electronic cigarettes (e-cigs continues to increase worldwide in parallel with accumulating information on their potential toxicity and safety. In this study, an in vitro battery of established assays was used to examine the cytotoxicity, mutagenicity, genotoxicity and inflammatory responses of certain commercial e-cigs and compared to tobacco burning cigarettes, smokeless tobacco (SLT products and a nicotine replacement therapy (NRT product. The toxicity evaluation was performed on e-liquids and pad-collected aerosols of e-cigs, pad-collected smoke condensates of tobacco cigarettes and extracts of SLT and NRT products. In all assays, exposures with e-cig liquids and collected aerosols, at the doses tested, showed no significant activity when compared to tobacco burning cigarettes. Results for the e-cigs, with and without nicotine in two evaluated flavor variants, were very similar in all assays, indicating that the presence of nicotine and flavors, at the levels tested, did not induce any cytotoxic, genotoxic or inflammatory effects. The present findings indicate that neither the e-cig liquids and collected aerosols, nor the extracts of the SLT and NRT products produce any meaningful toxic effects in four widely-applied in vitro test systems, in which the conventional cigarette smoke preparations, at comparable exposures, are markedly cytotoxic and genotoxic.
Misra, Manoj; Leverette, Robert D; Cooper, Bethany T; Bennett, Melanee B; Brown, Steven E
The use of electronic cigarettes (e-cigs) continues to increase worldwide in parallel with accumulating information on their potential toxicity and safety. In this study, an in vitro battery of established assays was used to examine the cytotoxicity, mutagenicity, genotoxicity and inflammatory responses of certain commercial e-cigs and compared to tobacco burning cigarettes, smokeless tobacco (SLT) products and a nicotine replacement therapy (NRT) product. The toxicity evaluation was performed on e-liquids and pad-collected aerosols of e-cigs, pad-collected smoke condensates of tobacco cigarettes and extracts of SLT and NRT products. In all assays, exposures with e-cig liquids and collected aerosols, at the doses tested, showed no significant activity when compared to tobacco burning cigarettes. Results for the e-cigs, with and without nicotine in two evaluated flavor variants, were very similar in all assays, indicating that the presence of nicotine and flavors, at the levels tested, did not induce any cytotoxic, genotoxic or inflammatory effects. The present findings indicate that neither the e-cig liquids and collected aerosols, nor the extracts of the SLT and NRT products produce any meaningful toxic effects in four widely-applied in vitro test systems, in which the conventional cigarette smoke preparations, at comparable exposures, are markedly cytotoxic and genotoxic.
Full Text Available Abstract Background Evidence shows that smokers are generally misinformed about the relative harmfulness of nicotine, and smokeless forms of nicotine delivery in relation to smoked tobacco. This study explores changing trends in the beliefs about the harmfulness and use of stop smoking medications and smokeless tobacco in adult smokers in four countries where public education and access to alternative forms of nicotine is varied (Canada, the US, the UK and Australia. Methods Data are from seven waves of the ITC-4 country study conducted between 2002 and 2009 with adult smokers from Canada, the US, the UK and Australia. For the purposes of this study, data were collected from 21,207 current smokers. Using generalised estimating equations to control for multiple response sets, multivariate models were tested to look for main effects of country, and trends across time, controlling for demographic variables. Results Knowledge remained low in all countries, although UK smokers tended to be better informed. There was a small but significant improvement across time in the UK, but mixed effects in the other three countries. At the final wave, between 37.5% (US and 61.4% (UK reported that NRT is a lot less harmful than cigarettes. In Canada and the US, where smokeless tobacco is marketed, only around one in six believed some smokeless tobacco products could be less harmful than cigarettes. Conclusions Many smokers continue to be misinformed about the relative safety of nicotine and alternatives to smoked tobacco, especially in the US and Canada. Concerted efforts to educate UK smokers have probably improved their knowledge. Further research is required to assess whether misinformation deters smokers from appropriate use of alternative forms of nicotine.
Borland, Ron; Cooper, Jae; McNeill, Ann; O'Connor, Richard; Cummings, K Michael
Evidence shows that smokers are generally misinformed about the relative harmfulness of nicotine, and smokeless forms of nicotine delivery in relation to smoked tobacco. This study explores changing trends in the beliefs about the harmfulness and use of stop smoking medications and smokeless tobacco in adult smokers in four countries where public education and access to alternative forms of nicotine is varied (Canada, the US, the UK and Australia). Data are from seven waves of the ITC-4 country study conducted between 2002 and 2009 with adult smokers from Canada, the US, the UK and Australia. For the purposes of this study, data were collected from 21,207 current smokers. Using generalised estimating equations to control for multiple response sets, multivariate models were tested to look for main effects of country, and trends across time, controlling for demographic variables. Knowledge remained low in all countries, although UK smokers tended to be better informed. There was a small but significant improvement across time in the UK, but mixed effects in the other three countries. At the final wave, between 37.5% (US) and 61.4% (UK) reported that NRT is a lot less harmful than cigarettes. In Canada and the US, where smokeless tobacco is marketed, only around one in six believed some smokeless tobacco products could be less harmful than cigarettes. Many smokers continue to be misinformed about the relative safety of nicotine and alternatives to smoked tobacco, especially in the US and Canada. Concerted efforts to educate UK smokers have probably improved their knowledge. Further research is required to assess whether misinformation deters smokers from appropriate use of alternative forms of nicotine.
... tobacco conducted by mail. One of the commenters further suggested that clove cigarettes, which the... tobacco products marketed as cigarettes, including those with clove flavoring, are prohibited in the...
Mushtaq, Nasir; Beebe, Laura A
There is considerable interest in using brief measures of dependence for evaluation and treatment of tobacco dependence. The Heaviness of Smoking Index (HSI) is a validated measure of dependence among cigarette smokers. However, a similar index has not been studied among ST users. The aim of this study is to develop similar ST use indices and evaluate their utility as concise dependence measures. Time to first chew/dip of the day (TTFD), number of cans of ST used per week (CPW), and number of dips/chews per day (DPD) were used to create three ST use indices; heaviness of ST use index (HSTI), ST dependence index (STDI), and ST quantity frequency index (ST-QFI). The study was based on data collected from a community based sample of exclusive ST users living in Oklahoma. Participants completed the self-administered survey which included dependence scales and questionnaires to measure sociodemographic factors and tobacco use characteristics. Saliva samples were obtained to measure cotinine concentration. Method of scoring for TTFD and DPD was similar to the scoring scheme employed for HSI items. DPD was transformed by a series of statistical tests into a three category scoring variable. Concurrent validity and reliability of the ST use indices were evaluated and overall accuracy of ST use indices was assessed. Level of agreement between the ST use indices and Fagerström Test for Nicotine Dependence for ST users (FTND-ST) was calculated to find the extent these indices were equivalent to FTND-ST in measuring dependence. ST use indices were significantly correlated with FTND-ST. ST users who had higher HSTI or STDI scores were more likely to have Tobacco Dependence Screener (TDS) based dependence diagnosis (OR: 1.50, 95%CI: 1.12, 2.02 and OR: 1.53, 95%CI: 1.16, 2.02, respectively). Study findings showed that all ST use indices were predictors of cotinine concentration. The internal consistency assessed by Cronbach's alpha indicated that STDI had acceptable reliability
Valliani, Arif; Ahmed, Bilawal; Nanji, Kashmira; Valliani, Salimah; Zulfiqar, Beenish; Fakih, Misbah; Mehdi, Mehwish; Khan, Anam; Sheikh, Sana Arshad; Fatima, Nida; Ahmad, Sobia; Farah, Fariya; Saleem, Shaheera; Ather, Sana; Majid, Syed Khubaib; Hashmi, Syed Salman; Arjan, Sunil
Use of smoke-less tobacco (SLT) is very common in South and South-East Asian countries. It is significantly associated with various types of cancers. The objectives of this study were to assess the proportion of hospital staff that use SLT, and to identify the factors associated with its use and their practices. In a cross-sectional study, 560 staff of two tertiary care hospitals were interviewed in the year 2009. Nurses, ward boys and technicians were counted as a paramedic staff while drivers, peons, security guards and housekeeping staff were labeled as non-paramedic staff. SLT use was considered as usage of any of the following: betel quid (paan) with or without tobacco, betel nuts with or without tobacco (gutkha) and snuff (naswar). About half (48.6%) of the hospital staff were using at least one type of SLT. Factors found to be statistically significant with SLT were being a male (OR=2.5; 95% CI=1.8-3.7); having no/fewer years of education (OR=1.7; 95% CI=1.2-2.4) and working as non-paramedic staff (OR=2.6; 95% CI=1.8-3.8). Majority of SLT users were using it on regular basis, for >5 years and keeping the tobacco products in the oral cavity for >30 minutes. About half of the users started due to peer pressure and had tried to quit this habit but failed. In this study, about half of the study participants were using SLT in different forms. We suggest educational and behavioral interventions for control of SLT usage.
Full Text Available This paper discusses patterns of daily smokeless tobacco (SLT use and correlates of poly SLT use among married women aged 18-40 years in a Mumbai slum community with implications for tobacco control.Using a mixed methods approach, the study included a structured survey with 409 daily SLT users and in-depth interviews with 42 women. Participants for the survey were selected using a systematic sampling procedure (one woman in every fourth eligible household. Univariate and bivariate analysis, and multiple logistic regressions were conducted to identify demographic and social factors associated with women's use of poly SLT products. To illustrate survey results, in-depth interviews were analyzed using Atlas ti software.Sixty-four percent of the women surveyed used only one type of SLT; of these, 30% used mishri, 32% used pan with tobacco and the rest used chewed tobacco (11%, gul (17% or gutkha (10%. Thirty-six percent used more than one type of SLT. Poly SLT users chewed or rubbed 50% more tobacco as compared to single users (mean consumption of tobacco per day: 9.54 vs. 6.49 grams; p<0.001. Women were more likely to be poly SLT users if they were illiterate as compared to literate (adjusted odds ratio [AOR]=1.67; 95% confidence interval [CI]=1.07-2.71, if they had lived in Mumbai for 10 years or more, versus less than ten years (AOR=1.67, 95% CI=1.03-2.71; and if their husband was a poly SLT user as compared to a non SLT user (AOR=2.78, 95% CI=1.63-4.76. No differences were noted between pregnant and non-pregnant women in SLT consumption patterns.Tobacco control policies and programs must focus specifically on both social context and use patterns to address SLT use among women of reproductive age with special attention to poly SLT users, an understudied and vulnerable population.
Biswas, Sushobhan; Manna, Krishnendu; Das, Ujjal; Khan, Amitava; Pradhan, Anirban; Sengupta, Aaveri; Bose, Surajit; Ghosh, Saurabh; Dey, Sanjit
Smokeless tobacco (SLT) remains a threat amongst a large population across the globe and particularly in India. The oral use of tobacco has been implicated to cause physiological stress leading to extreme toxicological challenge. The study included 47 SLT-users and 44 non-users providing a spectrum of pathophysiological, clinico-biochemical, antioxidant parameters, cell cycle progression study of PBMC and morphological changes of red blood cells (RBC). The expressions of p53, p21, Bax, Bcl-2, IL-6, TNF- α, Cox-2, iNOS were analyzed from thirteen representative SLT-users and twelve non-users. Difference in CRP, random glucose, serum cholesterol, TG, HLDL-C, LDL-C, VLDL-C, neutrophil count, monocyte count, ESR, SOD (PBMC) and TBARS (RBC membrane) were found to be statistically significant (p metabolic condition leading to a rise in the inflammatory status, increased apoptosis and RBC membrane damage. The above findings were substantiated with metabolic, clinical and biochemical parameters. This is possibly the first ever in-depth report and remains an invaluable document on the fatal effects of SLT.
Daniel N. Willis
Full Text Available The popularity of smokeless tobacco (ST is growing rapidly and its prevalence of use is rising globally. Consumption of Gutkha, an addictive form of ST, is particularly common amongst South Asian communities throughout the World. This includes within the US, following large-scale immigration into the country. However, there exists a lack of knowledge concerning these alternative tobacco products. To this end, a study was carried out to determine the toxicity of gutkha, and what role, if any, nicotine contributes to the effects. Adult male mice were treated daily for 3-week (5 day/week, once/day, via the oral mucosa, with equal volumes (50 μL of either sterile water (control, a solution of nicotine dissolved in water (0.24 mg of nicotine, or a solution of lyophilized guthka dissolved in water (21 mg lyophilized gutkha. Serum cotinine, measured weekly, was 36 and 48 ng/mL in gutkha- and nicotine-treated mice, respectively. Results demonstrated that exposure to nicotine and gutkha reduced heart weight, while exposure to gutkha, but not nicotine, decreased liver weight, body weight, and serum testosterone levels (compared to controls. These findings suggest that short-term guhtka use adversely impacts growth and circulating testosterone levels, and that gutkha toxicity may be driven by components other than nicotine. As use of guthka increases worldwide, future studies are needed to further delineate toxicological implications such that appropriate policy decisions can be made.
been implicated in oropharyngeal, prostate and pancreatic cancers [3–5] and, ultimately, these health effects contribute to higher all-cause mortality...Marine Corps populations are more likely to begin ST use [2,26,27]. In addition, ST uptake was associated with PTSD symptoms, as well as alcohol and...and have little need to supple- ment smoking with smokeless tobacco. The positive association between ST use and problem- atic alcohol consumption use
Secondhand smoke - risks; Cigarette smoking - risks; Smoking and smokeless tobacco - risks; Nicotine - risks ... tobacco that are known to cause cancer. HEALTH RISKS OF SMOKING OR USING SMOKELESS TOBACCO Knowing the ...
Full Text Available Smokeless tobacco usage is a growing public health problem worldwide. The molecular mechanism(s underlying smokeless tobacco associated tissue damage remain largely unidentified. In the present study we have tried to explore the effects of aqueous extract of smokeless tobacco (STE on tubulin-microtubule, the major cytoskeleton protein that maintains cells morphology and participates in cell division. Exposure to STE resulted in dose-dependent cytotoxicity in a variety of mammalian transformed cell lines such as human lung epithelial cells A549, human liver epithelial cells HepG2, and mouse squamous epithelial cells SCC7, [corrected] as well as non-tumorogenic human peripheral blood mononuclear cells PBMC. Cellular morphology of STE-treated cells was altered and the associated disruption of microtubule network indicates that STE targets tubulin-microtubule system in both cell lines. Furthermore it was also observed that STE-treatment resulted in the selective degradation of cellular tubulin, whereas actin remains unaltered. In vitro, polymerization of purified tubulin was inhibited by STE with the IC50 value∼150 µg/ml and this is associated with the loss of reactive cysteine residues of tubulin. Application of thiol-based antioxidant N-acetyl cysteine (NAC significantly abrogates STE-mediated microtubule damage and associated cytotoxicity in both A549 and HepG2 cells. These results suggest that microtubule damage is one of the key mechanisms of STE-induced cytotoxity in mammalian cells.
Khan, Zohaib; Khan, Sheraz; Christianson, Lara; Rehman, Sara; Ekwunife, Obinna; Samkange-Zeeb, Florence
Oral Potentially Malignant Disorders (OPMDs) are chronic lesions or conditions characterized by a potential for malignant transformation. While recent meta-analyses show that smokeless tobacco (SLT) use is a risk factor for oral cancer in South Asia, there is a lack of pooled evidence regarding SLT use and the development of OPMDs. We searched Medline via PubMed, the Science Citation Index (SCI) via Web of Science, Scopus, CINAHL, Global Index Medicus and Google Scholar databases for relevant literature using a combination of keywords and MeSH terms. Eighteen case-control studies were included in the review, all of which reported significantly elevated risk estimates for OPMDs associated with SLT use. Overall and subgroup, Meta Odds Ratios (mOR) were calculated through a random effects analysis using "generic inverse variance" method in Rev Man 5.3. Heterogeneity was quantified by calculating the I (2) statistic. The mOR for any OPMD with the use of any SLT product was 15.5 [95% Confidence Interval (CI), 9.9-24.2]. Women had a higher risk, mOR = 22.2 (95% CI, 9.1-54.1) compared to men, mOR = 8.7 (95% CI, 2.1-34.8). Betel quid with tobacco carried the highest risk for OPMD, mOR = 16.1 (95% CI, 7.8-33.5). Although the cumulative evidence is informed by case-control studies only, the magnitude of the pooled estimates and the presence of exposure-response indicate a very strong association between OPMDs and SLT use. In addition to tobacco control, results of this review may help in informing oral cancer control policies in South Asia, since OPMDs lie on the causal pathway for oral cancer. More than 250 million South and South East Asians use SLT in some form. As cigarettes prices climb up all over the world, more people could potentially take up SLT, particularly in the absence of epidemiological evidence regarding the harmful effects of these products, and SLT being advocated as a means of tobacco harm reduction. Our findings are thus relevant and timely in
Redner, Ryan; White, Thomas J; Harder, Valerie S; Higgins, Stephen T
Smoking prevalence is unevenly distributed in the U.S. population, with those with mental illness, other substance use disorders, and lower socioeconomic status being especially vulnerable. Less research has been conducted on the association between these same vulnerabilities and smokeless tobacco (ST) use. The present study examined cigarette and ST use among adolescents and adults who met diagnostic criteria for major depressive disorder in the National Survey on Drug Use and Health (NSDUH). Utilizing the most recent (2011) NSDUH, we compared odds for current cigarette smoking and ST use among adolescents and adults meeting criteria for past-year major depressive disorder to the general population, after adjusting for potential confounding influences of sociodemographic and other substance use characteristics. Analyses were conducted to examine sex as a moderator of the relation between major depressive disorder and tobacco use. Odds for current cigarette smoking among those classified with major depressive disorder were increased among adolescents (OR = 1.33, 95% CI [1.05, 1.69], p = .021) and adults (OR = 1.70, 95% CI [1.47, 1.97], p adolescents (OR = 0.90, 95% CI [0.54, 1.49], p = .678) and were lower among adults (OR = 0.68, 95% CI [0.51, 0.91], p = .010). Sex was not a significant moderator in adolescents or adults. Major depressive disorder is associated with increased risk for smoking but not ST use among adolescents and adults further demonstrating heterogeneity in predictors of vulnerability to use of different tobacco products.
Regan, Annette K; Dube, Shanta R; Arrazola, René
A number of noncigarette tobacco products, including some novel products, recently have been marketed by the tobacco industry, which raises concerns from tobacco control authorities. This study aimed to assess current popularity of several noncigarette tobacco products in the U.S. In 2009, a total of 10,587 adults completed a consumer mail-in survey (ConsumerStyles). Based on survey results, the weighted percentages of adults who heard and tried snus, dissolvable tobacco products, flavored little cigars, and flavored cigarettes were computed in 2010. A subset of this sample (n=4556) completed the HealthStyles survey, which included items about health perceptions of these products and use in the past 30 days. The percentage of U.S. adults in the sample who were aware of these products ranged from 10.4% (dissolvable tobacco) to 44.6% (flavored little cigars). One third of adults who had heard of flavored little cigars tried them and 10.1% had used them in the past 30 days; among those who had heard of them, 27.4% tried flavored cigarettes and 12.6% tried snus. In general, young adults, men, and smokers were most likely to have heard of each product. At least one third of adults were uncertain if these products were as harmful as cigarettes (range=37.3% [snus] to 50.3% [dissolvable tobacco]). The awareness of these tobacco products in this sample varied. Groups with a higher prevalence of smoking and tobacco use (e.g., men, people with low levels of education) may be a target audience for marketing and promotions. As availability of products change, continued surveillance is warranted in the U.S. Published by Elsevier Inc.
Blecher, Evan; Liber, Alex C; Chaussard, Martine; Fedewa, Stacey
The isolated island nation of Madagascar has substantial prevalence of both smoking and smokeless tobacco use, although not of dual use. Madagascar's tobacco market, much like its historical and cultural underpinnings, appears to have both Asian and African influences. Additionally, it has a unique market structure that plays an important role in influencing patterns of tobacco use. This study analyzes the determinants of smoking and smokeless tobacco use in Madagascar. We used the 2008 Madagascar Demographic and Health Survey to analyze both smoking tobacco and smokeless tobacco use, stratified by gender. Multivariate log binomial models were used to evaluate the relationship between tobacco use and age, residence (urban/rural), province, marital status, and education. Our analysis indicates that two distinctly different groups of people use two distinctly different tobacco products. Smoking is almost exclusively used by men and does not appear to be related to socioeconomic status. Conversely, smokeless tobacco is consumed by large proportions of both men and women, who are less educated and live in rural areas of the country. This disparate pattern in consumption is a reflection of the different market structures for smokeless tobacco (a cottage industry) and smoking tobacco (a near monopoly). Distinct market-based, geographic, and socioeconomic disparities in tobacco use are explored in order to begin the classification of Madagascar's tobacco epidemic as more African, more Asian, or as a distinctly different environment.
Popova, Lucy; Ling, Pamela M
..., including with "reduced harm" or "FDA Approved" messages. In this online experiment, 483 US adult non-users of tobacco were randomized to view print advertisements for moist snuff, snus, and e-cigarettes with either warning labels...
Arain, Sadaf S; Kazi, Tasneem G; Afridi, Hassan I; Talpur, Farah N; Kazi, Atif G; Brahman, Kapil D; Naeemullah; Arain, Mariam S; Sahito, Oan M
It has been extensively investigated that the chewing of smokeless tobacco (SLT) products may enhance the inflammation of the oral cavity. The aim of the present study is to evaluate the relationship between nickel (Ni) exposure via different SLT products with oral cancer (different sites) incidence in the population of Sindh, Pakistan. The different brands of SLT products (mainpuri, gutkha, and moist snuff) commonly consumed by the studied population were analyzed for Ni contents. The biological samples of oral cancer patients and noncancerous control subjects of both genders, who have or have not consumed SLT products, were collected. The concentration of Ni in biological samples and SLT products were measured by electrothermal atomic absorption spectrophotometer after microwave-assisted acid digestion. The validity and accuracy of the methodology were checked by using certified reference materials. The results of this study showed that the Ni level was significantly higher in scalp hair and blood samples of oral cancer patients compared to controls (P < 0.01). The study suggested that exposure of Ni as a result of chewing different SLT products may be synergistic with risk factors associated with oral cancer.
Arain, Sadaf S; Kazi, Tasneem G; Afridi, Hassan I; Talpur, Farah N; Kazi, Atif G; Brahman, Kapil D; Naeemullah; Panhwar, Abdul H; Kamboh, Muhammad A
It has been extensively reported that chewing of smokeless tobacco (SLT) can lead to cancers of oral cavity. In present study, the relationship between arsenic (As) exposure via chewing/inhaling different SLT products in oral cancer patients have or/not consumed SLT products was studied. The As in different types of SLT products (gutkha, mainpuri, and snuff) and biological (scalp hair and blood) samples of different types of oral cancer patients and controls were analyzed. Both controls and oral cancer patients have same age group (ranged 30-60 years), socio-economic status, localities, and dietary habits. The concentrations of As in SLT products and biological samples were measured by electrothermal atomic absorption spectrophotometer after microwave-assisted acid digestion. The validity and accuracy of the methodology were checked by certified reference materials. The resulted data of present study indicates that the concentration of As was significantly higher in scalp hair and blood samples of oral cancer patients than those of controls (p0.01). The intake of As via consuming different SLT may have synergistic effects, in addition to other risk factors associated with oral cancer.
... Education Act, as amended by the Family Smoking Prevention and Tobacco Control Act; and under the Federal... HUMAN SERVICES Food and Drug Administration Draft Guidance for Industry: Submission of Warning Plans for... Collection; Comment Request AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and...
Rantao, Masego; Ayo-Yusuf, Olalekan A.
Objectives: To determine factors associated with dual use of tobacco products in a population of black South African adolescents. Methods: Data were obtained from a self-administered questionnaire completed by a representative sample of grade 8 students from 21 randomly selected secondary state schools in the Limpopo Province, South Africa (n =…
Vidhubala, E.; Pisinger, C.; Basumallik, B.
available in Chennai, India. Methods: In systematically chosen zones and regions of Chennai city, we randomly identified three kinds of kiosks (n = 18) and asked for 'gutkha' and 'pan masala,' one of each product available. Details of each product were reviewed based on the information printed...... on the sachets. Results: Totally 65 STPs were collected; 26 distinct products and 23 brands. All products were claimed to be 'tobacco' by the shop keepers. Sixty-five percent of the products informed to contain tobacco and 15.4% to contain pan masala. Five sachets did not inform about the content; 30.8% did...... available and due to promotional laudatory messages and lacking information about the content and warning of health damage, the consumers are left with the perception that they buy more or less harmless product. The Indian Government must introduce policies to control production, import, and sale of illicit...
