Validity of self reports in a cohort of Swedish adolescent smokers and smokeless tobacco (snus) users

Objective: To validate self reports of cigarette and smokeless tobacco (snus) use in a prospective cohort of adolescents. Design: A cross sectional analysis of a cohort sub-sample. Setting: County of Stockholm, Sweden. Subjects: 520 adolescents in the final grade of junior high school (mean age 15.0 years). Main outcome measure: Concordance between self reported tobacco use and saliva cotinine concentration. Results: Using a cut point of 5 ng/ml saliva cotinine to discriminate active tobacco use, there was a 98% concordance between self reported non-use in the past month and cotinine concentration. The sensitivity of the questionnaire compared to the saliva cotinine test, used as the gold standard, was 90% and the specificity 93%. One hundred and fifteen out of 520 subjects (22%) reported monthly tobacco use. Among these, 67% (46/69) of the exclusive cigarette smokers, 82% (23/28) of exclusive snus users, and 94% (15/16) of mixed users (cigarettes + snus) had cotinine concentrations above 5 ng/ml. Among subjects reporting daily use 96% (64/67) had saliva cotinine concentrations above the cut point. Exclusive current cigarette users were more likely to be classified discordantly by questionnaire and cotinine test compared to snus users (odds ratio 3.2, 95% confidence interval 1.2 to 8.6). Conclusion: This study confirms the reliability of adolescents'' self reported tobacco use. In a context of low exposure to environmental tobacco smoke a cut off for saliva cotinine of 5 ng/ml reliably discriminated tobacco users from non-users. Irregular use of tobacco in this age group probably explains the discrepancy between self reported use and cotinine concentrations.     

Improving the self reporting of tobacco use: results of a factorial experiment

Objectives: To examine divergent estimates of smoking prevalence in two random digit dial surveys for the same population. Based upon internal and external reviews of survey procedures, differences in survey introductions (general health versus tobacco specific introduction) and/or differences in the use of filter questions were identified as the most likely explanations. This prompted an experiment designed to investigate these potential sources of measurement error. Design: A randomised 2 x 2 factorial experiment. Setting: A random digit dial telephone survey from July to September 2000. Subjects: 3996 adult Californian respondents. Main outcome measures: A series of smoking prevalence questions in the context of a tobacco or general health survey. Results: Logistic regression analyses suggest that, among females, prior knowledge (from the survey introduction) that a survey is concerned with tobacco use may decrease self reported smoking prevalence (approximately 4% absolute prevalence difference). Differences in the use of filter questions resulted in almost no misclassification of respondents. Conclusions: The tobacco specific survey introduction is causing some smokers to deny their tobacco use. The data suggest that these smokers tend to be women that smoked occasionally. A desire by the participants to minimise their personal time costs or a growing social disapproval of tobacco use in the USA may be contributing to the creation of previously undetected survey artefacts in the measurement of tobacco related behaviours.     

Tobacco use in six economically disadvantaged communities in the Dominican Republic.

The Dominican Republic is a tobacco-growing country, and tobacco control efforts there have been virtually nonexistent. This study provides a first systematic surveillance of tobacco use in six economically disadvantaged Dominican Republic communities (two small urban, two peri-urban, two rural; half were tobacco growing). Approximately 175 households were randomly selected in each community (total N = 1,048), and an adult household member reported on household demographics and resources (e.g., electricity), tobacco use and health conditions of household members, and household policies on tobacco use. Poverty and unemployment were high in all communities, and significant gaps in access to basic resources such as electricity, running water, telephones/cell phones, and secondary education were present. Exposure to tobacco smoke was high, with 38.4% of households reporting at least one tobacco user, and 75.5% allowing smoking in the home. Overall, 22.5% reported using tobacco, with commercial cigarettes (58.0%) or self-rolled cigarettes (20.1%) the most commonly used types. Considerable variability in prevalence and type of use was found across communities. Overall, tobacco use was higher in males, illiterate groups, those aged 45 or older, rural dwellers, and tobacco-growing communities. Based on reported health conditions, tobacco attributable risks, and World Health Organization mortality data, it is estimated that at least 2,254 lives could potentially be saved each year in the Dominican Republic with tobacco cessation. Although it is expected that the reported prevalence of tobacco use and health conditions represent underestimates, these figures provide a starting point for understanding tobacco use and its prevalence in the Dominican Republic.     

