Undocumented smokeless tobacco use in a family practice population

BACKGROUND: Smokeless tobacco (ST) use is associated with significant health risks and is increasing in prevalence in the United States. This study examined the prevalence of ST use among patients seen in two family practice centers and the documentation of that ST use in the medical record. METHODS: A survey of 209 patients seen in two family practice centers in northeast Tennessee was done to determine current and former smoking and ST use. Charts of all current ST users were reviewed for additional data. RESULTS: Current ST use was reported by 7.7% of patients. Highest rates were found in middle-aged men (27.8%) and elderly women (14.8%). Physicians rarely recorded ST use as a significant problem in the medical record. In several cases, management of other medical conditions may have been compromised by the physicians' lack of awareness of the ST use. CONCLUSIONS: The use of smokeless tobacco may be an important unrecognized problem in patients seen in family physicians' offices.     

Placebo control study of acute smokeless tobacco abstinence in young adult men.

Tobacco use can lead to dependence, as indicated by withdrawal symptomatology during abstinence. In smokers, nicotine-free cigarettes suppress tobacco withdrawal, suggesting that non-nicotine stimuli may be relevant to tobacco dependence. This study examined non-nicotine factors in smokeless tobacco (SLT) withdrawal. SLT users used their own brand of SLT, nicotine-free SLT, or no SLT hourly in 3 approximately 4.5-hr sessions. Participant-rated measures of craving and desire to use SLT were elevated in the abstinence condition relative to the own-brand and nicotine-free conditions. Heart rate was significantly elevated in sessions in which participants' own brand was administered relative to the nicotine-free and abstinence conditions. These results support the notion that stimuli associated with tobacco use may have some withdrawal suppressing qualities, at least in the short term. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Energy requirements of middle-aged men are modifiable by physical activity

BACKGROUND: Energy requirements for weight maintenance decrease with age. Often, this decline is not proportionately matched by reduced energy intake, resulting in weight gain. OBJECTIVE: We hypothesized that energy requirements for total daily weight maintenance in healthy, sedentary, middle-aged men would increase after regular aerobic exercise or aerobic exercise plus weight loss to levels comparable with those in middle-aged athletes. DESIGN: Weight-maintenance energy requirements were determined during weight stability (+/- 0.25 kg) in 14 lean, sedentary (LS) men; 18 obese, sedentary (OS) men; and 10 male athletes of comparable ages (x +/- SEM: 58 +/- 1 y). Studies were done at baseline and after 6 mo of aerobic exercise (LS men) or aerobic exercise plus weight loss (OS men) or 3 mo of deconditioning (athletes). RESULTS: The interventions raised maximal oxygen uptake (VO2max) by 15% in the LS men and by 13% in the OS men and decreased it by 14% in athletes (all P < 0.01), eliminating the differences among groups at baseline. Body fat was reduced significantly in LS and OS men; fat-free mass decreased in OS men. Average daily energy requirements increased by 8% in LS men and by 5% in OS men (both P < 0.01) to levels comparable with the baseline requirements of athletes and correlated with VO2max (r2 = 0.22, P < 0.0001) and fat-free mass (r2 = 0.05, P < 0.02) across the range of VO2max achieved by all subjects. CONCLUSIONS: Under free-living conditions, aerobic exercise eliminated the difference in weight-maintenance energy requirements between middle-aged sedentary and athletic men, suggesting that energy requirements of healthy, middle-aged men are modifiable by regular physical activity.     

Correlates of exclusive or combined use of cigarettes and smokeless tobacco among male adolescents

Past studies which examined correlates of smokeless tobacco or cigarette use have investigated use of one tobacco product regardless of use of the other product. Thus, the etiology of exclusive use of the two tobacco products is not clear. The present study investigated the relationship of problem-prone-related variables to exclusive versus overlapping use of smokeless tobacco and cigarettes. Two samples of southern California male students (eighth-grade and high school) were divided into groups according to their tobacco use status: neither product, cigarettes only, smokeless tobacco only, or both tobacco products. Generally, triers and monthly users of both tobacco products reported a higher risk-taking preference, greater susceptibility to peer social influence to use tobacco products, and greater likelihood to have tried marijuana and alcohol than did subjects who were not users of either tobacco product. Adolescents who used either product, but not both, reported similar scores on most of the variables examined, which fell in between combined or nonuse categories. These results suggest that the number of tobacco products used, not the specific product, is associated with problem-prone attributes.     