Full Text Available Background: Oral submucous fibrosis (OSMF is a debilitating, potentially cancerous oral condition. Although areca nut is the most important causative agent, it is also considered that the disease is immunologically mediated. Aim of the Study: To establish that autoimmunity and nutritional deficiency play a role in the etiopathogenesis of OSMF. Objectives of the Study: To show that serum immunoglobulin markers (immunoglobulin-G [IgG], immunoglobulin-A [IgA] and nutritional parameters such as total serum protein (TSP, Hemoglobin (Hb play a role in causing OSMF and also to correlate serum, salivary IgG, IgA levels in OSMF patients. Settings and Design: A case-control study was done with 50 patients (25 patients who were provisionally diagnosed as OSMF - Group I, and 25 patients who were chronic smokeless tobacco chewers and who did not have any intraoral lesion - Group II. Materials and Methods: Five milliliters of blood and saliva were collected from both the groups. Quantitative analysis of serum, and salivary IgG, IgA was done by turbidometric immunoassay. TSP and Hemoglobin (Hb were estimated by spectrophotometry. Statistical Analysis: Results were analyzed by independent samples t-test and one-way analysis of variance (ANOVA. Results: All patients of OSMF showed significant (P < 0.01 increase in serum IgG, IgA, and salivary IgG levels as compared to smokeless tobacco chewers. The salivary IgA levels showed a significant decrease in OSMF patients (P < 0.05. TSP and Hb levels showed significant (P < 0.01 decrease in OSMF patients as compared to smokeless tobacco chewers. Conclusion: The elevation of immunoglobulin levels supports the concept of autoimmunity. The decrease in TSP and Hb suggests that nutritional deficiency plays a defined role in the occurrence as well as a further progression of OSMF.
Bahreinifar, Sareh; Sheon, Nicolas M; Ling, Pamela M
Since 2006, leading US cigarette companies have been promoting new snus products as line extensions of popular cigarette brands. These promotional efforts include direct mail marketing to consumers on cigarette company mailing lists. This study examines smokers' reactions to this advertising and perceptions of the new snus products. Eight focus groups (n=65 participants) were conducted in San Francisco and Los Angeles in 2010 with smokers who received tobacco direct mail advertising. The focus group discussions assessed smokers' perceptions of the new snus products. Focus group videos were transcribed and coded using Transana software to identify common themes. Most participants were aware of snus advertising and many had tried free samples. Most were aware that snus was supposed to be 'different' from traditional chewing tobacco but consistently did not know why. Participants willing to try snus still identified strongly as smokers, and for some participants, trying snus reinforced their preference for smoking. Snus' major benefits were use in smoke-free environments and avoiding social stigma related to secondhand smoke. Participants were sceptical of the idea that snus was safer than cigarettes and did not see it as an acceptable substitute for cigarettes or as a cessation aid. Smokers repeated some messages featured in early snus advertising. Snus was not seen as an acceptable substitute for smoking or way to quit cigarettes. Current smoker responses to snus advertising are not consistent with harm reduction.
Full Text Available Introduction: Various pictorial and textual warnings are depicted with a hope that they will deter the individuals from using tobacco and inform them regarding the risks of tobacco. Yet there is lack of information regarding the comprehension of these signs by the adolescents. Aims: The aim was to explore the perception of the adolescents regarding the pictorial and textual warnings on tobacco packs. Materials and Methods: A cross-sectional study was conducted among 500 adolescents of Satara district using simple random sampling technique. A specially designed questionnaire was administered to assess understanding, credibility and persuasiveness of the pictorial and textual warnings on panel of smoked and chewable tobacco. A model containing the pictorial and textual warnings on panel of smoked and smokeless tobacco products were shown to the study subjects. Chi-square test was used for intergroup comparisons based on gender and age of the participants. The statistical analysis of data were done using SPSS version 20.0 (SPSS Inc., Chicago, IL, USA. Results: Nearly one-third of the study participants had often noticed warnings on tobacco packs in the last month, had sometimes read or looked closely at the warnings on tobacco packs in the last month and had rarely talked with anyone about these warnings. About more than two-third of the study participants had found the warning related pictures as not easy to understand, not believable and that these images did not deter them from the likely use of tobacco, and it did not stop them from using tobacco. Conclusion: We can infer that the textual and pictorial warnings failed to have desired deterrent impact on the adolescent who tend to initiate or continue the tobacco use despite the warning.
Novel smokeless tobacco products (such as snus) are aggressively promoted to smokers by the tobacco companies. The Extended Parallel Process Model (EPPM; Witte, 1992) was used to evaluate the current perceptions of threat, efficacy, attitudes, and behavioral intentions regarding snus in a nationally representative sample of 1,836 smokers. Participants were then exposed to messages designed to discourage smokers from trying snus. On average, smokers perceived health threat of snus as somewhat serious, but believed they can effectively avert this threat. Support was found for the EPPM's proposition that when efficacy is high, greater perceived threat is associated with greater desired outcomes (less favorable attitudes toward snus and lower behavioral intentions to try snus in the future). No support was found for the proposition that when perceived efficacy is low, greater threat is associated with greater message rejection. Instead, message rejection was explained by fear felt while exposed to the anti-smokeless ads. This finding indicates the need to more clearly distinguish between cognitive (danger control) and affective (fear control) responses posited by the EPPM.
Novel smokeless tobacco products (such as snus) are aggressively promoted to smokers by the tobacco companies. The Extended Parallel Process Model (EPPM; Witte, 1992) was used to evaluate the current perceptions of threat, efficacy, attitudes, and behavioral intentions regarding snus in a nationally representative sample of 1,836 smokers. Participants were then exposed to messages designed to discourage smokers from trying snus. On average, smokers perceived health threats of snus as somewhat serious, but believed they can effectively avert this threat. Support was found for the EPPM's proposition that when efficacy is high, greater perceived threat is associated with greater desired outcomes (less favorable attitudes towards snus and lower behavioral intentions to try snus in the future). No support was found for the proposition that when perceived efficacy is low, greater threat is associated with greater message rejection. Instead, message rejection was explained by fear felt while exposed to the anti-smokeless ads. This finding indicates the need to more clearly distinguish between cognitive (danger control) and affective (fear control) responses posited by the EPPM. PMID:24359298
Full Text Available Background: Use of ′Mishri′ (Tobacco containing teeth cleaning powder is common in the central and southern part of India. Objectives: To study the effects of Mishri use on the fetus during pregnancy and the perinatal outcome, and stopping its use. Materials and Methods: All apparently healthy pregnant women were enrolled at 20 weeks of gestation from rural Maharashtra, India. Information related to use and giving up of Mishri, previous obstetrical history, current pregnancy, delivery and outcome during the perinatal period were recorded. Appropriate tests of significance were applied. Results: Out of 705 enrolled pregnant women, 218 (30.9% were using Mishri. The proportion of women with complications during the previous perinatal period, complaints and complications during the current pregnancy/delivery and the number of stillbirths were significantly more among Mishri users. A relative risk of abnormal delivery was 2.7 for the users. In spite of counseling, 153 women never stopped the use of Mishri and gave birth to babies weighing on an average 169.9 gm less (statistically significant than babies born from the group that never used it. Babies of 28.8% who stopped/reduced consumption of Mishri were significantly benefited. Conclusions: The improvement seen in babies born to 28.8% mothers who stopped/reduced consumption of Mishri by 32 weeks during the current pregnancy is of paramount importance in the developing world for primary prevention of low birth weight.
Celik, Mustafa; Ekerbicer, Hasan Cetin; Ergun, Ufuk Guney; Kilinc, Metin
One hundred sixty-four adult male volunteers (29 controls [Group 1] and 135 combi drivers) enrolled in the study. The combi drivers were divided into three groups as nonusers of either Maras powder or cigarette (Group 2), smokers (Group 3), and users of Maras powder (Group 4). Blood lead levels (BLLs) were analyzed by atomic absorption spectrophotometer. BLL was detected as 2.8 +/- 2.3 microg/dL in Group 1 (n = 29); however, it was 3.5 +/- 1.6 microg/dL in Group 2 (n = 33), 3.8 +/- 2.4 microg/dL in Group 3 (n = 62), and 3.9 +/- 2.4 microg/dL in Group 4 (n = 40). BLL in Group 1 was found significantly lower than other groups (p powder by the drivers did not give rise to a marked difference on the BLLs (p > 0.05). BLL of (combi) drivers was detected to be significantly higher than nondrivers; however, it was still under the hazardous level of 10 microg/dL announced by WHO. Although there are publications reporting that usage of tobacco increases the level of lead in blood, both smoking and use of Maras powder did not affect BLL markedly in our study.
Caria, Maria Paola; Bellocco, Rino; Zambon, Antonella; Horton, Nicholas J; Galanti, Maria Rosaria
To study the association between measured or perceived overweight in adolescence and subsequent uptake of cigarette smoking and of the Swedish smokeless tobacco 'snus' (oral moist snuff). Population-based prospective cohort study with 7 years' follow-up. Self-administered questionnaires and school nurses' visits. A total of 2922 children of both sexes and mean age 11.6 years at recruitment, resident in the Stockholm region, Sweden. Tobacco use was self-reported at baseline and on six subsequent surveys. Subjects' height and weight were measured by school nurses during the first 4 years, self-reported thereafter. Overweight perception was self-reported at the age of 15 years. Overweight and perception of overweight were not associated with subsequent uptake of either smoking or snus among males. Among females, overweight at baseline was associated with uptake of smoking [adjusted hazard ratio (HR) 1.34, 95% confidence interval (CI) 1.09-1.63], but not of snus. A similar pattern was found with overweight status during follow-up. Among girls with low-educated parents, overweight at baseline predicted the uptake of both snus and smoking. Among 15-year-old females who never used tobacco perceived overweight was associated with subsequent uptake of smoking (adjusted HR 1.71, 95% CI 1.20-2.46), but not of snus. In Sweden, adolescent girls with actual or perceived overweight are at increased risk to start smoking, while indications that this increased risk applies to smokeless tobacco (snus) are limited to girls of low socio-economic status.
Full Text Available Abstract Background People of South Asian-origin are responsible for more than three-quarters of all the smokeless tobacco (SLT consumption worldwide; yet there is little evidence on the effect of SLT cessation interventions in this population. South Asians use highly addictive and hazardous SLT products that have a strong socio-cultural dimension. We designed a bespoke behaviour change intervention (BCI to support South Asians in quitting SLT and then evaluated its feasibility in Pakistan and in the UK. Methods We conducted two literature reviews to identify determinants of SLT use among South Asians and behaviour change techniques (BCTs likely to modify these, respectively. Iterative consensus development workshops helped in selecting potent BCTs for BCI and designing activities and materials to deliver these. We piloted the BCI in 32 SLT users. All BCI sessions were audiotaped and analysed for adherence to intervention content and the quality of interaction (fidelity index. In-depth interviews with16 participants and five advisors assessed acceptability and feasibility of delivering the BCI, respectively. Quit success was assessed at 6 months by saliva/urine cotinine. Results The BCI included 23 activities and an interactive pictorial resource that supported these. Activities included raising awareness of the harms of SLT use and benefits of quitting, boosting clients’ motivation and self-efficacy, and developing strategies to manage their triggers, withdrawal symptoms, and relapse should that occur. Betel quid and Guthka were the common forms of SLT used. Pakistani clients were more SLT dependent than those in the UK. Out of 32, four participants had undetectable cotinine at 6 months. Fidelity scores for each site varied between 11.2 and 42.6 for adherence to content – maximum score achievable 44; and between 1.4 and 14 for the quality of interaction - maximum score achievable was 14. Interviews with advisors highlighted the need for
Marclay, François; Saugy, Martial
Consumption of nicotine in the form of smokeless tobacco (snus, snuff, chewing tobacco) or nicotine-containing medication (gum, patch) may benefit sport practice. Indeed, use of snus seems to be a growing trend and investigating nicotine consumption amongst professional athletes is of major interest to sport authorities. Thus, a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for the detection and quantification of nicotine and its principal metabolites cotinine, trans-3-hydroxycotinine, nicotine-N'-oxide and cotinine-N-oxide in urine was developed. Sample preparation was performed by liquid-liquid extraction followed by hydrophilic interaction chromatography-tandem mass spectrometry (HILIC-MS/MS) operated in electrospray positive ionization (ESI) mode with selective reaction monitoring (SRM) data acquisition. The method was validated and calibration curves were linear over the selected concentration ranges of 10-10,000 ng/mL for nicotine, cotinine, trans-3-hydroxycotinine and 10-5000 ng/mL for nicotine-N'-oxide and cotinine-N-oxide, with calculated coefficients of determination (R(2)) greater than 0.95. The total extraction efficiency (%) was concentration dependent and ranged between 70.4 and 100.4%. The lower limit of quantification (LLOQ) for all analytes was 10 ng/mL. Repeatability and intermediate precision were ≤9.4 and ≤9.9%, respectively. In order to measure the prevalence of nicotine exposure during the 2009 Ice Hockey World Championships, 72 samples were collected and analyzed after the minimum of 3 months storage period and complete removal of identification means as required by the 2009 International Standards for Laboratories (ISL). Nicotine and/or metabolites were detected in every urine sample, while concentration measurements indicated an exposure within the last 3 days for eight specimens out of ten. Concentrations of nicotine, cotinine, trans-3-hydroxycotinine, nicotine-N'-oxide and cotinine-N-oxide were found to range
Berg, Carla J; Haardoerfer, Regine; Escoffery, Cam; Zheng, Pinpin; Kegler, Michelle
We examined: (a) current (past 30-day) smokers' interest in using or switching to electronic nicotine delivery systems (ENDS) or smokeless tobacco for various reasons; (b) correlates of interest in these products; and (c) subgroups of current smokers in relation to interest in these products. We conducted a cross-sectional survey assessing sociodemographics, tobacco use, interest in ENDS and smokeless tobacco among smokers, and knowledge about ENDS among 2,501 US adults recruited through an online consumer panel. We oversampled tobacco users (36.7% current cigarette smokers), ethnic minorities, and southeastern US state residents. On average, participants were more interested in ENDS than smokeless tobacco across all reasons provided. Additionally, they were less interested in either product because of their potential use in places prohibiting smoking or due to curiosity and more interested in reducing health risk or cigarette consumption or to aid in cessation. We documented high rates (27.9%) of misbeliefs about Food and Drug Administration approval of ENDS for cessation, particularly among current smokers (38.5%). Also, 27.2% of current smokers had talked with a health care provider about ENDS, with 18.0% reporting that their provider endorsed ENDS use for cessation. Furthermore, cluster analyses revealed 3 groups distinct in their interest in the products, sociodemographics, and smoking-related characteristics. This study highlights higher interest in ENDS versus smokeless tobacco and greater interest in both for harm reduction and cessation than due to novelty or smoking restrictions. Developing educational campaigns and informing practitioners about caveats around ENDS as cessation or harm reduction aids are critical. © The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: email@example.com.
... brand of smokeless tobacco product ``in accordance with a plan submitted by the tobacco product... announced the availability of a guidance entitled ``Enforcement Policy Concerning Rotational Warning Plans...
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Cooper, Maria; Case, Kathleen R.; Loukas, Alexandra; Creamer, MeLisa R.; Perry, Cheryl L.
Objectives We examined differences in the characteristics of youth non-users, cigarette-only, e-cigarette-only, and dual e-cigarette and cigarette users. Methods Using weighted, representative data, logistic regression analyses were conducted to examine differences in demographic characteristics and tobacco use behaviors across tobacco usage groups. Multiple linear regression analyses were conducted to examine differences in harm perceptions of various tobacco products and perceived peer use of e-cigarettes by tobacco usage group. Results Compared to non-users, dual users were more likely to be white, male, and high school students. Dual users had significantly higher prevalence of current use of all products (except hookah) than e-cigarette-only users, and higher prevalence of current use of snus and hookah than the cigarette-only group. Dual users had significantly lower harm perceptions for all tobacco products except for e-cigarettes and hookah as compared to e-cigarette-only users. Dual users reported higher peer use of cigarettes as compared to both exclusive user groups. Conclusion Findings highlight dual users’ higher prevalence of use of most other tobacco products, their lower harm perceptions of most tobacco products compared to e-cigarette-only users, and their higher perceived peer use of cigarettes compared to exclusive users. PMID:26685819
Cooper, Maria; Case, Kathleen R; Loukas, Alexandra; Creamer, Melisa R; Perry, Cheryl L
We examined differences in the characteristics of youth non-users, cigarette-only, e-cigarette-only, and dual e-cigarette and cigarette users. Using weighted, representative data, logistic regression analyses were conducted to examine differences in demographic characteristics and tobacco use behaviors across tobacco usage groups. Multiple linear regression analyses were conducted to examine differences in harm perceptions of various tobacco products and perceived peer use of e-cigarettes by tobacco usage group. Compared to non-users, dual users were more likely to be white, male, and high school students. Dual users had significantly higher prevalence of current use of all products (except hookah) than e-cigarette-only users, and higher prevalence of current use of snus and hookah than the cigarette-only group. Dual users had significantly lower harm perceptions for all tobacco products except for e-cigarettes and hookah as compared to e-cigarette-only users. Dual users reported higher peer use of cigarettes as compared to both exclusive user groups. Findings highlight dual users' higher prevalence of use of most other tobacco products, their lower harm perceptions of most tobacco products compared to e-cigarette-only users, and their higher perceived peer use of cigarettes compared to exclusive users.
Full Text Available Abstract Background Smokeless tobacco is an alternative for smokers who want to quit but require nicotine. Reliable evidence on its effects is needed. Boffetta et al. and ourselves recently reviewed the evidence on cancer, based on Scandinavian and US studies. Boffetta et al. claimed a significant 60–80% increase for oropharyngeal, oesophageal and pancreatic cancer, and a non-significant 20% increase for lung cancer, data for other cancers being "too sparse". We found increases less than 15% for oesophageal, pancreatic and lung cancer, and a significant 36% increase for oropharyngeal cancer, which disappeared in recent studies. We found no association with stomach, bladder and all cancers combined, using data as extensive as that for oesophageal, pancreatic and lung cancer. We explain these differences. Methods For those cancers Boffetta et al. considered, we compared the methods, studies and risk estimates used in the two reviews. Results One major reason for the difference is our more consistent approach in choosing between study-specific never smoker and combined smoker/non-smoker estimates. Another is our use of derived as well as published estimates. We included more studies, and avoided estimates for data subsets. Boffetta et al. also included some clearly biased or not smoking-adjusted estimates. For pancreatic cancer, their review included significantly increased never smoker estimates in one study and combined smoker/non-smoker estimates in another, omitting a combined estimate in the first study and a never smoker estimate in the second showing no increase. For oesophageal cancer, never smoker results from one study showing a marked increase for squamous cell carcinoma were included, but corresponding results for adenocarcinoma and combined smoker/non-smoker results for both cell types showing no increase were excluded. For oropharyngeal cancer, Boffetta et al. included a markedly elevated estimate that was not smoking-adjusted, and
Wagener, Theodore L; Tackett, Alayna P; Borrelli, Belinda
The study examined caregivers' interest in using potentially reduced exposure tobacco products for smoking cessation, reduction, and to help them not smoke in places such as around their child, as all three methods would potentially lead to reduced secondhand smoke exposure for their children. A sample of 136 caregivers completed carbon monoxide testing to assess smoking status and a brief survey. Few caregivers had ever used potentially reduced exposure tobacco products (tobacco products to help them quit/stay quit from smoking (p < .05). © The Author(s) 2015.
Turk, Tahir; Chaturvedi, Pankaj; Murukutla, Nandita; Mallik, Vaishakhi; Sinha, Praveen; Mullin, Sandra
The evidence on the efficacy of tobacco control messages in low and middle-income country (LMIC) settings is limited but growing. Low message salience and disengagement, in the face of tobacco control messages, are possible barriers to self-efficacy and cessation-related behaviours of tobacco users. Although adaptations of existing pretested graphic and emotional appeals have been found to impact on behaviours, more personalised, culturally relevant and compelling appeals may more fully engage message receivers to elicit optimal behavioural responses. The objective of these case studies is to use lessons learnt from high-income country tobacco control communication programmes, and adapt practical approaches to provide cost-effective, culturally nuanced, graphic and personalised messages from tobacco victims to achieve the optimal behavioural impact for population-level communication campaigns in the resource-constrained settings of LMICs. The 'raw and real' messaging approach, which emanated from message pretesting in India, outlines creative and production processes for the production of tobacco victim testimonials, given the need to source patients, facing life-threatening conditions. This cost-efficient approach uses real tobacco victims, doctors and family members in a cinéma vérité style approach to achieve more personalised and culturally resonant messages. The methodological approach, used for the development of a number of patient testimonial messages initially in India, and later adapted for tobacco cessation, smoke-free and graphic health warning communication campaigns in other countries, is outlined. Findings from campaigns evaluated to date are encouraging as a result of the simple fact that true stories of local people's suffering are simply too difficult to ignore. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Wu, Jingcun; Rickert, William S; Masters, Andrew
An improved HPLC method has been developed for the determination of major phenolic compounds in cigarette smoke. A novel reversed phase column with a pentafluorophenylpropyl (PFP) ligand in the stationary phase was chosen to separate the positional isomers (p-, m-, and o-cresols). Methanol instead of acetonitrile was used as the organic mobile phase component to improve the separation of the isomers and cope with the crisis of global acetonitrile shortage in 2009. A shorter analytical column with smaller particle size was used to further increase separation efficiency and reduces solvent consumption. These improvements have led to a new HPLC method that is simpler and faster than the GC-MS method and more sensitive, selective and efficient than the widely used traditional HPLC method. The limit of detection (LOD) and limit of quantification (LOQ) of this method are at the ng/mL level for most of the phenols with good linearity (R(2) ≥ 0.999) and precision (RSDcigarette smoke yields of phenolic compounds obtained by this method are comparable to those obtained by traditional HPLC method with the advantage that p-, m-, and o-cresols can be determined and reported separately by the new method. The method can also be applied for analysis of phenols in smokeless tobacco product. Copyright © 2012 Elsevier B.V. All rights reserved.
Arain, Sadaf S; Kazi, Tasneem G; Arain, Asma J; Afridi, Hassan I; Brahman, Kapil D; Naeemullah; Ali, Jamshed; Memon, G Zuhra
The present study was aimed to evaluate the cadmium (Cd) and lead (Pb) levels in the scalp hair samples of adolescent boys age ranged 12-15 years, chewing different smokeless tobacco (SLT) products. For comparative purpose, boys of the same age group who did not consume any SLT products were selected as referents. The concentrations of Cd and Pb in SLT products and the scalp hair samples were measured by electrothermal atomic absorption spectrophotometer (ETAAS) after microwave-assisted acid digestion. The validity and accuracy of the methodology were checked by certified reference materials (CRMs). The difference between experimental and certified values of both elements was not significant (p > 0.05). The resulted data indicated that the adolescent boys who consumed different SLT products have two- to threefold higher levels of Cd and Pb in the scalp hair samples as compared to the referent boys (p < 0.01). The adolescent chewing different SLT products have 82.2-110 and 60.6-94.5% higher levels of Cd and Pb, respectively, in their scalp hair as related to the referents.
How do consumers perceive differences in risk across nicotine products? A review of relative risk perceptions across smokeless tobacco, e-cigarettes, nicotine replacement therapy and combustible cigarettes.
Czoli, Christine D; Fong, Geoffrey T; Mays, Darren; Hammond, David
To systematically review the literature regarding relative risk perceptions (RRPs) across non-combustible nicotine products. MEDLINE and PsycINFO databases were searched for articles published up to October 2014. Of the 5266 records identified, articles not published in English that did not quantitatively assess RRPs across categories of non-combustible nicotine products were excluded, yielding 55 records. One reviewer extracted measures and findings of RRPs for product comparisons of smokeless tobacco (SLT), e-cigarettes (ECs) and nicotine replacement therapy (NRT) to one another, and to combustible cigarettes (CCs). A total of 157 samples from 54 studies were included in the analyses. The accuracy of RRPs differed based on the products being compared: although the accuracy of RRPs was variable across studies, substantial proportions of respondents reported inaccurate beliefs about the relative harmfulness of SLT versus CCs, as well as of ECs versus NRT. In addition, in most studies, respondents did not know the relative harmfulness of SLT versus NRT. In contrast, respondents in many studies correctly perceived NRT and ECs as less harmful than CCs. Cigarette smokers and users of non-combustible nicotine products tended to correctly perceive the relative harmfulness of products more often than non-users. Measures used to assess RRPs varied across studies, with different approaches characterised by certain strengths and limitations. The highly variable and context-specific nature of non-combustible nicotine product RRPs have direct implications for researchers and present several challenges for policymakers working with modified risk products, including issues of measurement, health risk communication and behaviour change. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Arain, Sadaf S; Kazi, Tasneem G; Arain, Asma J; Afridi, Hassan I; Arain, Muhammad B; Brahman, Kapil D; Naeemullah; Panhwar, Abdul H; Arain, Mariam S
Several studies have reported that the chewing habit of smokeless tobacco (SLT) has been associated with oral cancer. The aim of the present study was to evaluate the trace levels of lead (Pb) in biological samples (blood, scalp hair) of oral cancer patients and referents of the same age group (range 30-60 years). As the concentrations of Pb are very low in biological samples, so a simple and efficient ionic liquid-based microextraction in a single syringe system has been developed, as a prior step to determination by flame atomic absorption spectrometry. In this procedure, the hydrophobic chelates of Pb with ammonium pyrrolidinedithiocarbamate (APDC) were extracted into fine droplets of 1-butyl-3-methylimidazolium hexafluorophosphate [C4MIM][PF6] within a syringe while using Triton X-114 as a dispersant. Factors influencing the microextraction efficiency and determination, such as pH of the sample, volume of [C4MIM][PF6] and Triton X-114, ligand concentration, and incubation time, were studied. To validate the proposed method, certified reference materials were analyzed and the results of Pb(2+) were in good agreement with certified values. At optimum experimental values of significant variables, detection limit and enhancement factor were found to be 0.412 μg/L and 80, respectively. The coexisting ions showed no obvious negative outcome on Pb preconcentration. The proposed method was applied satisfactorily for the preconcentration of Pb(2+) in acid-digested SLT and biological samples of the study population. It was observed that oral cancer patients who consumed different SLT products have 2-3-fold higher levels of Pb in scalp hair and blood samples as compared to healthy referents (p < 0.001). While 31.4-50.8% higher levels of Pb were observed in referents chewing different SLT products as compared to nonconsumers (p < 0.01).