魔芋葡甘聚糖保润剂对烟丝吸湿特性的影响

利用烟草等温吸脱附性能检测装置考察施加了魔芋葡甘聚糖(KGM)保润剂的烟丝样品的吸湿特性,结果表明:KGM有助于增强烟丝的持水能力,减缓水分散失过程,KGM不同程度地降低了各部位烟丝的干燥速率常数;烟丝样品的等温吸湿—解湿曲线呈Ⅲ型吸附曲线,且KGM的施加会加剧吸湿滞后现象,吸湿滞后行为随温度升高有减弱趋势,中上部烟丝的吸湿滞后现象强于下部烟丝,DLP经验模型可较好地描述烟丝样品的等温吸湿—解湿行为。     

The influence of personality and affect on nicotine dependence among male college students.

Many clinicians and researchers hypothesize that tobacco use disorders, regardless of the route of administration, are maintained by the ability of nicotine to regulate positive and negative mood states. The present study (N=137) examined whether certain mood states predicted dependence on either cigarettes or smokeless tobacco and whether specific personality characteristics (e.g., extraversion, neuroticism, and psychoticism) mediated these relationships among young male college students. Results indicated that positive and negative moods predicted cigarette dependence (p values=.01) and that neuroticism partially mediated the relationship between positive affect and cigarette dependence. Exploratory analyses revealed that positive affect also interacted with neuroticism to predict smokeless tobacco dependence (p=.04). Simple effects analyses revealed that this relationship was maintained only among individuals high in neuroticism. Results suggested that dependence on cigarettes and smokeless tobacco among male college students may have different affective correlates and that certain personality characteristics may enhance and explain the effects of mood on tobacco dependence.     

Playing hide-and-seek with the tobacco industry.

Despite many peer-reviewed works that draw on tobacco industry documents that have now been made public, questions remain about how complete a picture has emerged. We present a conceptual framework that identifies and evaluates tobacco industry efforts to conceal information. Widespread document destruction like that in recent litigation in Australia is just one of more than a dozen tobacco industry efforts to prevent access, or at least timely access, to documents. Industry efforts range from small, locally employed initiatives to company-wide tactics. Some efforts, such as using "oral only" procedures, scrambling telephone lines, or involving lawyers in scientific projects, are preemptive. Others seek to deal with already existing documents by invoking bogus claims of legal privilege, stipulating "read then destroy" for memos, and rewriting problematic memos. That evidence of concealment has, in fact, been found in tobacco company archives attests to the futility of attempting to control the flow of millions of pieces of paper among tens of thousands of employees. However, researchers have yet to reveal the full story: We know of the industry's failures in concealing information, but not its successes. The industry's objective is not destruction of information per se, but prevention of public disclosure of that information. Exposing the tobacco industry's many approaches to concealment provides greater insight into companies' intentions and potential means for stripping away that concealment.     

Reducing the addictiveness of cigarettes

OBJECTIVE—To assess the feasibility of reducing tobacco-caused disease by gradually removing nicotine from cigarettes until they would not be effective causes of nicotine addiction.
DATA SOURCES—Issues posed by such an approach, and potential solutions, were identified from analysis of literature published by the US Food and Drug Administration (FDA) in its 1996 Tobacco Rule, comments of the tobacco industry and other institutions and individuals on the rule, review of the reference lists of relevant journal articles, other government publications, and presentations made at scientific conferences.
DATA SYNTHESIS—The role of nicotine in causing and sustaining tobacco use was evaluated to project the impact of a nicotine reduction strategy on initiation and maintenance of, and relapse to, tobacco use. A range of potential concerns and barriers was addressed, including the technical feasibility of reducing cigarette nicotine content to non-addictive levels, the possibility that compensatory smoking would reduce potential health benefits, and whether such an approach would foster illicit ("black market") tobacco sales. Education, treatment, and research needs to enable a nicotine reduction strategy were also addressed. The Council on Scientific Affairs came to the following conclusions: (a) gradually eliminating nicotine from cigarettes is technically feasible; (b) a nicotine reduction strategy holds great promise in preventing adolescent tobacco addiction and assisting the millions of current cigarette smokers in their efforts to quit using tobacco products; (c) potential problems such as compensatory over-smoking of denicotinised cigarettes and black market sales could be minimised by providing alternate forms of nicotine delivery with less or little risk to health, as part of expanded access to treatment; and (d) such a strategy would need to be accompanied by relevant research and increased efforts to educate consumers and health professionals about tobacco and health.
CONCLUSIONS—The council recommends the following: (a) that cessation of tobacco use should be the goal for all tobacco users; (b) that the American Medical Association continue to support FDA authority over tobacco products, and FDA classification of nicotine as a drug and tobacco products as drug-delivery devices; (c) that research be encouraged on cigarette modifications that may result in less addicting cigarettes; (d) that the FDA require that the addictiveness of cigarettes be reduced within 5-10 years; (e) expanded surveillance to monitor trends in the use of tobacco products and other nicotine-containing products; (f) expanded access to smoking cessation treatment, and strengthening of the treatment infrastructure; and (g) more accurate labelling of tobacco products, including a more meaningful and understandable indication of nicotine content.