Ambulatory 24-h blood pressure monitoring in healthy, middle-aged smokeless tobacco users, smokers, and nontobacco users

Ambulatory 24-h blood pressure monitoring was conducted in 135 healthy, normotensive, middle-aged (35 to 60 years) men, with no antihypertensive medication, to study the influence of habitual smokeless tobacco use (n = 47) and smoking (n = 29) on diurnal blood pressure and heart rate. Comparisons were made with nonusers of tobacco (n = 59). Adjustments were made for differences in age, body mass index, waist-hip ratio, physical fitness, and alcohol intake. Daytime ambulatory heart rates were significantly (P < .05) elevated in both smokeless tobacco users and smokers compared with nonusers (69 +/- 14 and 74 +/- 13 beats/min, respectively, versus 63 +/- 12 beats/min). In subjects > or = 45 years old, ambulatory daytime diastolic blood pressures were significantly elevated, on average by 5 mm Hg, in both smokeless tobacco users and smokers (P < .001) compared with nonusers. Clinical measurements of heart rate and systolic blood pressure in smokers were significantly lower compared with the ambulatory mean values. Nighttime measurements showed only minor differences between the tobacco habit groups. The higher heart rates and blood pressures noted during the daytime in smokers and smokeless tobacco users were most likely due to the effects of nicotine. A strong positive relationship was found between cotinine (major nicotine metabolite) and blood pressure in smokeless tobacco users (systolic blood pressure, r = 0.48, P < .001; diastolic blood pressure, r = 0.41, P = .005), whereas an inverse relationship was found in smokers (systolic blood pressure, r = -0.12, P = .47; diastolic blood pressure, r = -0.03, P = .84), indicating additional and more complex influences on vascular tone in smokers than the influence of nicotine in smokeless tobacco users.     

A pilot study of smokeless tobacco in smoking cessation

Two girls with florid extrapyramidal parkinsonism complicating systemic lupus erythematosus (SLE) are reported. One patient (15 years old) presented with extreme rigidity, irritability, and mutism initially diagnosed as acute psychosis. Examination revealed severe extrapyramidal akinetic mutism, along with marked restlessness. CT and MRI imaging of the brain were unremarkable. EEG revealed moderate generalized disturbance of background activity. 99mTc-HmPAO SPECT cerebral scanning detected decreased regional cerebral blood flow at the basal ganglia. Dopamine-agonist drugs led to complete recovery after 3 months, along with normalization of EEG and SPECT alterations. The second patient (16 years old) was assessed for progressive bradykinesia and apathy impeding her active daily activities, and she was suspected to have developed depression. Neurologic assessment revealed a parkinsonian syndrome that was less severe than that of the first patient. The EEG showed mild disturbance of background activity, and 99mTc-HmPAO SPECT demonstrated impaired regional cerebral blood flow over the basal ganglia. A parkinsonian extrapyramidal syndrome complicating SLE should therefore be taken into account in any patient with SLE presenting with marked behavioral alterations, rigidity, or akinetic mutism.     

Assessing the nicotine content of smokeless tobacco products

The nicotine content of 11 popular brands of smokeless tobacco--including moist snuff, plug and loose-leaf chewing tobacco--was analyzed. In general, moist snuff has the highest nicotine content and loose-leaf chewing tobacco has the lowest, with plug tobacco falling in the middle. Variability in nicotine content may affect smokeless tobacco use and should be considered when studying usage as a variable for adverse effects of ST use.     

Differentiating withdrawal patterns between smokers and smokeless tobacco users.

The present study was designed to document smokeless tobacco withdrawal patterns and to examine differential withdrawal responses between smokers and smokeless users. Participants (N?=?19) were studied under deprivation and nondeprivation conditions, 1 condition per week. The Withdrawal Symptoms Checklist was administered to assess cognitive and affective changes. Both smokers and smokeless users experienced substantially more withdrawal at 48-hr deprivation compared to the 48-hr nondeprivation condition. Participants in both groups endorsed decreasingly fewer withdrawal symptoms from 0 hr to 48 hr on nondeprivation days. This downward trend suggests a need for stabilizing withdrawal responses before deprivation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of behavioral and pharmacological treatment on smokeless tobacco users.

The purpose of this study was to examine the effects of 2 mg of nicotine polacrilex versus placebo gum and of 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. Follow-up assessments were made at 1, 6, and 12 months posttreatment. Survival curve analysis showed that any of the 3 treatment groups involving group behavioral therapy or placebo gum were equally effective and superior to the minimal contact plus 2 mg of nicotine gum treatment in terms of abstinence. On the other hand, withdrawal symptoms were significantly reduced by nicotine gum, compared with placebo during the initial phases of cessation. The ineffectiveness of nicotine gum on treatment outcome may be attributed to its similarity with smokeless tobacco. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of the evidence that pH is a determinant of nicotine dosage from oral use of smokeless tobacco