Arain, Sadaf Sadia; Kazi, Tasneem Gul; Arain, Jamshed Bashir; Afridi, Hassan Imran; Kazi, Atif Gul; Nasreen, Syeda; Brahman, Kapil Dev
Oropharyngeal cancer is a significant public health issue in the world. The incidence of oropharyngeal cancer has been increased among people who have habit of chewing smokeless tobacco (SLT) in Pakistan. The aim of present study was to evaluate the concentration of nickel (Ni) in biological samples (whole blood, serum) of oral (n = 95) and pharyngeal (n = 84) male cancer patients. For comparison purposes, the biological samples of healthy age-matched referents (n = 150), who consumed and did not consumed SLT products, were also analyzed for Ni levels. As the Ni level is very low in biological samples, a preconcentration procedure has been developed, prior to analysis of analyte by flame atomic absorption spectrometry (FAAS). The Ni in acid-digested biological samples was complexed with ammonium pyrrolidinedithio carbamate (APDC), and a resulted complex was extracted in a surfactant Triton X-114. Acidic ethanol was added to the surfactant-rich phase prior to its analysis by FAAS. The chemical variables, such as pH, amounts of reagents (APDC, Triton X-114), temperature, incubation time, and sample volume were optimized. The resulted data indicated that concentration of Ni was higher in blood and serum samples of cancer patients as compared to that of referents who have or have not consumed different SLT products (p = 0.012-0.001). It was also observed that healthy referents who consumed SLT products have two to threefold higher levels of Ni in both biological samples as compared to those who were not chewing SLT products (p < 0.01).
... campaigns. TABLE. Frequency of current use of cigarettes, e-cigarettes, cigars, and smokeless tobacco among middle and high ... States, 2014 Days of use Tobacco product Cigarettes E-cigarettes Cigars Smokeless tobacco % (95% CI) Estimated no. of ...
Gravely, Shannon; Fong, Geoffrey T; Driezen, Pete; Xu, Steve; Quah, Anne C K; Sansone, Genevieve; Gupta, Prakash C; Pednekar, Mangesh S
In 2009, after many delays and changes, India introduced a single pictorial health warning label (HWL) on smokeless tobacco (SLT) packing-a symbolic image of a scorpion covering 40% of the front surface. In 2011, the scorpion was replaced with 4 graphic images. This paper tested the effectiveness of SLT HWLs in India and whether the 2011 change from symbolic to graphic images increased their effectiveness. Data were from a cohort of 4733 adult SLT users (age15+) of the Tobacco Control Project (TCP) India Survey from 4 states. The surveys included key indicators of health warning effectiveness, including warning salience, and cognitive, emotional, and behavioral responses to the warnings. The HWL change from symbolic to graphic did not result in significant increases on any of the HWL outcome indicators. A substantial minority of SLT users were unaware that SLT packages contained HWLs (27% at both waves). Noticing the warnings was also remarkably low at both waves (W1 = 34.3%, W2 = 28.1%). These effects carried over to the cognitive and behavioural measures, where among those who noticed HWLs, about one-third reported forgoing SLT at least once because of the HWLs, and fewer than 20% reported that HWLs made them think about SLT risks or about quitting SLT. Even fewer reported avoiding HWLs (8.1 to 11.6%). Among those who quit using SLT by post-policy, awareness that SLT packaging contained HWLs was significantly greater at post-policy (86.8%) compared to pre-policy (77.8%, p = 0.02). Quitters were also significantly more aware of the post-policy HWLs compared to those who continued to use SLT (p < 0.001). Health warnings on SLT packages in India are low in effectiveness, and the change from the symbolic warning (pre-policy) to graphic HWLs (post-policy) did not lead to significant increases of effectiveness on any of the HWL indicators among those who continued to use SLT products, thus suggesting that changing an image alone is not enough to have an
Harrell, Paul T; Naqvi, Syeda Mahrukh H; Plunk, Andrew D; Ji, Ming; Martins, Silvia S
Despite significant declines in youth cigarette smoking, overall tobacco usage remains over 20% as non-cigarette tobacco product usage is increasingly common and polytobacco use (using 1+ tobacco product) remains steady. The present study was designed to identify patterns of youth tobacco use and examine associations with sociodemographic characteristics and tobacco dependence. The current analysis uses Latent Class Analysis (LCA) to examine the 6,958 tobacco users (n = 2,738 female) in the National Youth Tobacco Survey (2012 and 2013). We used as indicators past month use of tobacco products (cigarettes, cigars, smokeless tobacco, e-cigarettes, hookah, snus, pipes, bidis, and kreteks) and regressed resulting classes on sociodemographic characteristics and tobacco dependence. Nine classes emerged: cigarette smokers (33.4% of sample, also included small probabilities for use of cigars and e-cigarettes), cigar smokers (16.8%, nearly exclusive), smokeless tobacco users (12.3%, also included small probabilities for cigarettes, cigars, snus), hookah smokers (11.8%), tobacco smokers/chewers (10.7%, variety of primarily traditional tobacco products), tobacco/hookah smokers (7.2%), tobacco/snus/e-cig users (3.3%), e-cigarette users (2.9%,), and polytobacco users (1.7%, high probabilities for all products). Compared to cigarette smokers, tobacco/hookah smokers and hookah smokers were more likely to report Hispanic ethnicity. Polytobacco users were more likely to report dependence (AOR:2.77, 95% CI:[1.49-5.18]), whereas e-cigarette users were less likely (AOR:0.49, 95% CI:[0.24-0.97]). Findings are consistent with other research demonstrating shifts in adolescent tobacco product usage towards non-cigarette tobacco products. Continuous monitoring of these patterns is needed to help predict if this shift will ultimately result in improved public health.
Background: Smokeless and cigarette tobacco use is becoming increasingly popular among Nigerian adolescents. This study aimed to evaluate predictors of intention to quit tobacco use among adolescents that currently use tobacco products in Nigeria. Materials and Methods: A total of 536 male and female high school ...
... Rotational Warning Plans for Smokeless Tobacco; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and Drug Administration (FDA) is announcing the availability of a... packaging and advertising for each brand of smokeless tobacco must be ``in accordance with a plan submitted...
The effect of Jharda powder (smokeless tobacco) on some hematological and biochemical parameters in consumers was investigated. Hematological parameters including hemoglobin content and white blood cell and leukocyte counts were higher in jharda powder consumers, while monocytes and basophiles counts were ...
Jan 4, 2007 ... The effect of Jharda powder (smokeless tobacco) on some hematological and biochemical parameters in consumers was investigated. Hematological parameters including hemoglobin content and white blood cell and leukocyte counts were higher in jharda powder consumers, while monocytes and.
Full Text Available Smoking and passive smoking are collectively the biggest preventable cause of death in Bangladesh, with major public health burden of morbidity, disability, mortality and community costs. The available studies of tobacco use in Bangladesh, however, do not necessarily employ nationally representative samples needed to monitor the problem at a national scale. This paper examines the prevalence and patterns of tobacco use among adults in Bangladesh and the changes over time using large nationally representative comparable surveys.Using data from two enumerations of the International Tobacco Control (ITC Bangladesh Project conducted in 2009 and 2012, prevalence estimates are obtained for all tobacco products by socio-economic determinants and sample types of over 90,000 individuals drawn from over 30,000 households. Household level sample weights are used to obtain nationally representative prevalence estimates and standard errors. Statistical tests of difference in the estimates between two time periods are based on a logistic regression model that accounts for the complex sampling design. Using a multinomial logit model, the time trend in tobacco use status is identified to capture the effects of macro level determinants including changes in tobacco control policies.Between 2009 and 2012, overall tobacco use went down from 42.4% to 36.3%. The decline is more pronounced with respect to smokeless tobacco use than smoking. The prevalence of exclusive cigarette smoking went up from 7.2% to 10.6%; exclusive bidi smoking remained stable at around 2%; while smoking both cigarette and bidi went down from 4.6% to 1.8%; exclusive smokeless tobacco use went down from 20.2% to 16.9%; and both smokeless tobacco use and smoking went down from 8.4% to 5.1%. In general, the prevalence of tobacco use is higher among men, increases from younger to older age groups, and is higher among poorer people. Smoking prevalence is the highest among the slum population
Anand Thakur; K M Shivakumar; Snehal Patil; K V Suresh; Vidya Kadashetti
Introduction: Various pictorial and textual warnings are depicted with a hope that they will deter the individuals from using tobacco and inform them regarding the risks of tobacco. Yet there is lack of information regarding the comprehension of these signs by the adolescents. Aims: The aim was to explore the perception of the adolescents regarding the pictorial and textual warnings on tobacco packs. Materials and Methods: A cross-sectional study was conducted among 500 adolescents of Satara ...
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Popova, Lucy; Kostygina, Ganna; Sheon, Nicolas M.; Ling, Pamela M.
Cigarette companies increasingly promote novel smokeless tobacco products to smokers, encouraging them to use smokeless tobacco in smoke-free environments. New messages may counteract this promotion. We developed 12 initial anti-smokeless message ideas and tested them in eight online focus groups with 75 US smokers. Those smokers who never tried…
... The use of chewing tobacco and other smokeless tobacco products increases the risk of oral cancers — cancer of the mouth, throat, cheek, gums, lips or tongue. There's also an increased risk of cancers of the pancreas and ... Smokeless tobacco increases your risk of developing small white patches ...
National Cancer Inst. (NIH), Bethesda, MD.
This guide was originally designed for professional baseball players but it is now distributed to college athletes. The facts and strategies apply to any athlete in any sport. Use of smokeless tobacco or snuff greatly increases the risk of developing oral cancer and other serious medical conditions. The first part of this guide explains the health…
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Adkison, Sarah E; Bansal-Travers, Maansi; Smith, Danielle M; O'Connor, Richard J; Hyland, Andrew J
Research demonstrates that tobacco packaging elements (including health warning labels, descriptive characteristics, and corporate branding) are associated with knowledge of health risks and product appeal with cigarettes. Yet, little research has assessed this with smokeless tobacco (SLT) packaging. This study evaluates the association between three SLT packaging elements with knowledge of health risks and perceptions of novelty and appeal. Additionally, we assess how effects of these messages may differ across age groups, including youth (14-17 years), young adults (18-25 years), and older adults (26-65 years). 1000 participants were administered a web-based survey in 2010 and shown three sets of SLT packs in random order, varied by descriptor (flavor descriptor vs. none), warning label format (graphic vs. text), and corporate branding (branded vs. plain packaging). Participants rated the packs compared with "no difference" on appeal, novelty, and risk perceptions associated with product use. Chi-square tests were used to test for significant differences in pack selections. Multinomial regression was employed to evaluate the association between effects of packaging elements and participant age. More respondents selected the pack with the graphic warning label as the pack to make them consider the health risks associated with SLT use, attract their attention, and be least attractive to a smoker. The product with the text warning label was the product someone their age would want to be seen using and would appeal to peers. The SLT pack with the flavor descriptor was not associated with health risks associated with product use. The pack with corporate branding was selected as more appealing, to attract attention, and one they would want to be seen using; the plain pack was less attractive to smokers. Youth and young adults were more likely to indicate that pack elements affected their perceptions of appeal and risk associated with SLT products. These results suggest
The prevalence of tobacco use was 27.1% (n=101). The overall prevalence of smoking and smokeless tobacco use was 22.6% (n=84) and 7.8% (n=29) respectively. The prevalence of current tobacco use was 24.2% (n=90). Among the ever tobacco users, about 3% (n=11) had quit using tobacco. Tobacco consumption was ...
... for Social Research, Univ. of Mich., Monitoring the Future Studies, http://monitoringthefuture.org/new.html. Youth E-Cigarette ... commission-smokeless-tobacco-report/2015_smokeless_tobacco_report.pdf [Data for top 5 manufacturers ... marketing studies. Pollay, R, et al., “The Last Straw? Cigarette ...
Lee, Youn Ok; Hebert, Christine J; Nonnemaker, James M; Kim, Annice E
Noncigarette tobacco products are increasingly popular among youth, especially cigarette smokers. Understanding multiple tobacco product use is necessary to assess the effects of tobacco products on population health. This study examines multiple tobacco product use and associated risk factors among US youth. Estimates of current use were calculated for cigarettes, cigars, smokeless tobacco, hookah, e-cigarettes, pipes, bidis, kreteks, snus, and dissolvable tobacco by using data from the 2012 National Youth Tobacco Survey (n = 24 658), a nationally representative sample of US middle and high school students. Associations between use patterns and demographic characteristics were examined by using multinomial logistic regression. Among youth, 14.7% currently use 1 or more tobacco products. Of these, 2.8% use cigarettes exclusively, and 4% use 1 noncigarette product exclusively; 2.7% use cigarettes with another product (dual use), and 4.3% use 3 or more products (polytobacco use). Twice as many youth use e-cigarettes alone than dual use with cigarettes. Among smokers, polytobacco use was significantly associated with male gender (adjusted relative risk ratio [aRRR] = 3.71), by using flavored products (aRRR = 6.09), nicotine dependence (aRRR = 1.91), tobacco marketing receptivity (aRRR = 2.52), and perceived prevalence of peer use of tobacco products (aRRR = 3.61, 5.73). More than twice as many youth in the United States currently use 2 or more tobacco products than cigarettes alone. Continued monitoring of tobacco use patterns is warranted, especially for e-cigarettes. Youth rates of multiple product use involving combustible products underscore needs for research assessing potential harms associated with these patterns. Copyright © 2015 by the American Academy of Pediatrics.
Full Text Available Background: Nearly 275 million adults use tobacco in India, which contributes substantially to potentially preventable morbidity and mortality. Awareness towards tobacco is increasing steadily but its role towards cessation is questionable. There is little evidence available about quitting behavior in the Uttarakhand region. Aims & Objectives: To assess the quitting behavior among current tobacco users in a rural population of Dehradun. Material and Methods: The study was cross sectional in nature carried out among 993 current tobacco users aged 10 years and above in the field practice area and quitting behavior was assessed using a pretested and predesigned questionnaire. Result: Of the 993 Current tobacco users, 38% and 40% of the current smokers and current smokeless tobacco users respectively had attempted to quit smoking and smokeless tobacco use in the past 12 months. 54.3% of the smokers wanted to quit smoking with majority of male smokers (56.3% willing to quit smoking compared to only 40.5% of female smokers. 36.0% of the smokeless tobacco users wanted to quit smokeless tobacco use where in contrast more female smokeless tobacco users (39.3% wanted to quit smokeless tobacco compared to 33.3% of males. Conclusion: Previous quit attempts were found to be more among males compared to females. The desire to quit smoking tobacco was also found to be more among males as compared to female smokers. More females showed desire to quit smokeless tobacco compared to males.
... report said. Like cigarettes, all forms of smokeless tobacco contain nicotine, which is highly addictive. The products can cause oral, esophageal and pancreatic cancer, according to SAMHSA. "We need to raise public ...
Agaku, Israel T; Odani, Satomi; Sturgis, Stephanie; Harless, Charles; Glover-Kudon, Rebecca
Smokeless tobacco has been actively promoted by tobacco companies using endorsements by major sport figures, and research indicates that tobacco advertising can lead to youth initiation of tobacco use (1,2). Television and radio advertisements for cigarettes and smokeless tobacco have been prohibited since 1969,* and the 1998 Master Settlement Agreement(†) further prohibited tobacco companies from targeting youths with tobacco product advertisements in specified areas. In 2010, the Food and Drug Administration (FDA), under authority of the 2009 Family Smoking Prevention and Tobacco Control Act (FSPTCA), prohibited tobacco-brand sponsorship (i.e., sponsorship of sports and entertainment events or other social or cultural events using the tobacco brand name or anything identifiable with any brand of cigarettes or smokeless tobacco).(§) However, corporate-name tobacco sponsorship (i.e., sponsorship using the name of the corporation that manufactures regulated tobacco products) is still permitted under certain conditions.(¶) To monitor tobacco advertising and promotional activities in sports in the United States, CDC analyzed trends in sports-related marketing expenditures for cigarettes and smokeless tobacco during 1992-2013 using data from the Federal Trade Commission (FTC). During 1992-2013, sports-related marketing expenditures, adjusted by the consumer price index to constant 2013 dollars, decreased significantly for both cigarettes (from $136 million in 1992 to $0 in 2013) and smokeless tobacco (from $34.8 million in 1992 to $2.1 million in 2013). During 2010-2013, after the prohibition of tobacco-brand sponsorship in sports under the FSPTCA, cigarette manufacturers reported no spending (i.e., $0) on sports-related advertising and promotional activities; in contrast, smokeless tobacco manufacturers reported expenditures of $16.3 million on advertising and promoting smokeless tobacco in sports during 2010-2013. These findings indicate that despite prohibitions
Villanti, Andrea C; Pearson, Jennifer L; Glasser, Allison M; Johnson, Amanda L; Collins, Lauren K; Niaura, Raymond S; Abrams, David B
E-cigarette use occurs with tobacco product use in youth. Using the 2014 National Youth Tobacco Survey (NYTS), we examined past 30-day frequency of cigarette, cigar, smokeless, and e-cigarette use in the context of past 30-day and ever tobacco product use in US middle and high school students (N = 22 007). Frequency of product-specific use was examined by exclusive versus concurrent use with another product in the past 30 days (poly-use). In 2014, the majority (83%) of US middle and high school students had not used tobacco or e-cigarettes in the past 30 days. In the 9.3% of youth reporting any past 30-day e-cigarette use, 63% also reported using a tobacco product; among the 3.3% past 30-day exclusive e-cigarette users, about two-thirds (2.1%) had ever used combustible or non-combustible tobacco products and one-third (1.2%) had not. Few never tobacco users had used e-cigarettes on 10 or more days in the past month (absolute percent cigarette and smokeless users, the two highest frequency categories were 1-2 days and daily use; among past 30-day e-cigarette and cigar users, prevalence decreased with increasing frequency of use. The majority of past 30-day cigarette, cigar, smokeless, and e-cigarette users reported poly-use. Prevalence estimates for a single product mask the complex patterns of frequency, temporality, and poly-use in youth. Two-thirds of past 30-day exclusive e-cigarette users have ever used tobacco. Poly-use is the dominant pattern of tobacco and e-cigarette use among US middle and high school students. Our study highlights the complexity of tobacco use patterns in US middle and high school students. Future studies addressing the full public health impact of movement into or out of combustible tobacco use will require longitudinal data with appropriate measures of tobacco and e-cigarette product-specific use (eg, frequency and intensity), as well as adequate sample size and a sufficient number of waves to determine how use of individual products
Husain, Muhammad Jami; Virk-Baker, Mandeep; Parascandola, Mark; Khondker, Bazlul Haque; Ahluwalia, Indu B
The tobacco epidemic in Bangladesh is pervasive. Expenditures on tobacco may reduce money available for food in a country with a high malnutrition rate. The aims of the study are to quantify the opportunity costs of tobacco expenditure in terms of nutrition (ie, food energy) forgone and the potential improvements in the household level food-energy status if the money spent on tobacco were diverted for food consumption. We analyzed data from the 2010 Bangladesh Household Income and Expenditure Survey, a nationally representative survey conducted among 12,240 households. We present 2 analytical scenarios: (1) the lower-bound gain scenario entailing money spent on tobacco partially diverted to acquiring food according to households' food consumption share in total expenditures; and (2) the upper-bound gain scenario entailing money spent on tobacco diverted to acquiring food only. Age- and gender-based energy norms were used to identify food-energy deficient households. Data were analyzed by mutually exclusive smoking-only, smokeless-only, and dual-tobacco user households. On average, a smoking-only household could gain 269-497 kilocalories (kcal) daily under the lower-bound and upper-bound scenarios, respectively. The potential energy gains for smokeless-only and dual-tobacco user households ranged from 148-268 kcal and 508-924 kcal, respectively. Under these lower- and upper-bound estimates, the percentage of smoking-only user households that are malnourished declined significantly from the baseline rate of 38% to 33% and 29%, respectively. For the smokeless-only and dual-tobacco user households, there were 2-3 and 6-9 percentage point drops in the malnutrition prevalence rates. The tobacco expenditure shift could translate to an additional 4.6-7.7 million food-energy malnourished persons meeting their caloric requirements. The findings suggest that tobacco use reduction could facilitate concomitant improvements in population-level nutrition status and may inform the
... ``Regulations Restricting the Sale and Distribution of Cigarettes and Smokeless Tobacco to Protect Children and... Restricting the Sale and Distribution of Cigarettes and Smokeless Tobacco to Protect Children and Adolescents... any rights for or on any person and does not operate to bind FDA or the public. An alternative...
... Distribution of Cigarettes and Smokeless Tobacco to Protect Children and Adolescents.'' With the release of... Cigarettes and Smokeless Tobacco to Protect Children and Adolescents'' that were published by FDA on March 19... any person and does not operate to bind FDA or the public. An alternative approach may be used if such...
Full Text Available Abstract Major strides towards national tobacco control have been made since Nigeria became signatory to the WHO Framework Convention on Tobacco Control (FCTC in June 2004. The Nigerian senate passed a bill on March 15, 2011 which is expected to be signed into law shortly, to regulate and control production, manufacture, sale, advertising, promotion and sponsorship of tobacco or tobacco products. This paper highlights how the proposed tobacco control law provides a unique opportunity to domesticate the WHO FCTC, expand on smokeless tobacco regulation and develop a science base to improve tobacco control measures in Nigeria.
Conway, Kevin P; Green, Victoria R; Kasza, Karin A; Silveira, Marushka L; Borek, Nicolette; Kimmel, Heather L; Sargent, James D; Stanton, Cassandra A; Lambert, Elizabeth; Hilmi, Nahla; Reissig, Chad J; Jackson, Kia J; Tanski, Susanne E; Maklan, David; Hyland, Andrew J; Compton, Wilson M
Cigarette use is associated with substance use and mental health problems among youth, but associations are unknown for non-cigarette tobacco product use, as well as the increasingly common poly-tobacco use. The current study examined co-occurrence of substance use and mental health problems across tobacco products among 13,617 youth aged 12-17years from Wave 1 (2013-2014) of the nationally representative Population Assessment of Tobacco and Health (PATH) Study. Participants self-reported ever cigarette, e-cigarette, smokeless tobacco, traditional cigar, cigarillo, filtered cigar, hookah, and other tobacco product use; alcohol, marijuana, and other drugs; and lifetime substance use, internalizing and externalizing problems. In multivariable regression analyses, use of each tobacco product was associated with substance use, particularly cigarillos and marijuana (AOR=18.9, 95% CI: 15.3-23.4). Cigarette (AOR=14.7, 95% CI: 11.8-18.2) and cigarillo (AOR=8.1, 95% CI: 6.3-10.3) use were strongly associated with substance use problems and tobacco users were more likely to report internalizing (AOR=1.6, 95% CI: 1.4-1.8) and externalizing (AOR=1.4, 95% CI: 1.3-1.6) problems. Female tobacco users were more likely to have internalizing problems than male tobacco users. Poly-tobacco users were more likely than exclusive users to use substances (AOR=3.4, 95% CI: 2.7-4.3) and have mental health (AOR=1.2, 95% CI: 1.0-1.5) and substance use (AOR=4.7, 95% CI: 3.4-6.6) problems. Regardless of the tobacco product used, findings reveal high co-occurrence of substance use and mental health problems among youth tobacco users, especially poly-tobacco users. These findings suggest the need to address comorbidities among high risk youth in prevention and treatment settings. Copyright © 2017 Elsevier Ltd. All rights reserved.
Bansal-Travers, Maansi; Fong, Geoffrey T.; Quah, Anne C.K.; Sansone, Genevieve; Pednekar, Mangesh S.; Gupta, Prakash C.; Sinha, Dhirendra N.