     

Tobacco industry research and protection of human subjects: a case study of R. J. Reynolds.

Companies that conduct research are under no obligation to follow guidelines regarding treatment of human subjects in clinical trials. By contrast, clinical researchers funded by federal agencies or under U.S. Food and Drug Administration authority are required to follow federal regulations, and academics must adhere to their institutions' standards. We examined how one tobacco company, R. J. Reynolds, treated human subjects in internal research conducted from 1985 to 2000. We then compared this treatment with standards of the time. We focused on R. J. Reynolds because the company conducted a significant amount of research using human subjects. Tobacco industry documents were retrieved from the UCSF/Legacy Tobacco Documents Library, Tobacco Documents Online, and industry Web sites. Materials from 73 research projects, including informed consent forms, were analyzed. The U.S. Code of Federal Regulations, Title 45 Part 46, Protection of Human Subjects (the Common Rule) was the primary source for human subjects research guidelines and standards. R. J. Reynolds formed a human subjects review committee in 1985. The committee's structure and procedures did not meet generally accepted practices of the time regarding community representation, written procedures for adverse events, and other factors. In all 73 studies, consent procedures failed to meet five or more human subjects research standards. Policymakers should consider expanding the scope of federal human subjects research regulations to cover research undertaken by private firms such as tobacco companies.     

烟草样品等温吸湿模型的比较与分析

为了筛选出适合不同烟草样品的等温吸湿模型,从食品等温吸湿研究领域的众多模型中选择了14种常用的数学模型,包括理论模型8种:BET模型、GAB模型、Kühn模型、Smith模型1（非溶胀材料）、Smith模型2（溶胀材料）、Harkins模型、Hailwood模型和Lewicki模型,经验/半经验模型6种:Peleg模型、Ferro Fontan模型、DLP模型、Konstance模型、Oswin模型和Polynomial模型,对12个不同类型烟草样品的实验数据进行拟合,通过决定系数（R2）和平均相对误差（MRE）对模型的拟合效果进行了评价,并用18个不同类型的烟草样品对优选模型进行了验证。结果表明,GAB和DLP模型具有较好的普遍适用性,可分别作为烟草样品等温吸湿研究领域的理论模型和经验/半经验模型进行推广应用。      

"Pack year" smoking histories: what about patients who use loose tobacco?

Life time smoking of ready made cigarettes can be readily quantified as "pack years" smoked, but methods for measuring loose tobacco use are less well established. In this study the frequency of loose tobacco use by 247 hospital in-patients was determined; 64% were current or ex-smokers, 41.3% of whom (25.9% of participants) had smoked loose tobacco. A formula was developed for converting loose tobacco use to pack years smoked, based on the weight of tobacco in ready made cigarettes; 12.5 g or half an ounce of loose tobacco was approximately equivalent to one packet of 20 cigarettes. Using a questionnaire it was found that hospital physicians of all grades were able to convert smoking histories of ready made cigarettes, but not loose tobacco, into number of "pack years" smoked.     