The effect of calcium supplementation on bone mineral density (BMD) was evaluated in female twin pairs aged 10-17 years with a mean age of 14 years. Forty-two twin pairs (22 monozygotic, 20 dizygotic; (including one monozygotic pair from a set of triplets) completed at least 6 months of the intervention: 37 pairs to 12 months and 28 pairs to 18 months. BMD was measured by dual-energy X-ray absorptiometry (DXA). In a double-blind manner, one twin in each pair was randomly assigned to receive daily a 1000 mg effervescent calcium tablet (Sandocal 1000), and the other a placebo tablet similar in taste and appearance to the calcium supplement but containing no calcium. Compliance (at least 80% tablets consumed), as measured by tablet count, was 85% in the placebo group and 83% in the calcium group over the 18 months of the study, on average increasing dietary calcium to over 1600 mg/day. There was no within-pair difference in the change in height or weight. When the effect of calcium supplementation on BMD was compared with placebo at approximately 6, 12 and 18 months, it was found that there was a 0.015 +/- 0.007 g/ cm2 greater increase in BMD (1.62 +/- 0.84%) at the spine in those on calcium after 18 months. At the end of the first 6 months there was a significant within-pair difference of 1.53 +/- 0.56% at the spine and 1.27 +/- 0.50% at the hip. However, there were no significant differences in the changes in BMD after the initial effect over the first 6 months. Therefore, we found an increase in BMD at the spine with calcium supplementation in females with a mean age of 14 years. The greatest effect was seen in the first 6 months; thereafter the difference was maintained, but there was no accelerated increase in BMD associated with calcium supplementation. The continuance of the intervention until the attainment of peak bone mass and follow-up after cessation of calcium supplementation will be important in clarifying the optimal timing for increased dietary calcium and the sustained, long-term effects of this intervention.     

Aspirin use in middle-aged men with cardiovascular disease: are opportunities being missed?

BACKGROUND: Since the 1980s, clinical trial evidence has supported aspirin use in the secondary prevention of cardiovascular disease (CVD). AIM: To explore aspirin use among British men with known CVD in a population-based study. METHOD: Longitudinal study (British Regional Heart Study), in which subjects have been followed up for cardiovascular morbidity and mortality since 1978-1980. Aspirin use was assessed by questionnaires to study participants in November 1992 (Q92); cardiovascular diagnoses are based on general practice notifications to October 1992. A total of 5751 men aged 52-73 years (87% of survivors) completed questions on aspirin use. RESULTS: Overall, 547 men (9.5%) were taking aspirin daily, of whom 321 (59%) had documented CVD. Among men with pre-existing disease, 153 out of 345 (44%) men with myocardial infarction, 42 out of 109 (39%) with stroke, and 75 out of 247 (29%) with angina were taking aspirin daily. Among men with angina (54% versus 26%) or myocardial infarction (59% versus 42%), those who had undergone coronary artery bypass surgery (CABG) or angioplasty were more likely to be receiving aspirin. Higher rates of aspirin use were also found in those whose last major event occurred after January 1990 (47% versus 34%). There was no association between aspirin use and social class or region of residence. CONCLUSION: Despite strong evidence of its effectiveness, many patients with established CVD were not receiving aspirin. Daily aspirin treatment was less likely in men with less recent major CVD events and in those who had not received invasive treatment.     

Women helping chewers: Partner support and smokeless tobacco cessation.

Data from 363 male smokeless tobacco users and their romantic partners were analyzed to discern the role of support in cessation. Women reported playing a part in enrollment (71%), and more than half examined program materials or discussed cessation activities with the chewers. Women's reports of delivered support correlated substantially with men's experience of received support. Men's received positive support predicted abstinence at 6-month follow-up (odds ratio=1.29, confidence interval=1.03-1.61) and more than 24 hr of abstinence for those still using tobacco at 6 months (odds ratio=1.75, confidence interval=1.30-2.36) and moderated the effect of baseline depression and addiction on abstinence. Women played a major role through all stages of cessation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Chronic effects of smokeless tobacco extract on rat liver histopathology and production of HSP-90

Tobacco consumption is a worldwide problem. The recent increase in the consumption of the smokeless tobacco products (snuff and chewing tobacco) has stimulated interest into the carcinogenic effects of these forms of tobacco. The use of smokeless tobacco products has increased in popularity as the use of cigarettes has become less socially acceptable. For most individuals the use of tobacco is a chronic process. Therefore, the effects of an aqueous extract of smokeless tobacco (STE) in rats following low-dose exposure were examined. Female Sprague-Dawley rats were treated orally with 25 mg STE/kg every other day for 90 days. In order to obtain information regarding the cytotoxicity of STE, the ultrastructural changes occurring in livers of rats following administration of STE were examined under light and electron microscopy. Electron microscopy revealed that in the perisinusoidal spaces an accumulation of indistinct filamentous material occurred following 60 days of treatment, occupying most of the sinusoids. Moreover, the lipids were in a state of disintegration. Significant increases in 90 kDa protein expression were also observed due to chronic treatment with STE. Western blot analysis using a polyclonal mouse antibody against heat shock/stress protein 90 (HSP90) confirmed that the overexpressed proteins were heat shock/stress proteins (HSPs). The HSPs are believed to serve as adaptive or survival functions involving a rapid but transient reprogramming of cellular metabolic activity to protect cells from oxidative damage.     