Tobacco companies are utilizing similar strategies to advertise and promote their products in developing countries as they have used successfully for over 50 years in developed countries. The present study describes how adult smokers, smokeless tobacco users, and non-users of tobacco from the Tobacco Control Project (TCP) India Pilot Survey, conducted in 2006, responded to questions regarding their perceptions and observations of pro-tobacco advertising and promotion and beliefs about tobacco use. Analyses found that 74% (n=562) of respondents reported seeing some form of pro-tobacco advertising in the last six months, with no differences observed between smokers (74%), smokeless tobacco users (74%), and nonsmokers (73%). More than half of respondents reported seeing pro-tobacco advertising on store windows or inside shops. Overall, this study found that a significant percentage of tobacco users and non-users in India report seeing some form of pro-tobacco advertising and promotion messages. Additional analyses found that smokers were more likely to perceive tobacco use as harmful to their health compared with smokeless tobacco users and non-users (padvertising and promotion of tobacco products in India. PMID:25455648
Bansal-Travers, Maansi; Fong, Geoffrey T; Quah, Anne C K; Sansone, Genevieve; Pednekar, Mangesh S; Gupta, Prakash C; Sinha, Dhirendra N
Tobacco companies are utilizing similar strategies to advertise and promote their products in developing countries as they have used successfully for over 50 years in developed countries. The present study describes how adult smokers, smokeless tobacco users, and non-users of tobacco from the Tobacco Control Project (TCP) India Pilot Survey, conducted in 2006, responded to questions regarding their perceptions and observations of pro-tobacco advertising and promotion and beliefs about tobacco use. Analyses found that 74% (n=562) of respondents reported seeing some form of pro-tobacco advertising in the last six months, with no differences observed between smokers (74%), smokeless tobacco users (74%), and nonsmokers (73%). More than half of respondents reported seeing pro-tobacco advertising on store windows or inside shops. Overall, this study found that a significant percentage of tobacco users and non-users in India report seeing some form of pro-tobacco advertising and promotion messages. Additional analyses found that smokers were more likely to perceive tobacco use as harmful to their health compared with smokeless tobacco users and non-users (padvertising and promotion of tobacco products in India. Copyright © 2014 Ministry of Health, Saudi Arabia. Published by Elsevier Ltd. All rights reserved.
Ling, Pamela M; Haber, Lawrence A; Wedl, Stefani
Rodeo is one of the few sports still sponsored by the tobacco industry, particularly the US Smokeless Tobacco Company. Rodeo is popular in rural communities, where smokeless tobacco use is more prevalent. We used previously secret tobacco industry documents to examine the history and internal motivations for tobacco company rodeo sponsorship. Rodeos allow tobacco companies to reach rural audiences and young people, enhance brand image, conduct market research, and generate positive press. Relationships with athletes and fans were used to fight proposed restrictions on tobacco sports sponsorship. Rodeo sponsorship was intended to enhance tobacco sales, not the sport. Rural communities should question the tradition of tobacco sponsorship of rodeo sports and reject these predatory marketing practices.
Kumar, Ashok; Sharma, Amita; Ahlawat, Babita; Sharma, Sonam
An institutional study was carried out in 102 patients to investigate the site specific effect of addictions, that is, tobacco smoking and tobacco chewing (smokeless), both independently and synergistically in development of malignancies in upper aerodigestive tract through retrograde questionnaire. The histopathologically proven cases were interviewed regarding different forms of addictions followed by clinical examination and investigations for grading (according to Modified Broadmann's method) and TNM staging (according to UICC) according to the tumor site. Statistical analysis was done by Pearson test. Out of all proven cases of cancers, 29.4% were only tobacco chewers (smokeless), 25.5% were only smokers, 42.2% were having both types of tobacco addictions (smoke and smokeless), and only 2.9% were having no addiction. Out of only tobacco chewers (smokeless), 83.3% were of oral cavity cancers, 6.7% were of oro- and hypopharynx and the rest were of others. Among only smokers, 69.2% cases were of laryngeal and oro- and hypopharynx as compared to 11.5% of oral cavity cancers (nearly 6 times). Tobacco (smokeless) chewing is associated with oral cancers whereas tobacco smoking is associated with laryngeal and hypopharyngeal carcinoma. Both smoking and smokeless tobacco act in synergy with each other.
Full Text Available An institutional study was carried out in 102 patients to investigate the site specific effect of addictions, that is, tobacco smoking and tobacco chewing (smokeless, both independently and synergistically in development of malignancies in upper aerodigestive tract through retrograde questionnaire. The histopathologically proven cases were interviewed regarding different forms of addictions followed by clinical examination and investigations for grading (according to Modified Broadmann’s method and TNM staging (according to UICC according to the tumor site. Statistical analysis was done by Pearson test. Out of all proven cases of cancers, 29.4% were only tobacco chewers (smokeless, 25.5% were only smokers, 42.2% were having both types of tobacco addictions (smoke and smokeless, and only 2.9% were having no addiction. Out of only tobacco chewers (smokeless, 83.3% were of oral cavity cancers, 6.7% were of oro- and hypopharynx and the rest were of others. Among only smokers, 69.2% cases were of laryngeal and oro- and hypopharynx as compared to 11.5% of oral cavity cancers (nearly 6 times. Tobacco (smokeless chewing is associated with oral cancers whereas tobacco smoking is associated with laryngeal and hypopharyngeal carcinoma. Both smoking and smokeless tobacco act in synergy with each other.
Evaluation of the knowledge and perceptions with regards to pictorial health warnings on tobacco products among tobacco users diagnosed with head and neck carcinoma: a study from the Kumaon Hills of India.
Pant, Nirdosh Kumar; Pandey, Kailash Chandra; Madabhavi, Irappa; Pandey, Vinod; Revannasiddaiah, Swaroop
Tobacco products continue to be used in large quantities in India despite the mandatory inclusion of pictorial health warnings (PHWs) on all tobacco packaging. The circumstances as to how people could continue the use of tobacco to the point of developing head and neck cancer despite enhanced awareness about the ill effects of tobacco is the main focus of this study. This study concerned patients with least 5-years history of tobacco use, having been diagnosed with histopathologically proven malignancies of the hypopharynx, larynx, oropharynx and oral cavity presenting at the Government Medical College-Haldwani, Nainital, India. A total of 183 patients were eligible for inclusion during July 1 2013- June 30 2014. Of these, 59 patients used smoked tobacco exclusively, 22 patients used smokeless tobacco exclusively, and 102 patients used both forms of tobacco. Among users of smoked forms, 75.2% (n=121) were beedi users, and 24.8% (n=40) were cigarette users. Patients were asked direct questions as to whether they had noticed the presence of PHWs upon tobacco products. The reasons as to why PHWs were not effective in stopping the patients from tobacco use were investigated. Of the 183 patients, 146 reported being aware about the presence of PHWs, and when they were asked reasons as to why they continued tobacco despite being aware of ill-effects, the commonest reason chosen (by 53.4%) was that patients had not regarded themselves as using tobacco heavy enough to cause cancer. Among the 36 patients who reported as being oblivious to the presence of PHWs on tobacco products, 63.9% reported that the products they used never displayed any PHWs, and 36.1% reported never having paid attention to the packaging. The awareness about PHWs was higher among cigarette smokers in comparison to beedi smokers (100% vs 76.1%, p=0.0002). Locally produced and marketed tobacco products such as beedis and oral tobacco often fail to display PHWs. The presence of PHWs without doubt enhances
John, R M; Sung, H-Y; Max, W
Objective: To estimate the tobacco-attributable costs of diseases separately for smoked and smokeless tobacco use in India. Methods: The prevalence-based attributable-risk approach was used to estimate the economic cost of tobacco using healthcare expenditure data from the National Sample Survey, a nationally representative household sample survey conducted in India in 2004. Four major categories of tobacco-related disease—tuberculosis, respiratory diseases, cardiovascular diseases and neopla...
Wills, Thomas A; Knight, Rebecca; Williams, Rebecca J; Pagano, Ian; Sargent, James D
To describe electronic cigarette (e-cigarette) use and cigarette use among adolescents and determine whether established risk factors for smoking discriminate user categories. School-based survey of 1941 high school students (mean age 14.6 years) in Hawaii; data collected in 2013. The survey assessed e-cigarette use and cigarette use, alcohol and marijuana use, and psychosocial risk and protective variables (eg, parental support, academic involvement, smoking expectancies, peer smoking, sensation seeking). Analysis of variance and multinomial regression examined variation in risk and protective variables across the following categories of ever-use: e-cigarette only, cigarette only, dual use (use of both products), and nonuser (never used either product). Prevalence for the categories was 17% (e-cigarettes only), 12% (dual use), 3% (cigarettes only), and 68% (nonusers). Dual users and cigarette-only users were highest on risk status (elevated on risk factors and lower on protective factors) compared with other groups. E-cigarette only users were higher on risk status than nonusers but lower than dual users. E-cigarette only users and dual users more often perceived e-cigarettes as healthier than cigarettes compared with nonusers. This study reports a US adolescent sample with one of the largest prevalence rates of e-cigarette only use in the existing literature. Dual use also had a substantial prevalence. The fact that e-cigarette only users were intermediate in risk status between nonusers and dual users raises the possibility that e-cigarettes are recruiting medium-risk adolescents, who otherwise would be less susceptible to tobacco product use. Copyright © 2015 by the American Academy of Pediatrics.
Full Text Available Abstract Many xenobiotic compounds exert their actions through the release of free radicals and related oxidants 12, bringing about unwanted biological effects 3. Indeed, oxidative events may play a significant role in tobacco toxicity from cigarette smoke. Here, we demonstrate the direct in vitro release of the free radical nitric oxide (•NO from extracts and components of smokeless tobacco, including nicotine, nitrosonornicotine (NNN and 4-(methyl-N-nitrosamino-1-(3-pyridyl-1-butanone (NNK in phosphate buffered saline and human saliva using electron spin resonance and chemiluminescence detection. Our findings suggest that tobacco xenobiotics represent as yet unrecognized sources of •NO in the body.
Campbell-Grossman, Christie; Hudson, Diane Brage; Fleck, Margaret Ofe
The purposes of this pilot study were to describe the incidence of chewing tobacco use among rural midwestern adolescents and to describe rural midwestern adolescents' perceptions and knowledge about chewing tobacco use. A Smokeless Tobacco Use Survey was administered to 34 adolescent subjects who attended 5th-8th grades in two rural towns. None of the subjects reported trying chewing tobacco products. However, a group of male subjects who stated they may chew tobacco sometime in the future, performed less well on the test about chewing tobacco facts and perceptions of use, indicating some education needs are warranted. Risk factors and deterrent factors to using chewing tobacco are reported.
Mistry, Ritesh; Pednekar, Mangesh; Pimple, Sharmila; Gupta, Prakash C; McCarthy, William J; Raute, Lalit J; Patel, Minal; Shastri, Surendra S
India's Cigarettes and Other Tobacco Products Act bans tobacco sales and advertisements within 100 yards of educational institutions. In school-adjacent neighbourhoods in Mumbai, we assessed adherence to these policies and whether tobacco vendor and advertisement densities were associated with students' tobacco use. High school students' tobacco use was measured using a multistage cluster sampling survey (n=1533). Field geographic information systems data were obtained for all tobacco vendors and advertisements within 500 m of schools (n=26). Random-effects multilevel logistic regression was used to estimate associations of tobacco vendor and advertisement densities with ever tobacco use, current smokeless tobacco use and current tobacco use. There were 1741 tobacco vendors and 424 advertisements within 500 m of schools, with 221 vendors (13%) and 42 advertisements (10%) located within 100 m. School-adjacent tobacco vendor density within 100 m was not associated with the tobacco use outcomes, but tobacco advertisement density within 100 m was associated with all outcomes when comparing highest to lowest density tertiles: ever use (OR: 2.01; 95% CI 1.00 to 4.07), current use (2.23; 1.16, 4.28) and current smokeless tobacco use (2.01; 1.02, 3.98). Tobacco vendor density within 200, 300, 400 and 500 m of schools was associated with current tobacco use and current smokeless tobacco use, but not ever use. The tobacco sales ban near educational institutions could be expanded beyond 100 m. Greater enforcement is needed regarding the current bans, particularly because advertisement density within 100 m of schools was associated with all students' tobacco use outcomes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Le Houezec, Jacques; McNeill, Ann; Britton, John
Tobacco smoking, sustained by nicotine dependence, is a chronic relapsing disorder, which in many cases results in lifelong cigarette use and consequent death of one out of two lifelong smokers from a disease caused by their smoking. Most toxicity due to cigarette smoking is related to the burning process. Models of harm reduction applied to tobacco suggest that use of non-combustible, less toxic, nicotine-containing products as a substitute for cigarette smoking would reduce the death toll arising from tobacco use. Available options include medicinal nicotine and smokeless tobacco products. The potential role of nicotine replacement therapy (NRT) products in a harm reduction strategy is currently severely restricted by strict regulations on dose, safety and potential addictiveness. As a result, NRT products are designed to provide much less nicotine, and deliver it to the brain more slowly, than cigarettes, which are widely accessible and poorly regulated. Smokeless tobacco (snus) has proved to be an acceptable reduced hazard alternative to smoking in Sweden, but supply of snus is illegal elsewhere in the European Union. To increase accessibility and reach more smokers, barriers to the use of NRT use need to be removed and more effective NRTs need urgently to be developed. Smokeless tobacco could also play an important role in harm reduction, but current European Union regulations and concerns over exploitation by tobacco companies currently preclude wider use. To improve public health there is an urgent need for an appropriate regulatory framework and regulatory authority at the European level, controlling both tobacco and nicotine products to ensure that the least harmful products are the most accessible. © 2011 Australasian Professional Society on Alcohol and other Drugs.
This podcast reviews new federal tobacco product regulations that require retailers to sell cigarettes and smokeless tobacco products in a face-to-face exchange. Created: 9/30/2010 by The CDC Division of News and Electronic Media and the FDA Center for Tobacco Products. Date Released: 9/30/2010.
PSA helps raise retailers awareness of the new federal tobacco regulations related to sale of cigarettes and smokeless tobacco products to people under 18. Created: 7/8/2010 by The CDC Division of News and Electronic Media and the FDA Center for Tobacco Products. Date Released: 7/8/2010.
This podcast helps raise retailers awareness of the new federal tobacco regulations. Under the new regulations, retailers can not sell cigarettes or smokeless tobacco to anyone younger 18. Created: 7/8/2010 by The CDC Division of News and Electronic Media and the FDA Center for Tobacco Products. Date Released: 7/8/2010.
Schivo, Michael; Avdalovic, Mark V; Murin, Susan
Cigarette smoking is known to cause a wide range of damaging health outcomes; however, the effects of non-cigarette tobacco products are either unknown or perceived as less harmful than cigarettes. Smokeless tobacco, cigar smoking, and waterpipe smoking have increased in usage over the past few decades. Some experts believe that their use is reaching epidemic proportions. Factors such as a perception of harm reduction, targeted advertising, and unrecognized addiction may drive the increased consumption of non-cigarette tobacco products. In particular, the need for social acceptance, enjoyment of communal smoking activities, and exotic nature of waterpipe smoking fuels, in part, its popularity. The public is looking for "safer" alternatives to smoking cigarettes, and some groups advertise products such as smokeless tobacco and electronic cigarettes as the alternatives they seek. Though it is clear that cigar and waterpipe tobacco smoking are probably as dangerous to health as cigarette smoking, there is an opinion among users that the health risks are less compared to cigarette smoking. This is particularly true in younger age groups. In the cases of smokeless tobacco and electronic cigarettes, the risks to health are less clear and there may be evidence of a harm reduction compared to cigarettes. In this article, we discuss commonly used forms of non-cigarette tobacco products, their impacts on lung health, and relevant controversies surrounding their use.
Temperature-controlled ionic liquid-based ultrasound-assisted microextraction for preconcentration of trace quantity of cadmium and nickel by using organic ligand in artificial saliva extract of smokeless tobacco products
Arain, Sadaf Sadia; Kazi, Tasneem Gul; Arain, Asma Jabeen; Afridi, Hassan Imran; Baig, Jameel Ahmed; Brahman, Kapil Dev; Naeemullah; Arain, Salma Aslam
A new approach was developed for the preconcentration of cadmium (Cd) and nickel (Ni) in artificial saliva extract of dry snuff (brown and black) products using temperature-controlled ionic liquid-based ultrasound-assisted dispersive liquid-liquid microextraction (TIL-UDLLμE) followed by electrothermal atomic absorption spectrometry (ETAAS). The Cd and Ni were complexed with ammonium pyrrolidinedithiocarbamate (APDC), extracted in ionic liquid drops, 1-butyl-3-methylimidazolium hexafluorophosphate [C4MIM][PF6]. The multivariate strategy was applied to estimate the optimum values of experimental variables influence the % recovery of analytes by TIL-UDLLμE method. At optimum experimental conditions, the limit of detection (3s) were 0.05 and 0.14 μg L-1 while relative standard deviations (% RSD) were 3.97 and 3.55 for Cd and Ni respectively. After extraction, the enhancement factors (EF) were 87 and 79 for Cd and Ni, respectively. The RSD for six replicates of 10 μg L-1 Cd and Ni were 3.97% and 3.55% respectively. To validate the proposed method, certified reference material (CRM) of Virginia tobacco leaves was analyzed, and the determined values of Cd and Ni were in good agreement with the certified values. The concentration of Cd and Ni in artificial saliva extracts corresponds to 39-52% and 21-32%, respectively, of the total contents of both elements in dry brown and black snuff products.
Usmanova, Gulnoza; Neumark, Yehuda; Baras, Mario; McKee, Martin
Little is known about the prevalence of tobacco use in Uzbekistan, a country targeted intensively by the international tobacco industry. A national household survey elicited information about cigarette smoking and nasway use (a form of smokeless tobacco). Prevalence of past-month smoking and nasway use among men (N=1795) was 19.6% and 22.3%, respectively, and 1.6% and 0.5% among women (N=1831). Among men, smoking was independently associated with Uzbek ethnicity, urban residence, age and occupation; nasway use was associated with rural residence, age, being married and occupation. The smoking rate in Uzbekistan remains low relative to neighbouring countries, perhaps due to widespread use of cheaper nasway. These findings establish a baseline for future surveys and highlight the importance of smokeless tobacco in assessing overall consumption.
Pierce, John P; Sargent, James D; White, Martha M; Borek, Nicolette; Portnoy, David B; Green, Victoria R; Kaufman, Annette R; Stanton, Cassandra A; Bansal-Travers, Maansi; Strong, David R; Pearson, Jennifer L; Coleman, Blair N; Leas, Eric; Noble, Madison L; Trinidad, Dennis R; Moran, Meghan B; Carusi, Charles; Hyland, Andrew; Messer, Karen
Non-cigarette tobacco marketing is less regulated and may promote cigarette smoking among adolescents. We quantified receptivity to advertising for multiple tobacco products and hypothesized associations with susceptibility to cigarette smoking. Wave 1 of the nationally representative PATH (Population Assessment of Tobacco and Health) study interviewed 10 751 adolescents who had never used tobacco. A stratified random selection of 5 advertisements for each of cigarettes, e-cigarettes, smokeless products, and cigars were shown from 959 recent tobacco advertisements. Aided recall was classified as low receptivity, and image-liking or favorite ad as higher receptivity. The main dependent variable was susceptibility to cigarette smoking. Among US youth, 41% of 12 to 13 year olds and half of older adolescents were receptive to at least 1 tobacco advertisement. Across each age group, receptivity to advertising was highest for e-cigarettes (28%-33%) followed by cigarettes (22%-25%), smokeless tobacco (15%-21%), and cigars (8%-13%). E-cigarette ads shown on television had the highest recall. Among cigarette-susceptible adolescents, receptivity to e-cigarette advertising (39.7%; 95% confidence interval [CI]: 37.9%-41.6%) was higher than for cigarette advertising (31.7%; 95% CI: 29.9%-33.6%). Receptivity to advertising for each tobacco product was associated with increased susceptibility to cigarette smoking, with no significant difference across products (similar odds for both cigarette and e-cigarette advertising; adjusted odds ratio = 1.22; 95% CI: 1.09-1.37). A large proportion of US adolescent never tobacco users are receptive to tobacco advertising, with television advertising for e-cigarettes having the highest recall. Receptivity to advertising for each non-cigarette tobacco product was associated with susceptibility to smoke cigarettes. Copyright © 2017 by the American Academy of Pediatrics.
Full Text Available Socioeconomic differences in tobacco use have been reported, but there is a lack of evidence on how they vary according to types of tobacco use. This study explored socioeconomic differences associated with cigarette, bidi, smokeless tobacco (SLT, and dual use (smoking and smokeless tobacco use in India and tested whether these differences vary by gender and residential area. Secondary analysis of Global Adult Tobacco Survey (GATS 2009-10 (n=69,296 was conducted. The primary outcomes were self-reported cigarette, bidi smoking, SLT, and dual use. The main explanatory variables were wealth, education, and occupation. Associations were assessed using multinomial logistic regressions. 69,030 adults participated in the study. Positive association was observed between wealth and prevalence of cigarette smoking while inverse associations were observed for bidi smoking, SLT, and dual use after adjustment for potential confounders. Inverse associations with education were observed for all four types after adjusting for confounders. Significant interactions were observed for gender and area in the association between cigarette, bidi, and smokeless tobacco use with wealth and education. The probability of cigarette smoking was higher for wealthier individuals while the probability of bidi smoking, smokeless tobacco use, and dual use was higher for those with lesser wealth and education.
... 49 Transportation 2 2010-10-01 2010-10-01 false Smokeless powder for small arms. 173.171 Section 173.171 Transportation Other Regulations Relating to Transportation PIPELINE AND HAZARDOUS MATERIALS... Class 7 § 173.171 Smokeless powder for small arms. Smokeless powder for small arms which has been...
... or on any person and does not operate to bind FDA or the public. An alternative approach may be used... category (e.g., cigarettes, smokeless tobacco, etc.) (if applicable); 3. Product use (indicate for consumer...
World Health Organization and Indian Public Health Standards recommend provision of tobacco use screening and cessation help at primary care settings. Evidence shows that brief advice by healthcare provider helps tobacco user quit. It starts with asking the patient about his tobacco use status. The rate of tobacco use screening done by healthcare providers is very low and also depends on sociodemographic characteristics of patients along with several other factors. This paper intends to study how sociodemographic characteristics (age, gender, residence [rural/urban], education, and occupation) of tobacco users influence the tobacco use screening done by healthcare providers. The study was a secondary data analysis of the Global Adult Tobacco Survey India 2009-2010. There were 4958 smokers and 7255 smokeless tobacco users included in the study who visited healthcare provider in the past 12 months prior to the survey. The results showed that male smokers were more likely to be screened for smoking by healthcare providers as compared to female smokers. Furthermore, tobacco users in younger age groups were less likely to be screened for tobacco use by healthcare providers as compared to tobacco users in older age groups. Urban smokeless tobacco users were more likely to be screened for tobacco use by healthcare provider as compared to rural smokeless tobacco users. Healthcare providers were being biased in tobacco use screening of their patients based on demographic characteristics of patients, i.e., their age, gender, and rural/urban residence. However, the evidence shows that it is very imperative to screen each and every patient for tobacco use habit.
Full Text Available Introduction: World Health Organization and Indian Public Health Standards recommend provision of tobacco use screening and cessation help at primary care settings. Evidence shows that brief advice by healthcare provider helps tobacco user quit. It starts with asking the patient about his tobacco use status. The rate of tobacco use screening done by healthcare providers is very low and also depends on sociodemographic characteristics of patients along with several other factors. Objectives: This paper intends to study how sociodemographic characteristics (age, gender, residence [rural/urban], education, and occupation of tobacco users influence the tobacco use screening done by healthcare providers. Materials and Methods: The study was a secondary data analysis of the Global Adult Tobacco Survey India 2009-2010. There were 4958 smokers and 7255 smokeless tobacco users included in the study who visited healthcare provider in the past 12 months prior to the survey. Results and Discussion: The results showed that male smokers were more likely to be screened for smoking by healthcare providers as compared to female smokers. Furthermore, tobacco users in younger age groups were less likely to be screened for tobacco use by healthcare providers as compared to tobacco users in older age groups. Urban smokeless tobacco users were more likely to be screened for tobacco use by healthcare provider as compared to rural smokeless tobacco users. Conclusion: Healthcare providers were being biased in tobacco use screening of their patients based on demographic characteristics of patients, i.e., their age, gender, and rural/urban residence. However, the evidence shows that it is very imperative to screen each and every patient for tobacco use habit.
Cole, Adam G; Kennedy, Ryan David; Chaurasia, Ashok; Leatherdale, Scott T
Within tobacco prevention programming, it is useful to identify youth that are at risk for experimenting with various tobacco products and e-cigarettes. The susceptibility to smoking construct is a simple method to identify never-smoking students that are less committed to remaining smoke-free. However, the predictive validity of this construct has not been tested within the Canadian context or for the use of other tobacco products and e-cigarettes. This study used a large, longitudinal sample of secondary school students that reported never using tobacco cigarettes and non-current use of alternative tobacco products or e-cigarettes at baseline in Ontario, Canada. The sensitivity, specificity, and positive and negative predictive values of the susceptibility construct for predicting tobacco cigarette, e-cigarette, cigarillo or little cigar, cigar, hookah, and smokeless tobacco use one and two years after baseline measurement were calculated. At baseline, 29.4% of the sample was susceptible to future tobacco product or e-cigarette use. The sensitivity of the construct ranged from 43.2% (smokeless tobacco) to 59.5% (tobacco cigarettes), the specificity ranged from 70.9% (smokeless tobacco) to 75.9% (tobacco cigarettes), and the positive predictive value ranged from 2.6% (smokeless tobacco) to 32.2% (tobacco cigarettes). Similar values were calculated for each measure of the susceptibility construct. A significant number of youth that did not currently use tobacco products or e-cigarettes at baseline reported using tobacco products and e-cigarettes over a two-year follow-up period. The predictive validity of the susceptibility construct was high and the construct can be used to predict other tobacco product and e-cigarette use among youth. This study presents the predictive validity of the susceptibility construct for the use of tobacco cigarettes among secondary school students in Ontario, Canada. It also presents a novel use of the susceptibility construct for
Madani, Abdoul Hossain; Dikshit, Madhurima; Bhaduri, Debanshu
Oral cancer is one of the most common life threatening diseases in India. Tobacco and alcohol are considered to be the most risk factors for oral cancer. This study was conducted to investigate the association of tobacco and poly-ingredient oral dip products with oral cancer. A case-control study of 350 cases and 350 controls, over a period of 19 months, between February 2005 and September 2006 was carried out in Pune, India. The self-reported information about the consumption of tobacco, poly-ingredient oral dip products, alcohol, dietary habits and demographic status were collected by a researcher made questionnaire. Univariate and multivariate analysis were used to identify the risk of substances abuse. The frequency of smoking, smokeless and oral dip products in cases were significantly higher than controls (P tobacco (P oral dip products, consumption of gutkha (P oral cancer upon adjustment. This study provides strong evidence that gutkha, supari -areca nut- chewing tobacco (tobacco flakes), bidi smoking and mishiri (tobacco powder, which applied as a tooth and gum cleaner) are independent risk for oral cancer.