Differences in prevalence of tobacco use among Indian urban youth: the role of socioeconomic status

This study examined whether the distribution of tobacco use and related psychosocial risk factors among youth in urban India vary by socioeconomic status (SES). Data were derived from a cross-sectional survey of students enrolled in the 6th and 8th grades in 32 schools in Delhi and Chennai (N = 11,642). The survey was conducted in 2004, before the implementation of a program designed to prevent and reduce tobacco use (MYTRI). Mixed-effect regression models were used (a) to determine the prevalence of tobacco use among private (higher SES) and government (lower SES) school students, (b) to investigate whether certain psychosocial factors were associated with increased tobacco use, and (c) to determine how these factors varied by school type. Ever-use of multiple forms of tobacco (e.g., gutkha, bidis, and cigarettes) was more prevalent among government school students than private school students. After adjusting for city, gender, grade, and age, we found the prevalence rate for ever-use of any tobacco product to be 18.9% for government school students, compared with 12.2% for private school students (p<.01). Students in government schools scored lower than private school students on most psychosocial risk factors for tobacco use studied here, indicating higher risk. Government school students scored the lowest for refusal skills, self-efficacy, and reasons not to use tobacco. Social susceptibility to chewing tobacco and social susceptibility to smoking were strong correlates of current tobacco use among government school students. Exposure to tobacco advertising was also a strong correlate of current tobacco use for government school students but not private school students. In two large cities of India, students attending government schools are using many forms of tobacco at higher rates than private school students. The psychosocial risk profile of government school students suggests they are more vulnerable to initiation and use and to outside influences that encourage use.     

Comparing tobacco use among incoming recruits and military personnel on active duty in the United States

OBJECTIVE—To compare the tobacco use profile of recruits with that of military personnel on active duty to determine whether the military environment in some way induces service members to initiate tobacco use.
DESIGN AND SETTING—Cross-sectional survey of United States armed forces active duty and recruit personnel in 1994-95.
SUBJECTS—2711 military recruits and 4603 military personnel on active duty.
MAIN OUTCOME MEASURES—Comparative cigarette smoking and smokeless tobacco use prevalence between recruits and personnel on active duty controlling for age, sex, and race. Impact of demographic factors on the odds of smoking or using smokeless tobacco.
RESULTS—Increases in tobacco use in American military personnel occurred exclusively in men. The highest tobacco use resided with white men on active duty (43% cigarette smoking; 24% smokeless tobacco use) and represents a doubling of tobacco use seen among white male recruits. Among non-white men, tobacco use increased 2-4 times between recruits and personnel on active duty.
CONCLUSIONS—Efforts to reduce tobacco use by American military personnel on active duty should focus more on discouraging the initiation of tobacco use.


Keywords: tobacco use; military personnel; United States     

不同质量配方模块风选后片烟的化学成分变化

为了探索不同质量档次配方模块在各级风选单元分离片烟的化学成分变化趋势,以2021年东南烟区初烤烟叶经工业分级后产生的不同质量档次配方模块为研究对象,分别对各级风选单元分离的不同尺寸片烟的化学成分进行了系统分析并进行模块间比较,采用烤烟化学成分可用性指数CCUI对不同尺寸片烟进行评价。结果表明：(1)风选除杂单元产出片烟的化学成分协调性显著低于叶梗分离工序中产出的片烟。(2)在叶梗分离工序产出的不同尺寸片烟中,碎片的化学成分协调性低于大、中、小片,随着打叶级数的增加,碎片还原糖含量、糖碱比与其他尺寸片烟的差异逐渐减小。(3)质量档次较低的配方模块通过筛除碎片的方式进行品质提升的潜力更大。(4)质量档次较低的配方模块在二、三级打叶单元产出的大、中片具备较好的配方可用性。     

The development of tobacco use in adolescence among "snus starters" and "cigarette starters": an analysis of the Swedish "BROMS" cohort

Whether the use of smokeless tobacco can facilitate the transition to cigarette smoking and/or to prolonged tobacco use in adolescence is unclear. We analyzed data from a cohort of 2,938 Swedish adolescents, with six follow-up assessments of tobacco use between the ages of 11 and 18 years. The majority of tobacco users (70%) started by smoking cigarettes, 11% took up snus before smoking, and 19% used both tobacco types close in time. Ever users of tobacco at baseline had a higher risk of being current smokers and/or smokeless tobacco users at the end of follow-up compared with never users, with the highest excess relative risk for "mixed users." Adolescents who initiated tobacco use with cigarettes had a non-significantly increased probability to end up as current smokers compared with snus starters (adjusted OR=1.42; 95% CI 0.98-2.10) The OR of smoking for "mixed starters" was 2.54 (95% CI 1.68-3.91). The risk of becoming current user of any tobacco was also significantly enhanced for "mixed starters." Marked sex differences were observed in these associations, as initiation with cigarettes rather than with snus predicted current smoking or tobacco use only among females. Progression of tobacco use in adolescence is not predicted by onset with snus or cigarettes, but rather by initiation with both tobacco types close in time and/or at young age. The proportion of adolescent smoking prevalence attributable to a potential induction effect of snus is likely small.     