Smoking cessation improves insulin sensitivity in healthy middle-aged men

Cigarette smokers have recently been shown to exhibit insulin resistance, dyslipidaemia and markers of the insulin resistance syndrome (IRS). The aim of this study was to examine the effects of smoking cessation on insulin sensitivity and IRS. Forty male, non-obese healthy smokers participated in this open parallel study with 8 weeks of follow-up. Seventeen subjects were able to stop smoking, while 23 subjects continued to smoke and served as a controls group. Anthropometric and metabolic data were measured. Degree of insulin sensitivity was determined with the euglycaemic hyperinsulinaemic clamp technique. Smoking cessation increased insulin sensitivity and improved the lipoprotein profile in spite of a modest increase in body weight. Initial smoking habits correlated positively with the increase in BMI as well as the improvements in the metabolic variables after smoking cessation. These data support the view that smoking causes insulin resistance and IRS, and also demonstrate that the beneficial metabolic effects of smoking cessation override the effects of an accompanying modest increase in body weight.     

Effect of olive oil on immune function in middle-aged men

Autocrine motility factor is a tumor-secreted cytokine which regulates cellular growth and motility by a receptor-mediated pathway. In the accompanying report (Part I of II), it was demonstrated that high (K1735-M1) and low (K1735-C1.11) metastatic murine melanoma cells display distinct adhesion and spreading characteristics which correlate with their differential spontaneous and stimulated migrations on the extracellular matrix components fibronectin, laminin and collagen IV. These parameters were further related to discrete profiles of focal adhesion plaque integrity and reorganization. Here we describe unique migration patterns observed in these murine melanoma cells which reflect differences in degradation and/or remodeling of the cellular substratum. These profiles of matrix interaction were influenced distinctly by autocrine motility factor and dictated by both substrate composition and cellular phenotype. Since activation of the autocrine motility factor receptor stimulates invasion of a reconstituted basement membrane and enhances experimental metastasis by high- but not low-metastatic K1735 cells, differences in the invasive phenotypes of these cells may be due in part to their differential responses to external stimuli coupled with internal propensities toward either matrix degradation and migration (high-metastatic cells) or matrix remodeling and stasis (low-metastatic cells).     

Marihuana and tobacco use in pregnancy

Marihuana and tobacco smoking are two of the most commonly abused substances in pregnancy. Smoke from both agents contain a multitude of potentially active components, which make them difficult to study. Both have been associated with adverse effects in pregnancy in animal and human studies. Data on marihuana use during pregnancy have been conflicting. There is much evidence, however, demonstrating adverse pregnancy outcomes associated with cigarette smoking which, fortunately, can be reversed with smoking cessation.     

Oral mucosal changes and nicotine disposition in users of Swedish smokeless tobacco products: a comparative study

A survey was conducted to assess the knowledge of 30 oral hygiene (OH I & II) and 79 dental students (BCHD III & VI) on HIV infection and AIDS. A questionnaire consisting of twenty-nine questions based on the 'agree-disagree' format was prepared for this study. Clinical slides were projected to assess students' ability to identify oral manifestations of HIV infection. Most students agreed that HIV-sero-positive people were entitled to the same dignity and respect as those who were suffering from other illnesses. Students were concerned about treating sero-positive patients. They would preferably receive training in the management of these patients in a controlled environment. They had a poor perception of the risk of infection following needle-stick injury and whether HIV could be transmitted through contact with saliva. Most students felt that they had insufficient lectures on HIV/AIDS and had practically no clinical exposure to HIV-sero-positive patients.     

Life satisfaction and identity structure in late middle-aged men and women.

A total of 32 retirement-age subjects (17 men and 15 women) provided information about their lives by rating each of their identities in terms of a list of self-generated features. They also rank-ordered their currently enacted identities in terms of time spent in each and completed a life-satisfaction questionnaire. The Identities?×?Features matrices were analyzed by algorithms that generated a hierarchical model of identity structure for each subject based on feature ratings. The hierarchical levels of identities were combined with time-spent rankings to obtain an index of personal style, a measure that reflected the unique organization of identities for each subject. Personal style indices were then correlated with life-satisfaction scores. Results confirmed the prediction that life satisfaction in this age group is a function of the amount of time spent in identities that give expression to multiple aspects of the self. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social perception of middle-aged persons varying in physical attractiveness.

Presented 6 pictures of middle-aged persons varying in attractiveness to 90 married graduate students and 54 married elderly females. Results support the hypothesis that physically attractive middle-aged persons are judged in more socially desirable terms, and that the elderly hold a stronger physical attractiveness stereotype than young adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)