Oral cancer is one of the leading causes of human morbidity and mortality especially in developing countries like India. Tobacco consumption in smokeless and smoking form along with alcohol is considered as the primary risk factors. Tobacco is a major health challenge with various tobacco products available for use which are known to have deleterious effects on the oral mucosa. The oral lesions caused by tobacco are inclusive of those that are less likely to progress to cancer; lesions with i...
Tafawa, Adebola Odunlami; Viswanath, Kasisomayajula; Kawachi, Ichiro; Williams, David R
Mass media exposure is a strong determinant of tobacco use yet little is known about this relationship in African countries. We explored socio-demographic and socio-contextual correlates of tobacco consumption and associations between mass media exposure, gender and the use of any and various forms of tobacco among Nigerians. The study included 47,805 adults from the cross-sectional and nationally representative Nigeria demographic and health survey 2008. Weighted binary logistic models predicted any tobacco use whereas weighted multinomial logistic models predicted smoking and smokeless tobacco, all compared with no tobacco use. Approximately 4.2% of Nigerian adults used tobacco--2.7% smoked tobacco whereas 1.5% used smokeless tobacco. Tobacco use was more prevalent among men than women (12% vs. 0.6%; p value <0.0001). Gender modified the associations between tobacco use and radio exposure or TV exposure (p values ranged = 0.02-0.05). Among men, some radio exposure and high radio exposure were associated with increased odds of any tobacco use, compared with no radio exposure. Among men, infrequently reading newspapers/magazines and frequently reading newspapers/magazines were associated with higher odds of smokeless tobacco use, compared with not reading newspapers/magazines. Among women, infrequently reading newspapers/magazines was associated with reduced odds of smokeless tobacco use, compared with not reading newspaper/magazines. The relationships between mass media exposure and tobacco consumption differed by gender and were more pronounced among men. Research on radio programs may help to form policies that can address tobacco use among Nigerian men.
Ashok; Kumar; Amita Sharma; Babita Ahlawat; Sonam Sharma
An institutional study was carried out in 102 patients to investigate the site specific effect of addictions, that is, tobacco smoking and tobacco chewing (smokeless), both independently and synergistically in development of malignancies in upper aerodigestive tract through retrograde questionnaire. The histopathologically proven cases were interviewed regarding different forms of addictions followed by clinical examination and investigations for grading (according to Modified Broadmann's met...
Coppe, Jean-Philippe; Boysen, Megan; Sun, Chung Ho; Wong, Brian J F; Kang, Mo K; Park, No-Hee; Desprez, Pierre-Yves; Campisi, Judith; Krtolica, Ana
Cigarette smoke and smokeless tobacco extracts contain multiple carcinogenic compounds, but little is known about the mechanisms by which tumors develop and progress upon chronic exposure to carcinogens such as those present in tobacco products. Here, we examine the effects of smokeless tobacco extracts on human oral fibroblasts. We show that smokeless tobacco extracts elevated the levels of intracellular reactive oxygen, oxidative DNA damage, and DNA double-strand breaks in a dose-dependent manner. Extended exposure to extracts induced fibroblasts to undergo a senescence-like growth arrest, with striking accompanying changes in the secretory phenotype. Using cocultures of smokeless tobacco extracts-exposed fibroblasts and immortalized but nontumorigenic keratinocytes, we further show that factors secreted by extracts-modified fibroblasts increase the proliferation and invasiveness of partially transformed epithelial cells, but not their normal counterparts. In addition, smokeless tobacco extracts-exposed fibroblasts caused partially transformed keratinocytes to lose the expression of E-cadherin and ZO-1, as well as involucrin, changes that are indicative of compromised epithelial function and commonly associated with malignant progression. Together, our results suggest that fibroblasts may contribute to tumorigenesis indirectly by increasing epithelial cell aggressiveness. Thus, tobacco may not only initiate mutagenic changes in epithelial cells but also promote the growth and invasion of mutant cells by creating a procarcinogenic stromal environment.
Berg, Carla J; Haardörfer, Regine; Lewis, Michael; Getachew, Betelihem; Lloyd, Steven A; Thomas, Sarah Fretti; Lanier, Angela; Trepanier, Kelleigh; Johnston, Teresa; Grimsley, Linda; Foster, Bruce; Benson, Stephanie; Smith, Alicia; Barr, Dana Boyd; Windle, Michael
We examined psychographic characteristics associated with tobacco use among Project DECOY participants. Project DECOY is a 2-year longitudinal mixed-methods study examining risk for tobacco use among 3418 young adults across 7 Georgia colleges/universities. Baseline measures included sociodemographics, tobacco use, and psychographics using the Values, Attitudes, and Lifestyle Scale. Bivariate and multivariable analyses were conducted to identify correlates of tobacco use. Past 30-day use prevalence was: 13.3% cigarettes; 11.3% little cigars/cigarillos (LCCs); 3.6% smokeless tobacco; 10.9% e-cigarettes; and 12.2% hookah. Controlling for sociodemographics, correlates of cigarette use included greater novelty seeking (p fashion orientation (p = .007). Correlates of smokeless tobacco use included greater novelty seeking (p = .006) and less intellectual curiosity (p fashion orientation (p = .044), and self-focused thinking (p = .002), and less social conservatism (p < .001). Psychographic characteristics distinguish users of different tobacco products.
Gurung, Mongal Singh; Pelzom, Dorji; Dorji, Tandin; Drukpa, Wangchuk; Wangdi, Chador; Chinnakali, Palanivel; Goel, Sonu
Despite a comprehensive ban on cultivation, manufacture, distribution, and sale of tobacco products since 2004, two nationwide surveys conducted in 2012 and 2013 reported high tobacco use in Bhutan. National Health Survey 2012 reported that 4 % of the population aged 15-75 years used smoked tobacco and about 48 % used smokeless tobacco. Similarly, Global Youth Tobacco Survey (GYTS) of Bhutan reported tobacco use prevalence of 30.3 % in 2013. However, factors associated with this high tobacco use were not systematically studied. Hence, we assessed the prevalence of tobacco use and its associated sociodemographic, behavioral, and environmental factors. This cross-sectional analytical study used secondary data collected in a nationally representative Non-communicable Disease Risk Factors Surveillance STEPS Survey 2014 conducted among Bhutanese adults (18-69 years). The survey included a total of 2820 adults; selected using multistage stratified cluster sampling. Weighted analysis was done to calculate the prevalence of tobacco use. Unadjusted and adjusted prevalence ratios were calculated using log binomial regression. The prevalence of current overall tobacco use was 24.8 % (95 % CI: 21.4-28.3) and that of smoked, smokeless, and dual forms (smoked and smokeless forms) were 7.4 % (95 % CI: 5.8-9.0), 19.7 % (95 % CI: 16.5-22.9), and 2.3 % (95 % CI: 1.8-2.9), respectively. Significantly higher prevalence of tobacco use in all forms was found among males, younger age groups, and alcohol users. The prevalence of smoked form was higher in urban areas compared to rural areas (11 % vs 6 %; aPR 1.8, 95 % CI: 1.5-2.0). Among individuals who reported having a non-communicable disease, the prevalence of smoked tobacco use was significantly lower than those who did not have disease (3.5 % vs. 8.3 %; aPR 0.5, 95 % CI: 0.3-0.9). Exposure to health warnings was protective for current tobacco use and smokeless tobacco use, while exposure to tobacco warnings through
Townsend, Julie S.; Tai, Eric; White, Arica; Davis, Shane P.; Fairley, Temeika L.
Introduction People who continue to smoke after a cancer diagnosis have an increased risk for recurrences or development of new malignancies. These risks may be even higher among tobacco-related cancer survivors (TRCS). We describe tobacco use behaviors among TRCS, other cancer survivors, and people without a history of cancer. Methods We used 2009 Behavioral Risk Factor Surveillance System data to describe demographic characteristics, smoking history, current smoking prevalence, and smokeless tobacco use among TRCS, other cancer survivors, and people without a history of cancer (cigarette smoking and smokeless tobacco use were calculated after adjusting for age, sex, race, and insurance status). Tobacco-related cancers were defined as lung/bronchial, pharyngeal, laryngeal, esophageal, stomach, pancreatic, kidney/renal, urinary bladder, cervical, and acute myeloid leukemia. Results A total of 20 % of all cancer survivors were TRCS. TRCS were primarily female (68 %) and white (78 %). Smoking prevalence was higher among TRCS (27 %) compared with other cancer survivors (16 %) and respondents without a history of cancer (18 %). Smokeless tobacco use was higher among respondents without a history of cancer (4 %) compared with TRCS (3 %) and other cancer survivors (3 %). Conclusions The self-reported smoking prevalence among TRCS is higher than among other cancer survivors and people without a history of cancer. Targeted smoking prevention and cessation interventions are needed for cancer survivors, especially those diagnosed with a tobacco-related cancer. Implications for cancer survivors We recommend all cancer survivors be made aware of the health risks associated with smoking after a cancer diagnosis, and smoking cessation services be offered to those who currently smoke. Condensed abstract We provide the first population-based report on demographic characteristics and tobacco use behaviors among self-reported tobacco-related cancer survivors. PMID:22706885
Aslesh, Ottapura Prabhakaran; Paul, Sam; Paul, Lipsy; Jayasree, Anandabhavan Kumaran
Kerala is a highly urbanized state in India and interstate migrant laborers working there forms a marginalized community. It was generally perceived that use of tobacco and alcohol was high among the workers, but there are no epidemiological studies assessing the actual burden. To estimate the prevalence of use of tobacco and also the prevalence of oral mucosal lesions associated with such use consumption among the adult male interstate migrant workers in North Kerala. A cross sectional study was carried out among male migrant workers above 18 years working in different factories in urban parts of Kannur district. Total of 244 participants attending routine health check-up camp were assessed for the use of tobacco/alcohol, type, frequency and duration of their use by a questionnaire. The trained dental interns conducted oral cavity examination for detecting oral mucosal lesions associated with tobacco use. The prevalence of current use of smoked tobacco, smokeless tobacco and alcohol use were 41.8%, 71.7% and 56.6%, respectively among migrants. Oral mucosal lesions (OML) were seen in 36.3% of participants. Among smokeless tobacco users, 44.6% had lesions. Adjusted odds ratio for OML was 4.5 (CI: 1.9 - 19.84) among smokeless tobacco users. The current use of smokeless tobacco and oral mucosal lesions are highly prevalent among migrant workers.
The prevalence of cigarette smoking was 7.1% and the smokers had smoked for an average of 14.3 ± 5.2 years. Ten percent were currently using any form tobacco, while 0.6% reported current use of smokeless tobacco product daily and one third had been exposed to second-hand cigarette smoke in a closed place. Of the ...
Abstract Over the past five years there has been exponential expansion of interest in tobacco harm reduction (THR), with a concomitant increase in the number of published studies. The purpose of this manuscript is to review and analyze influential contributions to the scientific and medical literature relating to THR, and to discuss issues that continue to stimulate debate. Numerous epidemiologic studies and subsequent meta-analyses confirm that smokeless tobacco (ST) use is associated with m...
Stepanov, Irina; Yershova, Katrina; Carmella, Steven; Upadhyaya, Pramod; Hecht, Stephen S
N'-nitrosonornicotine (NNN), an esophageal and oral carcinogen present in tobacco products, has a chiral center in its structure. Of its two enantiomers, (S)-NNN exhibits higher tumorigenic potency than (R)-NNN. There is no information available on the levels of (S)-NNN in various tobacco products currently marketed in the United States. We used chiral gas chromatography analysis to determine (S)-NNN levels in a convenience sample of 37 tobacco products currently marketed in the United States: conventional smokeless tobacco, novel smokeless tobacco products, and cigarette tobacco filler. Among all products analyzed here, (S)-NNN averaged 62.9 ± 6.3% (SD) of NNN. The absolute amount of (S)-NNN in conventional moist snuff averaged 1.26 ± 0.5 µg/g tobacco; in novel smokeless products 0.70 ± 0.2 µg/g tobacco; and in cigarette filler 1.36 ± 0.6 µg/g tobacco (all values are per wet weight). For each cigarette brand, the enantiomeric composition of NNN in cigarette smoke was similar to that of the corresponding tobacco filler. Our results demonstrate that (S)-NNN is the predominant NNN enantiomer in moist snuff, novel smokeless tobacco products, and cigarettes currently marketed in the United States. Efforts toward the reduction of NNN in U.S. tobacco products should take into account its enantiomeric composition, with particular focus on (S)-NNN as a causative agent for esophageal and oral cancers associated with tobacco use.
Padrão, Patrícia; Silva-Matos, Carla; Damasceno, Albertino; Lunet, Nuno
Smoking, alcohol consumption and unhealthy diet are known to cluster, but evidence from developing countries at the early phases of the tobacco epidemics and with markedly different cultures, lifestyles and forms of tobacco use is scarce. The objective of this study was to quantify the association between tobacco consumption (manufactured cigarettes, hand-rolled cigarettes and smokeless tobacco) and alcohol, fruit and vegetable intake in Mozambique according to place of residence (urban/rural). A representative sample of 12 902 Mozambicans aged 25-64 years was evaluated in a national household survey conducted in 2003 using a structured questionnaire. Age- and education-adjusted ORs were computed to estimate the association between tobacco consumption and alcohol, fruit and vegetable intake. Tobacco use and overall alcohol drinking were positively associated, regardless of type of tobacco consumed, but smoking of hand-rolled cigarettes and consumption of smokeless tobacco was negatively associated with beer drinking. Smokers of manufactured cigarettes had a less frequent intake of fruit, but smokeless tobacco consumption and hand-rolled cigarette smoking were not inversely related with intake of fruit or vegetables. This pattern was relatively consistent across genders and urban/rural areas, with the observed differences likely to be explained either by random variation or heterogeneity in tobacco consumption patterns across genders or places of residence. Strong associations between tobacco consumption and the intake of alcoholic beverages, vegetable and fruit intake are found, but not consistently for all forms of tobacco use.
Full Text Available Abstract Over the past five years there has been exponential expansion of interest in tobacco harm reduction (THR, with a concomitant increase in the number of published studies. The purpose of this manuscript is to review and analyze influential contributions to the scientific and medical literature relating to THR, and to discuss issues that continue to stimulate debate. Numerous epidemiologic studies and subsequent meta-analyses confirm that smokeless tobacco (ST use is associated with minimal risks for cancer and for myocardial infarction; a small increased risk for stroke cannot be excluded. Studies from Sweden document that ST use is not associated with benign gastrointestinal disorders and chronic inflammatory diseases. Although any form of nicotine should be avoided during pregnancy, the highest risks for the developing baby are associated with smoking. It is documented that ST use has been a key factor in the declining rates of smoking and of smoking-related diseases in Sweden and Norway. For other countries, the potential population health benefits of ST are far greater than the potential risks. In follow-up studies, dual users of cigarettes and ST are less likely than exclusive smokers to achieve complete tobacco abstinence, but they are also less likely to be smoking. The health risks from dual use are probably lower than those from exclusive smoking. E-cigarette users are not exposed to the many toxicants, carcinogens and abundant free radicals formed when tobacco is burned. Although laboratory studies have detected trace concentrations of some contaminants, it is a small problem amenable to improvements in quality control and manufacturing that are likely with FDA regulation as tobacco products. There is limited evidence from clinical trials that e-cigarettes deliver only small doses of nicotine compared with conventional cigarettes. However, e-cigarette use emulates successfully the cigarette handling rituals and cues of cigarette
Over the past five years there has been exponential expansion of interest in tobacco harm reduction (THR), with a concomitant increase in the number of published studies. The purpose of this manuscript is to review and analyze influential contributions to the scientific and medical literature relating to THR, and to discuss issues that continue to stimulate debate. Numerous epidemiologic studies and subsequent meta-analyses confirm that smokeless tobacco (ST) use is associated with minimal risks for cancer and for myocardial infarction; a small increased risk for stroke cannot be excluded. Studies from Sweden document that ST use is not associated with benign gastrointestinal disorders and chronic inflammatory diseases. Although any form of nicotine should be avoided during pregnancy, the highest risks for the developing baby are associated with smoking. It is documented that ST use has been a key factor in the declining rates of smoking and of smoking-related diseases in Sweden and Norway. For other countries, the potential population health benefits of ST are far greater than the potential risks. In follow-up studies, dual users of cigarettes and ST are less likely than exclusive smokers to achieve complete tobacco abstinence, but they are also less likely to be smoking. The health risks from dual use are probably lower than those from exclusive smoking. E-cigarette users are not exposed to the many toxicants, carcinogens and abundant free radicals formed when tobacco is burned. Although laboratory studies have detected trace concentrations of some contaminants, it is a small problem amenable to improvements in quality control and manufacturing that are likely with FDA regulation as tobacco products. There is limited evidence from clinical trials that e-cigarettes deliver only small doses of nicotine compared with conventional cigarettes. However, e-cigarette use emulates successfully the cigarette handling rituals and cues of cigarette smoking, which produces
Richardson, Amanda; Ganz, Ollie; Stalgaitis, Carolyn; Abrams, David; Vallone, Donna
With declining cigarette sales, increasing restrictions, and recent Food and Drug Administration (FDA) regulation of cigarettes, there has been a dramatic rise in the marketing of noncombustible tobacco products (NCPs). However, little is known about how NCPs are advertised and to whom. Two full-service advertising firms were used to systematically collect all U.S. advertisements for NCPs (e-cigarettes, snus, dissolvables, and chew/dip/snuff,) running between June 1 and September 1, 2012. The advertisement and associated metadata (brand, media channel, observations, spend, and estimated reach) were examined. Attributes of print advertisements were examined relative to target demographics of the publications in which they ran. Over 3 months, almost $20 million was spent advertising NCPs. Although the greatest amount spent was on the promotion of smokeless (~$8 million) and snus (~$10 million), e-cigarette advertisements were the most widely circulated. Print advertisements, the majority of which were e-cigarettes and chew/dip/snuff, were heavily tailored to middle-aged White males. Many e-cigarette print ads suggested harm reduction and use when one cannot smoke (poly-use), while chew/dip/snuff focused on masculinity. Robust ongoing surveillance of NCP advertising is critical to inform the FDA and to protect public health. Both commercial advertising and public health media campaigns must ensure that content is not misleading and that it educates consumers about harm based on the available science. The way messages are framed have the potential to decrease tobacco use by promoting rather than undermining cessation of combusted products and/or by encouraging exclusive use of less harmful NCPs rather than poly-use of combusted and NCPs.
Mary Jane P. Spink
Full Text Available Esta pesquisa foi realizada no contexto das atuais medidas para controle do tabagismo e teve por objetivo entender os sentidos do ato de fumar para os fumantes e a maneira como vivenciam as pressões para cessar de fumar. Com base em 50 entrevistas com diferentes segmentos de uma universidade paulista (professores, funcionários de carreira e terceirizados, alunos de graduação e de pós-graduação, a análise focalizou três aspectos: por que as pessoas fumam, a ambivalência entre o prazer de fumar e os malefícios do tabaco, e as experiências de discriminação de fumantes. Concluiu-se que, na perspectiva da Saúde Coletiva, é necessário informar o público sobre os riscos associados ao tabagismo, contrapor os danos aos efeitos sedutores da publicidade da indústria tabagística e oferecer apoio para os que desejam cessar de fumar. Entretanto, para além dessas medidas, é preciso também entender o ponto de vista dos fumantes para os quais o tabaco ainda é uma droga legalizada que produz efeitos positivos, apesar de causar dependência física e psicológica, havendo, portanto, muitos obstáculos a serem enfrentados para dar fim a esse hábito. Tal cenário de múltiplas dificuldades nos leva a indagar se fumar não se enquadraria nos estilos de vida arriscados para os quais são pertinentes as abordagens voltadas à redução de danos.This research was conducted in the context of present-day measures to curb the use of tobacco so as to explore the meanings that smokers attribute to smoking and the manner in which pressure for cessation of smoking are experienced. Based on 50 interviews carried out with different segments of a university in São Paulo, Brazil (teachers, office workers, outsourced employees, undergraduate and graduate students, the analysis focused on three aspects: why people smoke, the ambivalence between pleasure and risks associated with tobacco, and smokers' discrimination experiences. It concludes that in a public
Southwell, Brian G; Kim, Annice E; Tessman, Greta K; MacMonegle, Anna J; Choiniere, Conrad J; Evans, Sarah E; Johnson, Robin D
The latest generation of smokeless tobacco products encompasses a wide range of offerings, including what is commonly referred to as dissolvable tobacco. Designed to deliver nicotine upon dissolving or disintegrating in a user's mouth, dissolvable tobacco products currently appear in various United States markets as strips, orbs, sticks, and lozenges. The emergence of these new products poses distinct opportunities and challenges for social and behavioral science and public health research and raises important public policy questions.
PSA to help raise retailers' awareness of the new federal tobacco regulations related to the sale of cigarettes and smokeless tobacco products to people under 18 and the requirement to sell products face-to-face. Created: 9/30/2010 by The CDC Division of News and Electronic Media and the FDA Center for Tobacco Products. Date Released: 9/30/2010.
Ornelas, Samuel; Benne, Paul D; Rosenkranz, Richard R
Tobacco use among military personnel is of concern given its substantial burden on military health care and combat readiness. This cross-sectional study investigated the prevalence of tobacco use and interest in tobacco cessation among active duty soldiers assigned to Fort Riley. Participants completed tobacco use questionnaires as part of a Soldier readiness process. SPSS v. 16.0 was used to calculate mean percent and multinomial logistic regression analysis. A total of 6,181 active duty soldiers participated in the study (91.2% male, mean age 26.8 years (SD = 6.8 years; range 17-56 years). Forty-nine percent reported using some form of tobacco (smoked tobacco or smokeless tobacco). Smoked tobacco use was 39%. Smokeless tobacco use was over 19%. Thirty-six percent of tobacco users reported interest in cessation. Results suggest that active duty soldiers serving at Fort Riley Army Post represent a high-risk population for tobacco use and there may be unique factors contributing to greater tobacco use and low interest in tobacco cessation. The observed increased use in the time period around deployment provides important information for local health care providers that can be used to tailor current prevention and cessation programs.
Creamer, MeLisa R; Delk, Joanne; Case, Kathleen; Perry, Cheryl L; Harrell, Melissa B
Outcome expectations are an important determinant of health behavior, according to Social Cognitive Theory; yet recent literature has not examined the relationship between outcome expectations and tobacco product use (e.g., use of cigarettes, cigars, hookah, e-cigarettes, or smokeless tobacco). This study examines if outcome expectations at baseline, among an adolescent cohort of never users of tobacco products, predicts tobacco product use (i.e., cigarettes, hookah, e-cigarette, cigar, or smokeless tobacco) or susceptibility to use at 6-month follow-up. Data are from the first two waves of a Texas cohort study of urban middle school and high school students, which were collected in 2014-2015. Logistic regression analyses were used; these adjusted for socio-demographic variables. Analyses were limited to never users of any tobacco product at baseline (n = 1999, N = 357,035). Outcome expectations related to stress relief predicted ever use of (AOR: 4.21, 95% CI 1.84-9.60) and susceptibility (AOR: 2.97, 95% CI 1.01-8.70) to tobacco products. Additional outcome expectations (e.g., relaxation, concentration, slimness, etc.) were not associated with ever use or susceptibility. Conclusions/Importance: This study extends the literature regarding outcome expectations among adolescents regarding tobacco products. It is important that interventions offer alternative solutions to stress relief that do not include tobacco products.