What should be the elements of any settlement with the tobacco industry?

Litigation and regulatory assaults on the tobacco companies may create a willingness among tobacco manufacturers to bargain resources and acceptance of public policy changes for limitations of liability, as has been seen by the recent settlement with the Liggett Group. Two elements absolutely critical to any plan are the elimination of tobacco advertising and promotion and the removal of addiction as a reason for tobacco use. Minimal components of any settlement should include: (a) acceptance by the tobacco manufacturers of the causal relationship between tobacco use and disease, and the addictive nature of nicotine; (b) a total ban on tobacco advertising and promotion; (c) FDA jurisdiction over tobacco products and their nicotine content, with the intent of removing nicotine as soon as acceptable nicotine substitution products are available; (d) reimbursement to the states for Medicaid and other state expenditures attributable to smoking, to the maximum extent feasible; (e) funding for local, state, and federal programmes and research in tobacco control; (f) acceptance of legislation and regulations protecting the right of non-smokers to breathe air free of tobacco smoke; (g) funding for a large, national, media-led, anti- tobacco campaign; and (h) cessation assistance for addicted smokers. If negotiations toward a settlement proceed, it is essential that the public health community participate in defining the elements of any agreement to ensure that whatever agreement develops is focused on reducing tobacco-related disease rather than continuing the profitability of American tobacco companies. That participation requires articulation of the core elements essential to an acceptable agreement. If resolution of the public health issues surrounding continued sale of tobacco products can be reached in the United States, it may provide a model for similar resolution in other countries.


     

Public reaction to the portrayal of the tobacco industry in the film The Insider

OBJECTIVES: To assess public perceptions of the tobacco industry and behavioural intentions for tobacco use in response to watching the film The Insider. DESIGN: Self administered pre-film survey conducted immediately before viewing and post-film telephone survey conducted within 1-5 weeks of viewing. SETTING: Two commercial cinemas in Melbourne, Australia. SUBJECTS: 323 cinema patrons were recruited before screening of target films. 182 watched The Insider, 141 watched Erin Brockovich. INTERVENTIONS: Subjects watched one of two films: The Insider which featured information about unethical conduct by the tobacco industry and negative information about the health effects of smoking, or the "control" film Erin Brockovich which had an analogous plot without anti-tobacco content. MAIN OUTCOME MEASURES: Pre-film questionnaire: assessed movie viewing habits, demographic characteristics, smoking status, attitudes towards the tobacco industry, intentions for smoking. Post-film questionnaire: assessed same attitudes and intentions plus questions on the film viewed and perceptions of smoking prevalence. RESULTS: 266 (82%) subjects completed the post-film survey. Attitudes toward the tobacco industry were unfavourable at baseline. Those who saw The Insider held more negative views of business conduct by the tobacco industry than those who saw Erin Brockovich, once pre-existing attitudes to the industry were controlled for. The Insider also appears to have promoted a short term reduction in intentions to smoke. CONCLUSIONS: Results of this study suggest that if people were recurrently exposed to anti-tobacco content in movies there is potential for a more substantial and lasting impact on attitudes toward the tobacco industry and smoking.     

Tobacco-related research funding at the National Cancer Institute: Portfolio analysis, fiscal year 2003.

A variety of methods is used to classify research conducted or funded by the National Institutes of Health (NIH). We undertook this analysis to delineate research funded by the National Cancer Institute (NCI) that specifically addresses a tobacco-related research question. Intramural projects, extramural grants, and contracts were coded according to eight categories based on information in the abstracts. One category, "research area," classified projects by the primary study outcome. A total of 318 projects met our inclusion criterion of addressing a tobacco-related research question. As a result, our estimate of about US$107 million in tobacco research during the 2003 fiscal year is different from what is officially reported by NCI. The greatest proportion of tobacco research dollars was devoted to policy research (20%, n = 47) and research on the determinants of tobacco use (19%, n = 36). The greatest number of studies focused on investigating the consequences of tobacco use (32%, n = 105). A substantial number of projects addressed a tobacco-related question specifically about women (n = 45) or a racial/ethnic group (n = 99) and used cigarettes as the primary tobacco product (n = 277). These findings elucidate key areas for future tobacco control research and may help to determine future funding priorities at NCI and in the research community at large. Although tobacco causes nearly 30% of all cancer deaths, NCI spent 2.3% of its total fiscal year 2003 budget on tobacco-related research funding.     

Sensitivity and specificity of a reagent-impregnated test strip in identifying smokeless tobacco users.

This study was designed to determine the sensitivity and specificity of a reagent-impregnated test strip in identifying habitual snuff users and tobacco chewers. Urine specimens were obtained from smokeless tobacco users and controls and blind tested on-site using a reagent-impregnated test strip. Samples also were sent to our university hospital lab for cotinine and nicotine analysis by gas chromatography (GC). The test strip results were compared with GC results and self-reported use of snuff and chewing tobacco. A total of 61 subjects enrolled in the study: 26 snuff users, 25 tobacco chewers, and 10 nonconsumers of nicotine. Using GC assessment of nicotine and cotinine (>or=200 ng/ml) as the standard, we found the sensitivity of the test strip to be 96% (25/26) for snuff users and 96% (24/25) for tobacco chewers. When compared with self-report, the sensitivity of the test strip was 92.3% (24/26) for snuff users and 84% (21/25) for tobacco chewers. The specificity for nonusers of nicotine was 100% (10/10) for both the self-report and GC conditions. These results suggest that a reagent-impregnated test strip is a rapid, valid, and user-friendly means of differentiating smokeless tobacco users from nonconsumers of tobacco. The intensity of the pink color on the test strip is proportional to the amount of nicotine or its metabolites present in urine and therefore offers a semiquantitative measure of nicotine consumption.     

A formative examination of messages that discourage tobacco use among junior enlisted members of the United States military.

Smoking prevalence among junior enlisted members of the United States armed forces significantly exceeds that of civilians. Furthermore, nearly 40% of junior enlisted who smoke reported they initiated smoking after joining the military. Although the tobacco industry has attempted to develop messages that encourage military members to use tobacco, no research has examined messages that would counteract industry messages and effectively discourage military members from using tobacco. This study conducted 24 focus groups on four Air Force and two Army installations (N = 189 personnel) to discover effective messages that discourage tobacco use among junior enlisted personnel. Four message themes were identified that hold promise for tobacco control efforts in the military: (a) smoking harms one's ability to positively influence others, (b) smoking increases the chance a military member will be discharged from the military prematurely, (c) smoking lowers readiness to fight and win wars, and (d) smokers are not as productive as other military personnel. In contrast, messages focusing on manipulation by the tobacco industry and the health effects of tobacco use were not strongly supported by military personnel.     

Hungry for tobacco: an analysis of the economic impact of tobacco consumption on the poor in Bangladesh

OBJECTIVE: To investigate the extent of tobacco expenditures in Bangladesh and to compare those costs with potential investment in food and other essential items. DESIGN: Review of available statistics and calculations based thereon. RESULTS: Expenditure on tobacco, particularly cigarettes, represents a major burden for impoverished Bangladeshis. The poorest (household income of less than $24/month) are twice as likely to smoke as the wealthiest (household income of more than $118/month). Average male cigarette smokers spend more than twice as much on cigarettes as per capita expenditure on clothing, housing, health and education combined. The typical poor smoker could easily add over 500 calories to the diet of one or two children with his or her daily tobacco expenditure. An estimated 10.5 million people currently malnourished could have an adequate diet if money on tobacco were spent on food instead. The lives of 350 children could be saved each day. CONCLUSION: Tobacco expenditures exacerbate the effects of poverty and cause significant deterioration in living standards among the poor. This aspect of tobacco use has been largely neglected by those working in poverty and tobacco control. Strong tobacco control measures could have immediate impact on the health of the poor by decreasing tobacco expenditures and thus significantly increasing the resources of the poor. Addressing the issue of tobacco and poverty together could make tobacco control a higher priority for poor countries.