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Gilmore, Anna B
This paper builds on tobacco document research by analysing contemporary materials to explore how the global tobacco market has changed, how transnational tobacco companies (TTCs) are responding and the implications for tobacco control. The methods involved analysis of a variety of materials, including tobacco company annual reports, investor relations materials, financial analyst reports, market research reports and data. Once China, where TTCs have little market share, is excluded, global cigarette volumes are already declining. Nevertheless, industry profits continue to increase. This pattern is explained by the pricing power of TTCs-their ability to increase prices faster than volumes fall, a consequence of market failure. Pricing power is now fundamental to the long term future of TTCs. Consequently, and in light of growing regulations, the business model of the TTCs is changing. Product innovation is now a key marketing technique used to drive consumers to buy more expensive (ie, profitable) premium cigarettes. Contrary to established wisdom, high tobacco excise rates, particularly where increases in excise are gradual, can benefit TTCs by enabling price (profit) increases to be disguised. Large intermittent tax increases likely have a greater public health benefit. TTC investments in smokeless tobacco appear designed to eliminate competition between smokeless tobacco and cigarettes, thereby increasing the pricing power of TTCs while enabling them to harness the rhetoric of harm reduction. Monitoring TTCs can inform effective policy development. The value maximising approach of TTCs suggests that a ban on product innovation and more informed tobacco excise policies are needed.
Godshall William T
Full Text Available Abstract According to the Centers for Disease Control and Prevention, about 45 million Americans continue to smoke, even after one of the most intense public health campaigns in history, now over 40 years old. Each year some 438,000 smokers die from smoking-related diseases, including lung and other cancers, cardiovascular disorders and pulmonary diseases. Many smokers are unable – or at least unwilling – to achieve cessation through complete nicotine and tobacco abstinence; they continue smoking despite the very real and obvious adverse health consequences. Conventional smoking cessation policies and programs generally present smokers with two unpleasant alternatives: quit, or die. A third approach to smoking cessation, tobacco harm reduction, involves the use of alternative sources of nicotine, including modern smokeless tobacco products. A substantial body of research, much of it produced over the past decade, establishes the scientific and medical foundation for tobacco harm reduction using smokeless tobacco products. This report provides a description of traditional and modern smokeless tobacco products, and of the prevalence of their use in the United States and Sweden. It reviews the epidemiologic evidence for low health risks associated with smokeless use, both in absolute terms and in comparison to the much higher risks of smoking. The report also describes evidence that smokeless tobacco has served as an effective substitute for cigarettes among Swedish men, who consequently have among the lowest smoking-related mortality rates in the developed world. The report documents the fact that extensive misinformation about ST products is widely available from ostensibly reputable sources, including governmental health agencies and major health organizations. The American Council on Science and Health believes that strong support of tobacco harm reduction is fully consistent with its mission to promote sound science in regulation and in
Rodu, Brad; Godshall, William T
According to the Centers for Disease Control and Prevention, about 45 million Americans continue to smoke, even after one of the most intense public health campaigns in history, now over 40 years old. Each year some 438,000 smokers die from smoking-related diseases, including lung and other cancers, cardiovascular disorders and pulmonary diseases. Many smokers are unable--or at least unwilling--to achieve cessation through complete nicotine and tobacco abstinence; they continue smoking despite the very real and obvious adverse health consequences. Conventional smoking cessation policies and programs generally present smokers with two unpleasant alternatives: quit, or die. A third approach to smoking cessation, tobacco harm reduction, involves the use of alternative sources of nicotine, including modern smokeless tobacco products. A substantial body of research, much of it produced over the past decade, establishes the scientific and medical foundation for tobacco harm reduction using smokeless tobacco products. This report provides a description of traditional and modern smokeless tobacco products, and of the prevalence of their use in the United States and Sweden. It reviews the epidemiologic evidence for low health risks associated with smokeless use, both in absolute terms and in comparison to the much higher risks of smoking. The report also describes evidence that smokeless tobacco has served as an effective substitute for cigarettes among Swedish men, who consequently have among the lowest smoking-related mortality rates in the developed world. The report documents the fact that extensive misinformation about ST products is widely available from ostensibly reputable sources, including governmental health agencies and major health organizations. The American Council on Science and Health believes that strong support of tobacco harm reduction is fully consistent with its mission to promote sound science in regulation and in public policy, and to assist
Rodu, Brad; Godshall, William T
According to the Centers for Disease Control and Prevention, about 45 million Americans continue to smoke, even after one of the most intense public health campaigns in history, now over 40 years old. Each year some 438,000 smokers die from smoking-related diseases, including lung and other cancers, cardiovascular disorders and pulmonary diseases. Many smokers are unable – or at least unwilling – to achieve cessation through complete nicotine and tobacco abstinence; they continue smoking despite the very real and obvious adverse health consequences. Conventional smoking cessation policies and programs generally present smokers with two unpleasant alternatives: quit, or die. A third approach to smoking cessation, tobacco harm reduction, involves the use of alternative sources of nicotine, including modern smokeless tobacco products. A substantial body of research, much of it produced over the past decade, establishes the scientific and medical foundation for tobacco harm reduction using smokeless tobacco products. This report provides a description of traditional and modern smokeless tobacco products, and of the prevalence of their use in the United States and Sweden. It reviews the epidemiologic evidence for low health risks associated with smokeless use, both in absolute terms and in comparison to the much higher risks of smoking. The report also describes evidence that smokeless tobacco has served as an effective substitute for cigarettes among Swedish men, who consequently have among the lowest smoking-related mortality rates in the developed world. The report documents the fact that extensive misinformation about ST products is widely available from ostensibly reputable sources, including governmental health agencies and major health organizations. The American Council on Science and Health believes that strong support of tobacco harm reduction is fully consistent with its mission to promote sound science in regulation and in public policy, and to assist
Sutfin, Erin L; Sparks, Alicia; Pockey, Jessica R; Suerken, Cynthia K; Reboussin, Beth A; Wagoner, Kimberly G; Spangler, John; Wolfson, Mark
As the tobacco market expands, so too have the opportunities for youth to be introduced to nicotine. The goal of this study was to identify product choice for initial tobacco trial, correlates associated with product choice, and the relationship between first product and current cigarette smoking among college students. A cross-sectional web survey of 3146 first-year students at 11 universities in North Carolina and Virginia was conducted in fall 2010. Weighted prevalence of ever use of tobacco was 48.6%. Cigarettes were the most common first product (37.9%), followed by cigars (29.3%), hookahs (24.6%), smokeless tobacco (6.1%), and bidis/kreteks (2.2%). Two thirds (65%) of current smokers initiated with cigarettes, but 16.4% started with cigars, 11.1% with hookahs, 5.7% with smokeless, and 1.7% with bidis/kreteks. Females were more likely to report their first product was cigarettes and hookahs, while males were more likely to start with cigars and smokeless tobacco. Compared to those whose first product trial occurred after the age of 18, younger age of initiation (17years or younger) was associated with cigarettes and smokeless as first products, while older age of initiation (18 or older) was associated with starting with hookahs and cigars. Dual or poly tobacco use was more common among those who initiated with hookahs and smokeless tobacco. While over a third of students used cigarettes first, two thirds started with a non-cigarette product. Just about a third of current cigarette smokers initiated with a non-cigarette product, suggesting that those non-cigarette products may have facilitated escalation to cigarettes. Copyright © 2015 Elsevier Ltd. All rights reserved.
Full Text Available This study is an assessment of the influence of parent’s tobacco use on prospective tobacco use trajectories among young offspring. The study is based on unit level data from District Level Household and Facility Survey-4 (2012-2013 comprising 27,706 youths in 15–24 years’ age group from northeastern states of India and used multilevel regression to identify the potential risk factors of tobacco consumption. The likelihood of using tobacco was found to be 3.4 and 1.14 times more, respectively, for the youths coresiding with mothers who use tobacco and fathers who use tobacco, in comparison to youths staying with parents not taking tobacco. The significant effect of peers on tobacco consumption among youths was also observed. School-going youths had significantly lower risk of tobacco use. The estimated likelihood of a young person from a household to use any tobacco, use smokeless tobacco, and smoke was found to be 28, 12, and 17 percent, respectively. There is an urgent need to extend National Tobacco Control Programme (NTCP to the community level involving civil societies and young and adult generations for spreading awareness about the health hazards of tobacco use, providing support and facilitating quitting tobacco use.
Gupta, S; Gupta, O P; Srivastava, S
The aim of the study to find out role of CYP2E1 genetic polymorphism in development of oral leukoplakia among tobacco users in North Indian population, this study was carried out at Department of Oral and Maxillofacial Pathology, King George's Medical University, Lucknow, UP. Study include a total of 105 leukoplakia patients were genotyped for CYP2E1 polymorphism (93 males and 12 females; mean age ± SD: 47.5 ± 10.6) and 96 unrelated healthy controls (85 males and 11 females; mean age ± SD: 49 ± 11.1). All the patients had either reported for treatment of leukoplakia or were diagnosed with leukoplakia during routine oral examination. A total of 105 leukoplakia patients and 96 controls were included in the study. The mean age of leukoplakia patients and control were 47 ± 10 and 51 ± 10 years respectively. The exclusive smokers comprised 62 (59%) leukoplakia patients and 53 (53%) controls. The exclusive smokeless tobacco users were 16 (15%) in leukoplakia patients and 27 (28%) in controls groups, while 27 (26%) leukoplakia patients and 16 (17%) controls have both types (smoking as well as smoke less) of tobacco habits simultaneously. Range of life time smoking exposure in leukoplakia and controls were (5-80 PY in both groups) but the mean smoking exposure in both groups were (leukoplakia: 28 ± 21.8 PY, control: 27: ±17 PY). But the mean smokeless tobacco dose in two groups were (leukoplakia: 150 ± 175 CY, controls: 137 ± 110 CY). All the results demonstrate an association between CYP2E1 genetic polymorphism and leukoplakia risk, premalignant lesion. It indicates that the CYP2E1 polymorphism, singly showed a protection towards the oral leukoplakia. Independent confirmation of this finding is required, and additional examination of the joint effect of CYP2E1genotype and other non-tobacco-related exposures is needed before more conclusive interpretation of our results can be made. This study demonstrates the importance of genetic variations in CYP2E1genes in
Apelberg, Benjamin J; Corey, Catherine G; Hoffman, Allison C; Schroeder, Megan J; Husten, Corinne G; Caraballo, Ralph S; Backinger, Cathy L
A growing body of evidence suggests that tobacco dependence symptoms can occur soon after smoking onset and with low levels of use. However, limited data are available nationally and among non-cigarette tobacco users. To examine the prevalence and determinants of tobacco dependence symptoms among adolescent tobacco users in the 2012 National Youth Tobacco Survey, a nationally representative, school-based survey of U.S. middle and high school students. Multivariate logistic regression was used to identify independent predictors of dependence symptoms among current users (i.e., past 30-day use) of cigarettes, cigars, or smokeless tobacco. Analyses were conducted in 2013 using SAS-callable SUDAAN, version 11 to account for the complex survey design. Prevalence of tobacco dependence symptoms ranged from 20.8% (95% CI=18.6, 23.1) of current tobacco users reporting wanting to use tobacco within 30 minutes of waking to 41.9% (95% CI=39.3, 44.5) reporting recent strong cravings. Reporting of dependence symptoms was most consistently associated with polytobacco use, higher frequency of use, earlier initiation age, and female gender. A 2-4-fold increase in the odds of symptom reporting was found in adolescents using tobacco products on as few as 3-5 days compared to those who only used it for 1-2 of the past 30 days. A substantial proportion of U.S. adolescent tobacco users, including those with low levels of use, report symptoms of tobacco dependence. These findings demonstrate the need for full implementation of evidence-based strategies to prevent both experimentation and progression to regular tobacco use among youth. Published by Elsevier Inc.
Full Text Available BACKGROUND: Tobacco use leads to many health complications and is a risk factor for the occurrence of cardio vascular diseases, lung and oral cancers, chronic bronchitis etc. Almost 6 million people die from tobacco-related causes every year. This study was conducted to measure the prevalence of tobacco use in three different areas around Chennai city, south India. METHODS: A survey of 7510 individuals aged > = 15 years was undertaken covering Chennai city (urban, Ambattur (semi-urban and Sriperumbudur (rural taluk. Details on tobacco use were collected using a questionnaire adapted from both Global Youth Tobacco Survey and Global Adults Tobacco Survey. RESULTS: The overall prevalence of tobacco use was significantly higher in the rural (23.7% compared to semi-urban (20.9% and urban (19.4% areas (P value <0.001 Tobacco smoking prevalence was 14.3%, 13.9% and 12.4% in rural, semi-urban and urban areas respectively. The corresponding values for smokeless tobacco use were 9.5%, 7.0% and 7.0% respectively. Logistic regression analysis showed that the odds of using tobacco (with smoke or smokeless forms was significantly higher among males, older individuals, alcoholics, in rural areas and slum localities. Behavioural pattern analysis of current tobacco users led to three groups (1 those who were not reached by family or friends to advice on harmful effects (2 those who were well aware of harmful effects of tobacco and even want to quit and (3 those are exposed to second hand/passive smoking at home and outside. CONCLUSIONS: Tobacco use prevalence was significantly higher in rural areas, slum dwellers, males and older age groups in this region of south India. Women used mainly smokeless tobacco. Tobacco control programmes need to develop strategies to address the different subgroups among tobacco users. Public health facilities need to expand smoking cessation counseling services as well as provide pharmacotherapy where necessary.
Zheng, Yuqing; Zhen, Chen; Dench, Daniel; Nonnemaker, James M
This study estimated a system of demand for cigarettes, little cigars/cigarillos, large cigars, e-cigarettes, smokeless tobacco, and loose smoking tobacco using market-level scanner data for convenience stores. We found that the unconditional own-price elasticities for the six categories are -1.188, -1.428, -1.501, -2.054, -0.532, and -1.678, respectively. Several price substitute (e.g., cigarettes and e-cigarettes) and complement (e.g., cigarettes and smokeless tobacco) relationships were identified. Magazine and television advertising increased demand for e-cigarettes, and magazine advertising increased demand for smokeless tobacco and had spillover effects on demand for other tobacco products. We also reported the elasticities by U.S. census regions and market size. These results may have important policy implications, especially viewed in the context of the rise of electronic cigarettes and the potential for harm reduction if combustible tobacco users switch to non-combustible tobacco products. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.
Samatha, Yalamanchili; Sankar, Avula Jogendra Sai; Ganapathy, K S; Srinivas, Kandula; Ankineedu, Dasari; Choudary, Alluri Leela Subhashini
Tobacco usage in different forms is the single most common etiological factor responsible for oral cancers. The aim of the present study was to record various mucosal lesions associated with tobacco usage and to ascertain the prevalence of dysplasia in them by histopathological evaluation and to compare the extent of dysplastic features seen among patients associated with a habit of smoked and smokeless form of tobacco. Seventy-six patients with the clinical diagnosis of tobacco related lesions (Leukoplakia, Erythroplakia, Nicotina stomatitis, Tobacco pouch keratosis) were selected. A detailed description of the clinical presentation of the lesion was noted and the patients were subjected to incisional biopsy followed by a histopathological evaluation. Showed dysplastic changes in 50 cases (65.8%) ranging from mild dysplasia in 27 cases (35.5%), moderate dysplasia in 17 cases (22.4%) and 6 cases (7.9%) showed severe dysplasia. Moderate to severe dysplasia was 1.83 times more likely to occur with smokeless tobacco usage when compared to smoked form. Data obtained from this study reveals that patients with a duration of tobacco usage more than 10 years were 2.17 times more likely to have moderate to severe dysplasia (p = 0.154). Thus, the study highlights the role of oral physicians in detecting oral mucosal lesions and screening high-risk patients on a regular basis and also reaffrms the importance of public education, stressing the risk factors for oral cancers.
Arbabi-Kalati, Fateme; Salimi, Saeede; Nabavi, Saeede; Rigi, Sahebdad; Miri-Moghaddam, Masoud
Background: Tobacco use is a harmful habit that causes adverse effects on oral health and plays a most important role in cancer development. Saliva is the first fluid that is exposed to tobacco and its antioxidant system plays an important role in anti-cancer potential; therefore, this study was designed to compare the antioxidant activity and immunologic system of saliva in tobacco users (smokers and smokeless tobacco users) and non-users. Materials and Methods: In this cross-sectional study, unstimulated saliva samples of 75 healthy individuals from three equal groups were investigated. Participants in group A had no periodontal disease and never smoked. Group B had no periodontal disease, never used smokeless tobacco, but had 3 years history of smoking at least 10 cigarettes daily. The twenty-five participants in group C had no periodontal disease and had 1 year history of chewing a 10-g tobacco packet daily. Activity of salivary superoxide dismutase (SOD), salivary glutathione peroxide, and salivary IgA concentration was evaluated. Data were analyzed using SPSS (version 18) and running Kruskal-Wallis test. Statistical significance was set at ptobacco users. (Ptobacco users than users (Ptobacco users (p=0.04). Conclusion: Based on the results of the present study, the use of tobacco products decreases the antioxidative activity of the saliva and increases salivary IgA levels at the same time. Creative Commons Attribution License
Chavan, B S; Sidana, Ajeet; Kaushal, Tanuja
Tobacco use is a major public health issue today and it is expected that 650 million smokers will die prematurely due to tobacco use. On 15 July 2007, Chandigarh became the first city to go smoke-free. However, there is no data on the impact of smoke-free law. The objective of the present study was therefore to study the pattern and prevalence of tobacco use and to examine the impact of smoke-free law in Chandigarh. Total sample comprised of 3000 subjects. Socio-demographic data sheet along with initial two questions from the General questionnaire were administered on each individual. In addition, all the tobacco users underwent administration of the Fagerstrom test for nicotine dependence or the Fagerstrom test for smokeless tobacco (smokeless tobacco users). There were 43.9% tobacco users in the sample of 3000 subjects. Out of these tobacco users, 357 (11.9%) were pure smokers and 370 (12.3%) were using smokeless tobacco and 590 (19.6%) used both. The mean number of cigarettes/bidis smoked per day was 14 (+8.64) and the mean age of starting smoking was 19.41 (SD + 4.5 years).73.2% of population was aware about implementation of smoke-free law and all the participants (100%) reported smoking in public places. 43.4% smokers reported thoughts of quitting nicotine. Although the prevalence of tobacco use in Chandigarh is lower than the national average but the rates are still alarming and need attention. The findings of this study will help in designing tobacco control strategies and understanding the epidemiology of tobacco related health burden.
Gilpin, Elizabeth A; Pierce, John P
To describe patterns and correlates of tobacco product use other than cigarettes in adolescents 12-17 years of age. Adolescent respondents (N = 6090) to the 1999 California Tobacco Survey provided estimates of ever and current use (in last 30 days) of smokeless tobacco, cigars, and bidis, which were examined by cigarette smoking experience, demographics, and known predictors of cigarette use. Only 3% of adolescents who never smoked cigarettes experimented with other tobacco products. Among ever smokers who were not current smokers, the rate was 35%. Nearly 60% of current cigarette experimenters had tried another tobacco product, but almost 90% of current established smokers had experimented with one. Over 40% of current established smokers used another tobacco product in the last 30 days. Factors predictive of cigarette smoking were also highly associated with other tobacco use. In ever cigarette smokers, having peers who used other tobacco products was most highly associated with other tobacco use. Problem or risky behaviors, beliefs that cigarettes are safe or beneficial, and receptivity to tobacco promotions were also independently associated with other tobacco product use. Adolescent smokers who use other tobacco products may be prone to risky behavior and such use may hasten the development of nicotine tolerance.
Asawa, Kailash; Doshi, Astha; Bhat, Nagesh; Tak, Mridula; Chhajlani, Ashish; Bhosle, Satish; Jain, Sandeep; Shah, Disha
Parents influence their child's conduct and adolescence hostility either directly or indirectly. Similarly children can acquire a particular behaviour by observing and intentionally imitating their parents in order to simply copy them without understanding the positive or negative outcome. To assess and compare the association between parental tobacco usage and parental bonding with participants tobacco usage habits. A descriptive cross-sectional study was conducted among 130 adults. Information pertaining to demographics, parental bonding (using parental bonding index) and behavioural habits (e.g., smoking, alcohol) of both participants and their parents was collected with the use of a questionnaire-based interview. Tobacco usage was measured as categorical variable as ever chewer and never chewer. Chi-square test, independent sample t-test, multinomial logistic regression and rotated factor loadings was used to analyse the data. Majority of the participants were males with a mean age of 30.4±8.5 years. Tobacco use was prevalent among less educated males. Parental smokeless tobacco use, paternal alcohol and maternal paan chewing was significantly associated with participants adverse habits. Multinomial logistic regression showed a significant association between parental and participant's tobacco usage. Perceived parental bonding were also significantly associated with participant's tobacco usage habit. Parental bonding measures and tobacco usage was significantly associated with the participant's tobacco use. Hence, interventional and educational efforts to weaken intergenerational influences should target parents. In addition to parents, the smoking behaviour of adults should also be targeted for prevention efforts.
Renner, Caroline C; Patten, Christi A; Enoch, Carrie; Petraitis, John; Offord, Kenneth P; Angstman, Sarah; Garrison, Andrew; Nevak, Caroline; Croghan, Ivana T; Hurt, Richard D
Tobacco dependence interventions developed for Alaska Natives are virtually nonexistent. Alaska Natives residing on the Yukon-Kuskokwim (Y--K) Delta in southwestern Alaska use a unique form of smokeless tobacco (ST) known as Iqmik. This study employed focus group methodology to explore attitudes toward tobacco use and tobacco dependence interventions among Alaska Natives residing on the Y-K Delta. Twelve focus groups of former and current tobacco users were conducted in four villages in the Y-K Delta. Participants were 35 adults (83% female) and 22 adolescents (27% female). Participants completed a brief demographic and tobacco use history form. Statements from the focus groups were transcribed for content coding and analysis of the major themes. Use of Iqmik in the villages is thought to be ubiquitous. Y-K Delta Alaska Natives are introduced to Iqmik at a very young age. Iqmik is mostly used and prepared by young Alaska Natives and adult women. There are few perceived adverse health effects of Iqmik or other tobacco use. Although there is interest in stopping, there is a perceived lack of availability of tobacco dependence interventions. The major barriers to preventing the initiation of and stopping tobacco use are the social acceptance and widespread use and availability of tobacco. The attitudes toward tobacco and identified barriers to stopping will be useful in developing tobacco dependence interventions for Alaska Natives.
Christen, A G
Smoked and smokeless tobacco use produces profound effects on soft and hard tissues in and around the oral cavity. Because many of these changes are clinically observable, dentists, oral hygienists, and related health professionals are in ideal positions to give patients specific information concerning the oral ill effects of tobacco use. This article links tobacco use with a wide range of malignant, precancerous, and nonmalignant changes in the oral and perioral environment and addresses the documented benefits of quitting. Oral conditions less definitively linked to tobacco are also discussed.
Vijayaraghavan, Maya; Pierce, John P; White, Martha; Messer, Karen
With the declining sales of cigarettes, the tobacco industry has been promoting other forms of combustible and smokeless tobacco to current and former cigarette smokers. Exposure to the promotion of tobacco products has been shown to vary by income level. We combined the 2006 through 2011 National Surveys on Drug Use and Health to compare the prevalence and patterns of other tobacco use (cigar, snuff, and chewing tobacco) between current and former cigarette smokers by income level. Other tobacco use was minimal among females and among male non-smokers. Approximately a third of both current and former male cigarette smokers reported past-year other tobacco use. Overall, current smokers were more likely than former smokers to have used cigars (adjusted odds ratio (AOR) 1.69, 95% CI 1.50-1.92) or snuff (AOR 1.14, 95% CI 1.01-1.28) in the past year. The association of smoking status with other tobacco use differed by income level (interaction term p-value<0.001). Among lower income groups, current smokers were more likely to use cigars and snuff compared to former smokers. Among the highest income group, former smokers were just as likely to use smokeless tobacco as current smokers. The differing patterns of use of other tobacco between current and former smokers by income level highlight a need for studies to understand the motivations for the use of these products and their role in smoking cessation. Copyright © 2014 Elsevier Ltd. All rights reserved.
Full Text Available Background: Long-term adverse cardiovascular effects of smokeless tobacco are well established, however, the effect of chewing tobacco on coronary microcirculation and hemodynamic have not been studied. We intended to analyze the acute effect of chewing tobacco on coronary microcirculation and hemodynamics in habitual tobacco chewers with stable coronary artery disease undergoing elective percutaneous coronary intervention (PCI. Materials and Methods: We prospectively enrolled seven habitual tobacco chewers with stable coronary artery disease with single vessel disease or double vessel disease satisfying the criteria for elective PCI. Patients were instructed to keep 1 g of crushed dried tobacco leaves in the mouth after a successful PCI. Lesion in last stented vessels was evaluated for fractional flow reserve (FFR, coronary flow reserve (CFR, and index of microcirculatory resistance (IMR post-PCI, after 15 min and 30 min of tobacco chewing along with the measurement of serum cotinine levels. Results: Oral tobacco led to high levels of cotinine in the majority of patients. There was an insignificant rise in heart rate, systolic and diastolic blood pressure following tobacco consumption. Baseline CFR (median 1.6, range 1.1–5.5 was low in tobacco chewers after PCI even after optimum FFR (0.9 ± 0.05 in the majority of patients suggesting abnormal microvascular hemodynamics (high IMR in 3 patients, overall median 14.2, range 7–36.2. However, there was no significant change in the estimated CFR or IMR values following tobacco chewing. One patient had bradycardia and hypotension which may be related to vagal reaction or acute nicotine poisoning. Conclusion: Tobacco chewers have abnormal coronary microcirculation hemodynamics even following a successful PCI. However, the coronary micocirculation and hemodynamics do not change acutely following tobacco chewing despite high serum cotinine concentrations.
Sexual minority youth face health disparities and a high risk of substance abuse. This study sought to fully characterize the disparity of tobacco use and risk factors in this high-risk subpopulation. Using data from the 2015 Youth Risk Behavior Survey, the current use of various tobacco products (cigarettes, smokeless tobacco, cigars, and e-cigarettes) was compared according to sex and distinct sexual identities (lesbian, gay, bisexual, and unsure). Heterosexual/straight adolescents served as the control group. Of 14 703 respondents, 88.8% were heterosexual/straight, 2.0% were lesbian or gay, 6.0% were bisexual, and 3.2% were unsure about their sexual identity. Sexual minorities had a higher prevalence of tobacco product use than their heterosexual/straight counterparts. Sex had a significant effect on the disparities of tobacco use. Lesbian and bisexual girls had higher odds of reporting current use of any tobacco product, cigarettes, cigars, and e-cigarettes than did straight girls, whereas sexual minority boys had similar smoking behaviors compared with straight boys. Substance use, including marijuana use, drinking, and binge drinking, was significantly associated with any tobacco use. Tobacco use differs among subgroups of sexual minority youth, with lesbians and bisexual girls having a higher prevalence of tobacco use than their straight peers. Heterogeneity of tobacco use across distinct sexual identity groups underscores the need to develop evidence-based tobacco control strategies for sexual minority youth. Copyright © 2017 by the American Academy of Pediatrics.
Carr, Alan B; Ebbert, Jon
Tobacco use has significant adverse effects on oral health. Oral health professionals in the dental office or community setting have a unique opportunity to increase tobacco abstinence rates among tobacco users. This review assesses the effectiveness of interventions for tobacco cessation delivered by oral health professionals and offered to cigarette smokers and smokeless tobacco users in the dental office or community setting. We searched the Cochrane Tobacco Addiction Group Specialized Register (CENTRAL), MEDLINE (1966-November 2011), EMBASE (1988-November 2011), CINAHL (1982-November 2011), Healthstar (1975-November 2011), ERIC (1967-November 2011), PsycINFO (1984-November 2011), National Technical Information Service database (NTIS, 1964-November 2011), Dissertation Abstracts Online (1861-November 2011), Database of Abstract of Reviews of Effectiveness (DARE, 1995-November 2011), and Web of Science (1993-November 2011). We included randomized and pseudo-randomized clinical trials assessing tobacco cessation interventions conducted by oral health professionals in the dental office or community setting with at least six months of follow-up. Two authors independently reviewed abstracts for potential inclusion and abstracted data from included trials. Disagreements were resolved by consensus. The primary outcome was abstinence from smoking or all tobacco use (for users of smokeless tobacco) at the longest follow-up, using the strictest definition of abstinence reported. The effect was summarised as an odds ratio, with correction for clustering where appropriate. Heterogeneity was assessed using the I² statistic and where appropriate a pooled effect was estimated using an inverse variance fixed-effect model. Fourteen clinical trials met the criteria for inclusion in this review. Included studies assessed the efficacy of interventions in the dental office or in a community school or college setting. Six studies evaluated the effectiveness of interventions among
Amrock, Stephen M; Lee, Lily; Weitzman, Michael
Electronic cigarettes (e-cigarettes) are now the most commonly used tobacco product among US youth. The extent to which perceptions of e-cigarettes' harm and addictiveness differ from those of other products remains unknown, as does whether these perceptions have changed over time. Data from the 2012 and 2014 National Youth Tobacco Survey, a repeated cross-sectional survey of grade 6 to 12 students, were used. Cross-tabulations and logistic regression models were used to describe correlates of perceptions of harm and addictiveness of e-cigarettes, cigars, and smokeless tobacco compared with cigarettes. Trends in perceptions of e-cigarettes' harm among different demographic groups were also assessed. In 2014, 73.0% believed that e-cigarettes were less harmful than cigarettes, compared with 20.2% for smokeless tobacco and 25.8% for cigars. By comparison, 47.1% believed that e-cigarettes were less addictive than cigarettes, compared with only 14.0% for smokeless tobacco and 31.5% for cigars. Use of each product was associated with a perception of decreased harm and addictiveness in adjusted analyses, as was being male, being a non-Hispanic white, and residing with a household member who used that product. Between 2012 and 2014, increasing numbers of US youth thought they were able to assess the relative harm of e-cigarettes and increasingly believed that e-cigarettes are less harmful than cigarettes. Most US youth view e-cigarettes as less harmful and addictive than cigarettes. Far fewer think similarly about cigars and smokeless tobacco. Increases in e-cigarettes' perceived safety mirrors rapid increases observed in their use. Perceived safety correlates with use of each tobacco product. Copyright © 2016 by the American Academy of Pediatrics.
Cavazos-Rehg, Patricia A; Krauss, Melissa J; Spitznagel, Edward L; Lowery, Ashley; Grucza, Richard A; Chaloupka, Frank J; Bierut, Laura Jean
Google Trends is an innovative monitoring system with unique potential to monitor and predict important phenomena that may be occurring at a population level. We sought to validate whether Google Trends can additionally detect regional trends in youth and adult tobacco use. We compared 2011 Google Trends relative search volume data for cigars, cigarillos, little cigars and smokeless tobacco with state prevalence of youth (grades 9-12) and adult (age 18 and older) use of these products using data from the 2011 United States state-level Youth Risk Behaviors Surveillance System and the 2010-2011 United States National Survey on Drug Use and Health (NSDUH), respectively. We used the Pearson correlation coefficient to measure the associations. We found significant positive correlations between state Google Trends cigar relative search volume and prevalence of cigar use among youth (r=0.39, R(2) = 0.154, p=0.018) and adults (r=0.49, R(2) = 0.243, pGoogle Trends smokeless tobacco relative search volume and prevalence of smokeless tobacco use among youth and adults were both positive and significant (r=0.46, R(2) = 0.209, p=0.003 and r=0.48, R(2) = 0.226, pGoogle Trends has the potential to be a valuable monitoring tool for tobacco use. The near real-time monitoring features of Google Trends may complement traditional surveillance methods and lead to faster and more convenient monitoring of emerging trends in tobacco use. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Donaldson, Elisabeth A; Hoffman, Allison C; Zandberg, Izabella; Blake, Kelly D
Addiction beliefs about tobacco use are associated with intentions to use and use of tobacco products. Exposure to information about tobacco products in media sources may affect addiction beliefs. To examine the relationship between media exposure and tobacco product addiction beliefs. A nationally representative sample of US adults (n=3738) from the 2015 National Cancer Institute's Health Information National Trends Survey was used to examine addiction beliefs about cigarettes, cigars, smokeless tobacco, electronic cigarettes, hookah/waterpipe tobacco, and roll-your-own cigarettes. We used logistic regression to examine the relationship between media exposure and addiction beliefs. We defined media exposure by hours exposed, as well as exposure to tobacco use health effects information through media sources including social media. We categorized media sources by whether respondents actively or passively engaged with the source. A majority (60.6% to 87.3%) of respondents believed that cigarettes, cigars, roll-your-own cigarettes and smokeless tobacco are addictive. Less than half of respondents believed that electronic cigarettes or hookah/waterpipes are addictive (45.2% and 49.8%, respectively). Respondents exposed to messages about tobacco use health effects on active media channels (e.g., social media) had greater odds of believing that smokeless tobacco (adjusted odds ratio [AOR]=1.48), hookah/waterpipe (AOR=1.69), and roll-your-own cigarettes (AOR=1.61) are addictive. Respondents exposed to tobacco use health effects messages on passive media channels (e.g., television), had greater odds of believing that cigarettes (AOR=2.76) and electronic cigarettes (AOR=2.12) are addictive. US adult exposure to information about the health effects of tobacco use was associated with addiction beliefs about tobacco products. Published by Elsevier Ltd.
Tobacco-related diseases burden fragile healthcare systems and hinder productivity. Tobacco is ... relatively recent innovation of flavouring the tobacco. IDRC partners at the American. University of ... Tobacco and Taxes: A winning strategy, IDRC 2006 http://www.idrc.ca/en/ev-94887-201-1-DO_TOPIC.html. JA. C. O. B. K.
Peltzer, Karl; Pengpid, Supa
To investigate the prevalence and correlates of tobacco use among school-going adolescents. This cross-sectional study consisted of a secondary analysis of existing cross-sectional survey data from the Global School-based Health Survey from Cambodia and Vietnam in 2013, and comprised schoolchildren. Data was analysed using Stata 13.. The study comprised 7,137 schoolchildren. The overall mean age was 15.5±1.4 years. Besides, 3,806(53.33%) were from Cambodia and 3,331(46.67%) from Vietnam. Overall, 279(5.1%) students reported currently using tobacco (smoking and/or smokeless), including 214(6.2%) boys and 65(1.6%) girls, and 127(3.6%) in Cambodia and 152(5.2%) in Vietnam. Current cigarette smoking was 239(4.5%) and smokeless tobacco use was 143(2.4%). Tobacco use was found to be significantly high among schoolchildren in Cambodia and Vietnam.
Mukherjee, Anindya; Sinha, Abhik; Taraphdar, Pranita; Basu, Gandhari; Chakrabarty, Debadatta
Adolescents are vulnerable targets of tobacco industry with all consequences of usage. Studies reveal that tobacco abuse is rising in this age group in India. A cross sectional survey was carried out in two coeducational high schools of Anandanagar village of Singur block, Hooghly district, West Bengal among 276 students of VIII-IX standard to study the knowledge and abuse of tobacco and to find out influencing socio-demographic factors. Knowledge score was higher in females, students from nuclear families, and those with literate parents. Low prevalence of tobacco intake was obtained among the students, with 9.8% reported having ever used smokeless tobacco and 4.3% ever smoked. Tobacco intake was higher among those with a history of parental tobacco intake. Continued information education and communication (IEC) activities should be conducted by the school authorities, with involvement of nongovernment organizations (NGOs) and parents for primary prevention.
Full Text Available Background: Knowing the prevalence of tobacco use and the socio-demographic profile of users might prove useful in further strengthening the information, education, communicationand regulatory activities, thereby by decreasing tobacco use. The objective was to study the prevalence and pattern of tobacco use among rural men aged 18 years and above in rural area of Tamil Nadu.Methods: A cross sectional study was performed among 714 males aged 18 years and above in Vadagarai village of Tamil Nadu during 2010 and interviewed with a pretested questionnaire. Systematic random sampling was used to select the participants. Results: Prevalence of smoking was found to be 36.7%. Cigarette smoking was more common than beedi and smokeless tobacco.Conclusion: Strict enforcement of anti-tobacco legislation and awareness measures targeting ill-effects of tobacco can be intensified to reduce tobacco related morbidity and mortality.
Courtemanche, Charles J; Palmer, Makayla K; Pesko, Michael F
This paper estimated the association between the U.S. Food and Drug Administration's 2009 ban on flavored cigarettes (which did not apply to menthol cigarettes or tobacco products besides cigarettes) and adolescents' tobacco use. Regression modeling was used to evaluate tobacco use before and after the ban. The analyses controlled for a quadratic time trend, demographic variables, prices of cigarettes and other tobacco products, and teenage unemployment rate. Data from the 1999-2013 National Youth Tobacco Surveys were collected and analyzed in 2016. The sample included 197,834 middle and high schoolers. Outcomes were past 30-day cigarette use; cigarettes smoked in the past 30 days among smokers; rate of menthol cigarette use among smokers; and past 30-day use of cigars, smokeless tobacco, pipes, any tobacco products besides cigarettes, and any tobacco products including cigarettes. Banning flavored cigarettes was associated with reductions in the probability of being a cigarette smoker (17%, pcigarettes smoked by smokers (58%, p=0.005). However, the ban was positively associated with the use by smokers of menthol cigarettes (45%, pcigarette ban did achieve its objective of reducing adolescent tobacco use, but effects were likely diminished by the continued availability of menthol cigarettes and other flavored tobacco products. Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
Fumagalli, Chiara; Motta, Massimo; Rønde, Thomas
This paper studies a model whereby exclusive dealing (ED) can both promote investment and foreclose a more efficient supplier. Since ED promotes the incumbent seller's investment, the seller and the buyer realize a greater surplus from bilateral trade under exclusivity. Hence, the parties involved...... may sign an ED contract that excludes a more efficient entrant in circumstances where ED would not arise absent investment. The paper therefore invites a more cautious attitude towards accepting possible investment promotion arguments as a defense for ED....
Sardana, Mohini; Goel, Sonu; Gupta, Madhu; Sardana, Veera; Singh, B S
The rise in consumption of tobacco products among youth is a public health concern in India. Several studies have shown that advertisements promoting tobacco products influence decisions and behaviour of youth towards smoking. To ascertain which method of Tobacco Advertising, Promotion and Sponsorship (TAPS) was more influential for initiating tobacco use in youth in India. The secondary data of youth (15-24 years) from nationally representative Global Adult Tobacco Survey (GATS) conducted in 2009-2010 was analyzed. Odds ratio and p-value were used to know the association between TAPS and initiation of use of tobacco products among youth. Logistic regression was used to determine the most significant means of TAPS altering the youth's behaviour towards tobacco products. Out of 13,383 youths, 1,982 (14.7%) used smokeless forms of tobacco and 860 (6.38%) used smoke forms. Logistic regression reveals that promotional activities mainly through cinemas (padvertisements particularly in cinema and promotional activities like distribution of free samples, coupons and sales on the price of tobacco products. Stronger legislative measures should be enforced to curb promotional advertisements in cinemas and distribution of free samples.
Pesko, Michael F; Robarts, Adam M T
Adults and adolescents who reside in rural areas of the United States are traditionally more likely to be tobacco users. This urban-rural disparity remains largely unexplained and, more recently, it is unclear what impact the emergence of electronic cigarettes (e-cigarettes) has had on adolescent tobacco use in urban and rural areas. Our objective is to evaluate the influence of sociodemographics and tobacco control policy environments on adolescent tobacco use in urban versus rural areas, as well as to identify the effect of e-cigarettes on traditional patterns of urban-rural tobacco use. This study analyzes repeated cross-sectional data from the National Youth Tobacco Survey for the years 2011-2014. We estimate the associations between rural residence, cigarette taxes, tobacco advertisement exposure, and ease of access to tobacco with six tobacco use outcomes: current (past 30-day) use of cigarettes, e-cigarettes, cigars, smokeless tobacco, multiple tobacco products, and any tobacco. E-cigarette use among urban youths aged 11-17 years in the United States increased from .82% in 2011 to 8.62% in 2014 (p e-cigarettes. Our predictors account for approximately 40% of the difference in urban-rural cigarette use. Sociodemographics, cigarette taxes, and tobacco advertisement exposure are significant predictors of adolescent tobacco use in the United States but do not entirely explain urban-rural disparities. In addition, e-cigarettes appear to be rapidly changing traditional patterns of tobacco use, particularly in urban areas. Copyright © 2017 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
This year, NCI was re-accredited as one of nearly 200 CEO Cancer Gold Standard employers across the United States. According to its website, “the CEO Cancer Gold Standard provides a framework for employers to have a healthier workplace by focusing on cancer risk reduction, early detection, and access to clinical trials and high-quality care.” As part of this re-accreditation, NCI has updated its Tobacco-Free Policy. Part of this policy includes posting signs around campus reminding visitors and staff that NCI’s campus is tobacco-free. Therefore, the use of all tobacco products is prohibited. This includes cigarettes, cigars, pipes, e-cigarettes, and smokeless tobacco.
Johnson, Sarah E.; Holder-Hayes, Enver; Tessman, Greta K.; King, Brian A.; Alexander, Tesfa; Zhao, Xiaoquan
Introduction A growing body of evidence reveals higher rates of tobacco use among sexual minority populations relative to non-minority (“straight”) populations. This study seeks to more fully characterize this disparity by examining tobacco use by distinct sexual identities and gender to better understand patterns of: (1) cigarette smoking and smoking history; and (2) use of other tobacco products including cigars, pipes, hookah, e-cigarettes, and smokeless tobacco. Methods Data from the 2012–2013 National Adult Tobacco Survey, a random-digit dialed landline and cellular telephone survey of U.S. adults aged ≥18 years, were analyzed in 2014. A sexual minority category was created by combining gay, lesbian, and bisexual responses, along with those who selected an option for other non-heterosexual identities. Results Smoking prevalence was higher among sexual minority adults (27.4%) than straight adults (17.3%). Cigarette smoking was particularly high among bisexual women (36.0%). Sexual minority women started smoking and transitioned to daily smoking earlier than their straight peers. Use of other tobacco products was higher among sexual minority women: prevalence of e-cigarette (12.4%), hookah (10.3%), and cigar use (7.2%) was more than triple that of their straight female peers (3.4%, 2.5%, and 1.3%, respectively). Likewise, prevalence of sexual minority men’s e-cigarette (7.9%) and hookah (12.8%) use exceeded that of straight men (4.7% and 4.5%, respectively). Conclusions Tobacco use is significantly higher among sexual minority than straight adults, particularly among sexual minority women. These findings underscore the importance of tobacco control efforts designed to reach sexual minorities and highlight the heterogeneity of tobacco use within this population. PMID:26526162
Kasza, Karin A; Bansal-Travers, Maansi; O'Connor, Richard J; Compton, Wilson M; Kettermann, Anna; Borek, Nicolette; Fong, Geoffrey T; Cummings, K Michael; Hyland, Andrew J
The purpose of this study was to evaluate the prevalence and correlates of use of nicotine-containing tobacco products such as cigars, pipe tobacco, and cigarettes that promise less exposure to toxins; e-cigarettes; and smokeless tobacco products among a cohort of conventional cigarette smokers followed over the past decade. We also evaluated associations between use of such products and cigarette quitting. Participants were 6,110 adult smokers in the United States, who were interviewed as part of the International Tobacco Control Four Country Survey between 2002 and 2011. Respondents reported their concurrent use of other smoked tobacco products (including cigars, pipe tobacco, and cigarillos), smokeless tobacco products (including chewing tobacco, snus, and snuff), unconventional cigarettes (including Omni, Accord, and Eclipse), and electronic cigarettes. Prevalence and correlates of use and associations between use and cigarette quitting were assessed using regression analyses via generalized estimating equations. Most cigarette smokers did not use unconventional tobacco products, although use of any of these products started to rise at the end of the study period (2011). For each type of tobacco product evaluated, use was most prevalent among those aged 18-24 years. Smokers who did use unconventional tobacco products did not experience a clear cessation advantage. During the past decade, relatively few cigarette smokers reported also using other tobacco products. Those that did use such products were no more likely to stop using conventional cigarettes compared with those who did not use such products.
Introduction: The purpose of this study was to evaluate the prevalence and correlates of use of nicotine-containing tobacco products such as cigars, pipe tobacco, and cigarettes that promise less exposure to toxins; e-cigarettes; and smokeless tobacco products among a cohort of conventional cigarette smokers followed over the past decade. We also evaluated associations between use of such products and cigarette quitting. Methods: Participants were 6,110 adult smokers in the United States, who were interviewed as part of the International Tobacco Control Four Country Survey between 2002 and 2011. Respondents reported their concurrent use of other smoked tobacco products (including cigars, pipe tobacco, and cigarillos), smokeless tobacco products (including chewing tobacco, snus, and snuff), unconventional cigarettes (including Omni, Accord, and Eclipse), and electronic cigarettes. Prevalence and correlates of use and associations between use and cigarette quitting were assessed using regression analyses via generalized estimating equations. Results: Most cigarette smokers did not use unconventional tobacco products, although use of any of these products started to rise at the end of the study period (2011). For each type of tobacco product evaluated, use was most prevalent among those aged 18–24 years. Smokers who did use unconventional tobacco products did not experience a clear cessation advantage. Conclusions: During the past decade, relatively few cigarette smokers reported also using other tobacco products. Those that did use such products were no more likely to stop using conventional cigarettes compared with those who did not use such products. PMID:24376276
Minaker, Leia M; Ahmed, Rashid; Hammond, David; Manske, Steve
This study examined patterns of use of flavored tobacco products in a nationally generalizable sample of Canadian students in grades 9 through 12 after the implementation of a national ban on certain flavored tobacco products. Data from the 2010-2011 Youth Smoking Survey, a nationally generalizable sample of Canadian students in grades 9 through 12 (n = 31,396), were used to examine tobacco product use. Logistic regression models were used to examine differences in use of flavored tobacco products (cigarettes, pipes, little cigars or cigarillos, cigars, roll-your-own cigarettes, bidis, smokeless tobacco, water pipes, and blunt wraps) by sociodemographic and regional characteristics. Approximately 52% of young tobacco users used flavored products in the previous 30 days. Flavored tobacco use varied by product type and ranged from 32% of cigarette smokers reporting menthol smoking to 70% of smokeless tobacco users reporting using flavored product in the previous 30 days. The percentage of last-30-day users who used flavored tobacco was significantly higher in Quebec than in Ontario and significantly higher among youths who received weekly spending money than among those who received no money. More than half of tobacco users in grades 9 through 12 in Canada use flavored tobacco, despite a national ban on certain flavored tobacco products.
Margolis, Katherine A; Bernat, Jennifer K; Keely O'Brien, Erin; Delahanty, Janine C
Tobacco products and smoke contain more than 7000 chemicals (ie, constituents). Research shows that consumers have poor understanding of tobacco constituents and find communication about them to be confusing. The current content analysis describes how information is communicated about tobacco constituents online in terms of source, target audience, and message. A search was conducted in September 2015 using tobacco constituent and tobacco terms and identified 226 relevant Web sites for coding. Web sites were coded for type, target audience, reading level, constituent information, type of tobacco product, health effects, and emotional valence by two coders who independently coded half of the sample. There was a 20% overlap to assess interrater reliability, which was high (κ = .83, p < .001). The mean reading grade level of information online was 8.2 (SD = 2.8) with 81.7% of Web sites above the sixth grade reading level. Nearly all Web sites presented information in a qualitative narrative format (93%) and almost half (48.2%) presented information in a quantitative format. Nicotine (59.3%) and nitrosamines (28.8%) were the mostly frequently mentioned tobacco constituents. Cancer was the most frequently mentioned health effect (51.3%). Nearly a quarter (23%) of the Web sites did not explicitly state that tobacco constituents or tobacco products are associated with health effects. Large gaps exist in online information about tobacco constituents including incomplete information about tobacco constituent-related health effects and limited information about tobacco products other than cigarettes and smokeless tobacco. This study highlights opportunities to improve the content and presentation of information related to tobacco constituents. The US Food and Drug Administration (FDA) is required to publicly display a list of tobacco constituents in tobacco products and tobacco smoke by brand. However, little is known about tobacco constituent information available to the
Tobacco smoking is the main known cause of urinary bladder cancer in humans. In most populations, over half of cases in men and a sizeable proportion in women are attributable to this habit. Epidemiological studies conducted in different populations have shown a linear relationship between intensity and duration of smoking and risk. Quitting smoking reduces the risk of bladder cancer. Smoking black (air-cured) cigarettes results in a higher risk than smoking blond (flue-cured) tobacco cigarettes; results on inhalation patterns and use of filter are not consistent. Cigar and pipe smoking also increases the risk of bladder cancer; data on other tobacco products are limited. The evidence for non-transitional bladder carcinoma is limited, but consistent with an increased risk. The available evidence does not point towards a different carcinogenic effect of tobacco smoking in men and women or in whites and blacks. Data on involuntary smoke and use of smokeless tobacco products are limited, but do not suggest an increased risk of bladder cancer.
Full Text Available Abstract Background We have recently published some work on CEA levels in hookah (also called narghile, shisha elsewhere and cigarette smokers. Hookah smokers had higher levels of CEA than non-smokers although mean levels were low compared to cigarette smokers. However some of them were also users of other tobacco products (cigarettes, bidis, etc.. Objectives To find serum CEA levels in ever/exclusive hookah smokers, i.e. those who smoked only hookah (no cigarettes, bidis, etc., prepared between 1 and 4 times a day with a quantity of up to 120 g of a tobacco-molasses mixture each (i.e. the tobacco weight equivalent of up to 60 cigarettes of 1 g each and consumed in 1 to 8 sessions. Methods Enhanced chemiluminescent immunometric technique was applied to measure CEA levels in serum samples from 59 exclusive male smokers with age ranging from 20–80 years (mean = 58.8 ± 14.7 years and 8–65 years of smoking (mean = 37.7 ± 16.8. 36 non-smokers served as controls. Subjects were divided into 3 groups according to the number of preparations; the number of sessions and the total daily smoking time: Light (1; 1; ≤ 20 minutes; Medium (1–3; 1–3; >20 min to ≤ 2 hrs and Heavy smokers (2–4; 3–8; >2 hrs to ≤ 6 hrs. Because of the nature of distribution of CEA levels among our individuals, Wilcoxon's rank sum two-sample test was applied to compare the variables. Results The overall CEA levels in exclusive hookah smokers (mean: 3.58 ± 2.61 ng/ml; n = 59 were not significantly different (p ≤ 0.0937 from the levels in non-smokers (2.35 ± 0.71 ng/ml. Mean levels in light, medium and heavy smokers were: 1.06 ± 0.492 ng/ml (n = 5; 2.52 ± 1.15 ng/ml (n = 28 and 5.11 ± 3.08 ng/ml (n = 26 respectively. The levels in medium smokers and non-smokers were also not significantly different (p ≤ 0.9138. In heavy smokers, the CEA levels were significantly higher than in non-smokers (p ≤ 0.0001567. Conclusion Overall CEA levels in exclusive hookah
Gilreath, Tamika D; Leventhal, Adam; Barrington-Trimis, Jessica L; Unger, Jennifer B; Cruz, Tess Boley; Berhane, Kiros; Huh, Jimi; Urman, Robert; Wang, Kejia; Howland, Steve; Pentz, Mary Ann; Chou, Chih Ping; McConnell, Rob
There is a growing public health concern related to the rapid increase in the use of multiple tobacco products among adolescents. This study examined patterns of adolescent use of cigarettes, e-cigarettes, cigars/cigarillo, hookah/waterpipe, and smokeless/dip/chewing tobacco in a population of southern California adolescents. Data from 2,097 11th- and 12th-grade participants in the Southern California Children's Health Study were collected via self-report in 2014. Study participants were asked about lifetime and current (past 30 days) use of cigarettes, cigars/cigarillos/little cigars, e-cigarettes, hookah/waterpipe, and smokeless/dip/chewing tobacco. Latent class analysis (LCA) was used to identify patterns of tobacco use. Hookah/waterpipe tobacco use had the highest current prevalence (10.7%) followed by e-cigarettes (9.6%). The prevalence of use of smokeless/dip/chewing tobacco was lowest, with 2.2% of adolescents reporting current use. The LCA suggested four distinct classes, comprising nonusers (72.3% of the sample), polytobacco experimenters (13.9%), e-cigarette/hookah users (8.2%), and polytobacco users (5.6%). Multinomial logistic regression based on these four classes found that males had double the odds to be polytobacco users relative to nonusers compared to females (odds ratio, 2.3; 95% confidence interval, 1.26-4.25). By identifying naturally occurring configurations of tobacco product use in teens, these findings may be useful to practitioners and policymakers to identify the need for tobacco control interventions that address specific tobacco products and particular combinations of polytobacco use. LCA can be used to identify segments of the population overrepresented among certain tobacco use classes (e.g., boys) that may benefit most from targeted polyproduct intervention approaches. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
Bandiera, Frank C; Loukas, Alexandra; Wilkinson, Anna V; Perry, Cheryl L
There is a well-established link between cigarette smoking and depression; less is known about the potential association between alternative tobacco products, such as hookah, cigars, smokeless tobacco, and electronic cigarette (e-cigarette use) with depression. The Food and Drug Administration (FDA) is now regulating tobacco products and is interested in tobacco product use among those with mental health problems and other special populations such as college students. Cross-sectional statewide convenience sample study of 5438 college students in 24 colleges and universities in Texas. Past 30-day use of hookah, cigar, smokeless tobacco, cigarette, and e-cigarette use were measured by self-report. Depressive symptoms were measured by the 10-item short form of the Center for Epidemiologic Studies scale. Only e-cigarette use was positively associated with depressive symptoms, even after accounting for all other tobacco products and socio-demographics. There were no significant interactions between race/ethnicity or gender with each of the tobacco products on depressive symptoms. E-cigarette use was positively associated with depressive symptoms among college students in Texas. Further research is needed to determine causality, which may inform FDA regulatory planning. Copyright © 2016 Elsevier Ltd. All rights reserved.
Al Suwaidi, Jassim; Al Habib, Khalid; Singh, Rajvir; Hersi, Ahmad; Al Nemer, Khalid; Asaad, Nidal; Al Saif, Shukri; Al-Motarreb, Ahmed; Almahmeed, Wael; Sulaiman, Kadhim; Amin, Haitham; Al-Lawati, Jawad; Al Bustani, Nizar; Al-Sagheer, Norah Q; Ali, Waleed M
The authors evaluated the prevalence and effect of the various tobacco use modalities among patients presenting with acute coronary syndrome (ACS) and compared them with non-tobacco and ex-tobacco users. An analysis of the 2nd Gulf Registry of Acute Coronary Events conducted between October 2008 and June 2009 and which included 7930 consecutive patients hospitalised with ACS was made. Patients initially were divided into non-tobacco users, ex-tobacco users and current tobacco users. Subanalysis according to the tobacco modality used was subsequently made: cigarette, waterpipe or smokeless tobacco users. Overall, 2834 (36%) patients were current tobacco users, 306 (3.9%) patients were waterpipe smokers and 240 patients (3%) were oral tobacco users. When compared with non-tobacco and ex-tobacco users, overall current tobacco users were younger, more likely to be male subjects and less likely to have diabetes mellitus, hypertension and dyslipidaemia. Mortality rate (p=0.001) and overall cardiovascular events (p=0.001) were lower among current tobacco users when compared with the other two groups. After adjustment for baseline variables, tobacco use was not an independent predictor of adverse events. Subset analysis demonstrates oral tobacco users and waterpipe smokers were older and more likely to be women when compared with cigarette smokers. Among the various tobacco groups, inhospital mortality rates were significantly higher among the waterpipe smokers when compared with the other two groups. Clinical characteristics and outcomes of ACS patients depend on the tobacco modality used. Further studies are required to evaluate the impact of emerging tobacco use modalities on patients with coronary artery disease.
Sohini Das Biswas
Full Text Available Background: Tobacco use has toxic effects on different organs. This study was carried out to assess the effect of indigenous tobacco both in smoking (bidi and smokeless (gutkha, zarda and khaini forms on buccal cells at chromosomal level, through assessment of different nuclear anomalies as biomarker. Methods:This study was done on people living in Durgapur and its adjacent areas, West Bengal, India during January to July 2011. The samples were collected from 50 smokers (case group, 50 smokeless tobacco consumers or chewers (case group and 50 non-tobacco consumers (control group. Micronucleus assay was used to assess buccal cell nuclear changes. Buccal smears collected from study subjects were prepared on a grease free slide. Prepared slides were observed under light microscope and 2 to 5 fields were observed randomly for counting the different anomalies. In each field, the frequency of each anomaly was assessed in 100 cells and reported with percentage. Results:Chewers had significantly the highest frequency of all nuclear anomalies compared to smokers and healthy controls (HCs. Smokers also had significantly more anomalies compared to HCs. Condensed chromatin (CC, karyolysis (KL and bi-nucleation (BN in chewers and CC, pyknosis and BN in smokers were the most frequent anomalies. KL was significantly more frequent in chewers compared to smokers (59.8 ± 6.4 vs. 24.2 ± 12.4%, P < 0.001, however, the frequency of other nuclear anomalies were not significantly different in these two study groups. Presence of each nuclear anomaly was significantly greater in older ages in all study groups. Conclusion:Tobacco can cause and increase the rate of nuclear anomalies in both smoking and smokeless forms compared to HCs. The genotoxic effects of tobacco on buccal cells are partly age-related. Cell nuclear anomalies in buccal tissue can be used as biomarker indicating the detrimental effects of tobacco.
Saunders, Charles; Geletko, Karen
This study uses the most recent data from the nationally representative National Youth Tobacco Survey (NYTS) to examine the use of alternative tobacco products among U.S. cigarette smokers and non-cigarette smokers aged 14-17. Alternative tobacco product use is defined as use of one or more of the following products: smokeless tobacco, cigars, pipes, bidis, or kreteks. Using the results from the 2004, 2006, and 2009 NYTS, multivariate logistic regressions were used to investigate separately the extent of alternative tobacco product use in current cigarette smokers and in those who reported not smoking cigarettes controlling for demographic and other independent influences. The results indicate that for adolescent smokers and nonsmokers, the use of one type of alternative tobacco product made it much more likely the individual would use one or more of the other alternative tobacco products. Non-cigarette smokers using these tobacco products appeared to exhibit symptoms of nicotine dependence comparable to those of cigarette smokers. More information on adolescent use of alternative tobacco products is needed. Current cigarette use declined 3.4% annually over 2004-2009 for the NYTS 14- to 17-year-old population, but this cohort's use of alternative tobacco products was unchanged. The number of adolescents aged 14-17 who did not smoke cigarettes but used alternative tobacco products increased 5.9% per year over the same period. Current surveillance measures need to be expanded in order to gain a more comprehensive understanding of adolescent alternative tobacco use.
Phillips, Elyse; Wang, Teresa W; Husten, Corinne G; Corey, Catherine G; Apelberg, Benjamin J; Jamal, Ahmed; Homa, David M; King, Brian A
Tobacco use remains the leading cause of preventable disease and death in the United States (1). Despite declining cigarette smoking prevalence among U.S. adults, shifts in the tobacco product landscape have occurred in recent years (2,3). Previous estimates of tobacco product use among U.S. adults were obtained from the National Adult Tobacco Survey, which ended after the 2013-2014 cycle. This year, CDC and the Food and Drug Administration (FDA) assessed the most recent national estimates of tobacco product use among adults aged ≥18 years using, for the first time, data from the 2015 National Health Interview Survey (NHIS), an annual, nationally representative, in-person survey of the noninstitutionalized U.S. civilian population. The 2015 NHIS adult core questionnaire included 33,672 adults aged ≥18 years, reflecting a 55.2% response rate. Data were weighted to adjust for differences in selection probability and nonresponse, and to provide nationally representative estimates. In 2015, 20.1 % of U.S. adults currently (every day or some days) used any tobacco product, 17.6% used any combustible tobacco product, and 3.9% used ≥2 tobacco products. By product, 15.1% of adults used cigarettes; 3.5% used electronic cigarettes (e-cigarettes); 3.4% used cigars, cigarillos, or filtered little cigars; 2.3% used smokeless tobacco; and 1.2% used regular pipes, water pipes, or hookahs.* Current use of any tobacco product was higher among males; persons aged adults with serious psychological distress compared with 19.2% among those without serious psychological distress. Proven population-level interventions that focus on the diversity of tobacco product use are important to reducing tobacco-related disease and death in the United States (1).
Corey, Catherine G; Ambrose, Bridget K; Apelberg, Benjamin J; King, Brian A
The 2009 Family Smoking Prevention and Tobacco Control Act prohibits "characterizing flavors" (e.g., candy, fruit, and chocolate) other than tobacco and menthol in cigarettes; however, characterizing flavors are not currently prohibited in other tobacco products. Analyses of retail sales data suggest that U.S. consumption of flavored noncigarette tobacco products, including flavored cigars and flavored e-cigarettes, has increased in recent years. There is growing concern that widely marketed varieties of new and existing flavored tobacco products might appeal to youths (2) and could be contributing to recent increases in the use of tobacco products, including e-cigarettes and hookah, among youths. CDC and the Food and Drug Administration (FDA) analyzed data from the 2014 National Youth Tobacco Survey (NYTS) to determine the prevalence of past 30 day use (current use) of flavored e-cigarette, hookah tobacco, cigar, pipe tobacco or smokeless tobacco products, and menthol cigarettes among middle and high school students, and the proportion of current tobacco product users who have used flavored products. An estimated 70.0% (3.26 million) of all current youth tobacco users had used at least one flavored tobacco product in the past 30 days. Among current users, 63.3%, (1.58 million) had used a flavored e-cigarette, 60.6%, (1.02 million) had used flavored hookah tobacco, and 63.5% (910,000) had used a flavored cigar in the past 30 days. Given the millions of current youth tobacco users, it is important for comprehensive tobacco prevention and control strategies to address all forms of tobacco use, including flavored tobacco products, among U.S. youths.
The association between cigarette smoking and the risk of cardiovascular diseases (CVD) is well established. However, the effect of other, less common, types of smoking on CVD risk, such as pipes and cigars in developed countries, remains uncertain. By contrast, in developing countries, a large panel of smokeless tobacco products are consumed alongside smoking products, with unknown effects on the risk of CVD. The aim of this thesis is to investigate the association between various forms of t...
Kyaing, Nyo Nyo; Islam, Md Ashadul; Sinha, Dhirendra N; Rinchen, Sonam
This paper examines the social, cultural, economic and legal dimensions of tobacco control in the South-East Asia Region in a holistic view through the review of findings from various studies on prevalence, tobacco economics, poverty alleviation, women and tobacco and tobacco control laws and regulations. Methods were Literature review of peer reviewed publications, country reports, WHO publications, and reports of national and international meetings on tobacco and findings from national level surveys and studies. Tobacco use has been a social and cultural part of the people of South-East Asia Region. Survey findings show that 30% to 60% of men and 1.8% to 15.6% of women in the Region use one or the other forms of tobacco products. The complex nature of tobacco use with both smoking and smokeless forms is a major challenge for implementing tobacco control measures. Prevalence of tobacco use is high among the poor and the illiterate. It is higher among males than females but studies show a rising trend among girls and women due to intensive marketing of tobacco products by the tobacco industry. Tobacco users spend a huge percent of their income on tobacco which deprives them and their families of proper nutrition, good education and health care. Some studies of the Region show that cost of treatment of diseases attributable to tobacco use was more than double the revenue that governments received from tobacco taxation. Another challenge the Region faces is the application of uniform tax to all forms of tobacco, which will reduce not only the availability of tobacco products in the market but also control people switching over to cheaper tobacco products. Ten out of eleven countries are Parties to the WHO Framework Convention on Tobacco Control and nine countries have tobacco control legislation. Enforcement of control measures is weak, particularly in areas such as smoke-free environments, advertisement at the point of sale and sale of tobacco to minors. Socio
Mall, Anjali Sunil Kumar; Bhagyalaxmi, Aroor
Tobacco use among adolescence is one of the important preventable causes of death as well as a leading public health problem all over the world. The present study was conducted with the objective of studying the effect of peer-led interventions on tobacco use among adolescents. Twenty schools were randomly selected and ten schools each were identified as cluster for intervention and control groups. A total of 402 students in intervention group and 422 in control group were studied. About 48% and 41% of adolescents were consuming smokeless tobacco in any form in the intervention and control groups, respectively. Prevalence of consumption of smokeless tobacco was significantly high among boys as compared to girls. Pan masala was the most common form of consumption. After conducting A Stop Smoking in School Trial-like peer-led intervention, a significant reduction in tobacco consumption of any form was observed in the intervention group (48%-36%) during the follow-up (Z = 3.2, P group (32%-29%) was also observed. All the students smoking initially had stopped smoking at the end of the follow-up in both the groups. It was found that peer-led intervention was effective in reducing the consumption of smokeless tobacco in any form. The rate of reduction was more in the first follow-up as compared to the end of the intervention. Sustained intervention in the form of retraining is needed for the long-term effect.
Tiwari, Ram Vinod; Gupta, Anjali; Agrawal, Ankush; Gandhi, Aniruddh; Gupta, Manjari; Das, Mayank
Tobacco consumption has become pandemic, and is estimated to have killed 100 million people in the 20th century worldwide. Some 700,000 out of 5.4 million deaths due to tobacco use were from India. The era of global modernization has led to an increase in the involvement of women in tobacco consumption in the low income and middle-income countries. Tobacco consumption by females is known to have grave consequences. To assess: (1) the tobacco use among urban and rural women; (2) the discrepancy in the knowledge, belief and behavior towards tobacco consumption among urban and rural women in Durg-Bhilai Metropolitan, Chhattisgarh, Central India. The study population consisted of 2,000 18-25 year old young women from Durg-Bhilai Metropolitan, Chhattisgarh, Central India, from both urban and rural areas. Data were collected using a pretested, anonymous, extensive face to face interview by a female investigator to assess the tobacco use among women and the discrepancy in the knowledge, belief and behavior towards tobacco consumption among urban and rural individuals. The prevalence of tobacco use was found to be 47.2%. Tobacco consumption among rural women was 54.4% and in urban women was 40%. The majority of the women from urban areas (62.8%) were smokers whilst rural women (77.4%) showed preponderance toward smokeless tobacco use. Urban women had a better knowledge and attitude towards harms from tobacco and its use than the rural women. Women in rural areas had higher odds (1.335) of developing tobacco habit than the urban women. Increased tobacco use by women poses very severe hazards to their health, maternal and child health, and their family health and economic well-being. Due to the remarkably complex Indian picture of female tobacco use, an immediate and compulsory implementation of tobacco control policies laid down by the WHO FCTC is the need of the hour.
Halstead, Mary M; Watson, Clifford H; Pappas, R Steven
Although quantitative trace toxic metal analyses have been performed on tobacco products, little has been published on inorganic particulate constituents on and inside the products. We analyzed these constituents using scanning electron microscopy with energy dispersive X-ray spectroscopy (SEM-EDS). The nature of SEM-EDS instrumentation makes it an ideal choice for inorganic particulate analyses and yields relevant information to potential exposures during consumption of oral tobacco products, and possibly as a consequence of smoking. Aluminum silicates, silica and calcium compounds were common inorganic particulate constituents of tobacco products. Aluminum silicates and silica from soil were found on external leaf surfaces. Phytolithic silica, found in the lumen of the plant leaf, is of biogenic origin. Calcium oxalate was also apparently of biogenic origin. Small mineral deposits on tobacco could have health implications. Minerals found on the surfaces of smokeless tobacco products could possibly abrade the oral mucosa and contribute to the oral inflammatory responses observed with smokeless tobacco product use. If micron and sub-micron size calcium particles on cigarette filler were transported in mainstream smoke, they could potentially induce a pulmonary irritant inflammation when inhaled. The transport of aluminum silicate and silica in smoke could potentially also contribute to chronic inflammatory disease. Published by Oxford University Press 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.
Lee, Joseph G L; Henriksen, Lisa; Rose, Shyanika W; Moreland-Russell, Sarah; Ribisl, Kurt M
We systematically reviewed evidence of disparities in tobacco marketing at tobacco retailers by sociodemographic neighborhood characteristics. We identified 43 relevant articles from 893 results of a systematic search in 10 databases updated May 28, 2014. We found 148 associations of marketing (price, placement, promotion, or product availability) with a neighborhood demographic of interest (socioeconomic disadvantage, race, ethnicity, and urbanicity). Neighborhoods with lower income have more tobacco marketing. There is more menthol marketing targeting urban neighborhoods and neighborhoods with more Black residents. Smokeless tobacco products are targeted more toward rural neighborhoods and neighborhoods with more White residents. Differences in store type partially explain these disparities. There are more inducements to start and continue smoking in lower-income neighborhoods and in neighborhoods with more Black residents. Retailer marketing may contribute to disparities in tobacco use. Clinicians should be aware of the pervasiveness of these environmental cues.
Henriksen, Lisa; Rose, Shyanika W.; Moreland-Russell, Sarah; Ribisl, Kurt M.
We systematically reviewed evidence of disparities in tobacco marketing at tobacco retailers by sociodemographic neighborhood characteristics. We identified 43 relevant articles from 893 results of a systematic search in 10 databases updated May 28, 2014. We found 148 associations of marketing (price, placement, promotion, or product availability) with a neighborhood demographic of interest (socioeconomic disadvantage, race, ethnicity, and urbanicity). Neighborhoods with lower income have more tobacco marketing. There is more menthol marketing targeting urban neighborhoods and neighborhoods with more Black residents. Smokeless tobacco products are targeted more toward rural neighborhoods and neighborhoods with more White residents. Differences in store type partially explain these disparities. There are more inducements to start and continue smoking in lower-income neighborhoods and in neighborhoods with more Black residents. Retailer marketing may contribute to disparities in tobacco use. Clinicians should be aware of the pervasiveness of these environmental cues. PMID:26180986
Full Text Available Background: Adolescence is a very delicate and vulnerable age when children are exposed to the harmful and damaging culture of the society. Tobacco habits are increasingly becoming an annoying menace to the Indian society since the past few years. The teenage group is fast catching up the tobacco habits because of its easy availability in the local Indian markets. Thus, this study was envisaged to analyze the factors responsible for this adverse habit and to obtain an overview of the trends in tobacco habits in young children of North India. Methods: Eight hundred and sixteen schoolchildren in the age group of 14–19 years of different schools of Meerut city were instructed to fill the prepared questionnaires. Results were formulated and statistical analysis was done. Results: Chi-square analysis revealed significant difference between tobacco users and nonusers. Smokeless habit was more prevalent among adolescent boys. Peer pressure was the most cited reason for initiating the tobacco habit while parental influence helped the most in abstaining from this adverse addiction. Conclusion: Despite the existence of anti-tobacco regulations in India, tobacco dependence in adolescents raises an alarm for the Indian community and stringent steps are required to remove this menace.
Al-Lawati, Jawad A.; Nooyi, Shalini C.; Al-Lawati, Alya M.
Tobacco use among Omani physicians and dentists has not been studied, so we conducted a cross-sectional survey using a WHO questionnaire to measure prevalence and to learn about smoking practices among this population and about their knowledge and attitudes of the health effects of tobacco use and tobacco control. The 1191 subjects who participated (787 men and 404 women) ranged in age from 24 to 65 years with a mean (SD) of 41.7 (6.8) years for men and 38.1 (6.9) years for women. The prevalence of tobacco use was 16.4% among males and less than 1% among females. Manufactured cigarettes were the most common form of tobacco used (14.7%), followed by smokeless tobacco (2.2%) and waterpipes (1.7%). Tobacco users were significantly less favorable to strict control and policy measures than never tobacco users and had less knowledge of some of the heatlh effects of tobacco use. Tobacco use among physicians and dentists in Oman is lower than in other countries in the region, but remains a cause of concern. Programs and policies should strive to maintain the low level of tobacco use or reduce it further. PMID:19318747
Majmudar, V Parishi; Mishra, A Gauravi; Kulkarni, V Sheetal; Dusane, R Rohit; Shastri, S Surendra
Tobacco use is an important health issue globally. It is responsible for a large number of diseases and deaths in India. Female tobacco users have additional health risks. The aim was to assess changes in pre and post-intervention tobacco-related knowledge, attitudes, and practices among women from urban low socioeconomic strata, after three rounds of interventions. A structured questionnaire was used to interview women living in low socioeconomic housing clusters in Mumbai, regarding their tobacco consumption, attitudes, and practices, by Medical Social Workers. These data were entered into IBM SPSS Statistics, version 20 and analysed. Interventions for tobacco cessation were provided 3 times over a span of 9 months, comprising of health education and counseling. Post-intervention questionnaire was introduced at 12 months. There was statistically significant improvement in the knowledge of women, following the interventions, with particular reference to poor oral hygiene and tobacco use being main cause of oral cancer (P = 0.007), knowledge of ill effects of second hand smoke (P = 0.0001), knowledge about possibility of early detection of oral cancer (P = 0.0001), perception of pictorial and written warnings on tobacco products (P = 0.0001), and availability of help for quitting tobacco (P = 0.024). The prevalence of smokeless tobacco use is very high among urban women from lower socioeconomic strata. Therefore, tobacco awareness programs and tobacco cessation services tailor made for this group of women must be planned and implemented.
Wagoner, Kimberly G; Sutfin, Erin L; Song, Eunyoung; King, Jessica L; Egan, Kathleen L; Reboussin, Beth; Debinski, Beata; Spangler, John; Wolfson, Mark
Colleges have implemented policies to limit tobacco use on-campus; however, the off-campus environment is often overlooked in tobacco control efforts. We assessed availability, marketing, and promotion of cigarettes, snus, and traditional smokeless tobacco (SLT) in a sample of communities surrounding 11 college campuses in North Carolina and Virginia. Between January-March of 2011, 2012 and 2013, 481 tobacco-selling retailers, including convenience stores, pharmacies and supermarkets, located near campuses were assessed. Trained observers completed annual point-of-sale assessments. The percentage of stores selling (81.4% to 58.6%; p<.0001) and advertising snus (80.1% to 53.11%; p<.0001) significantly decreased over time. Convenience stores increased promotions of cigarettes (65.4% to 72.8%; p = 0.04) and SLT (3.1% to 23.3%; p = 0.02). Off-campus environments have abundant tobacco availability and marketing. Colleges should collaborate with state and local tobacco control advocates to address tobacco promotion near campuses to potentially decrease product appeal and access among young adults.
Escobedo, Patricia; Cruz, Tess Boley; Tsai, Kai-Ya; Allem, Jon-Patrick; Soto, Daniel W; Kirkpatrick, Matthew G; Pattarroyo, Monica; Unger, Jennifer B
Limited information exists about strategies and methods used on brand marketing websites to transmit pro-tobacco messages to tobacco users and potential users. This study compared age verification methods, themes, interactive activities and links to social media across tobacco brand websites. This study examined 12 tobacco brand websites representing four tobacco product categories: cigarettes, cigar/cigarillos, smokeless tobacco, and e-cigarettes. Website content was analyzed by tobacco product category and data from all website visits (n = 699) were analyzed. Adult smokers (n=32) coded websites during a one-year period, indicating whether or not they observed any of 53 marketing themes, seven interactive activities, or five external links to social media sites. Most (58%) websites required online registration before entering, however e-cigarette websites used click-through age verification. Compared to cigarette sites, cigar/cigarillo sites were more likely to feature themes related to "party" lifestyle, and e-cigarette websites were much more likely to feature themes related to harm reduction. Cigarette sites featured greater levels of interactive con