Perceived risk of harm from cigarettes or smokeless tobacco among U.S. high school seniors.

This study examined perceived risk of harm from smoking or ST use in a U.S. nationally representative sample of high school seniors and examined its association with current smoking status. Data were derived from the Monitoring the Future project for 1999 through 2003 (n = 11,093). We used multiple logistic regression analysis to examine the association between comparative perceived risk of harm of smoking and ST use with current smoking status, while adjusting for sex, race, and perceived risk of harm from smoking. In 1999-2003, 74.0% of high school seniors perceived great risk of harm from smoking and 44.9% perceived great risk from using ST. Perceived risk varied by smoking intensity: 80.3% of non-smokers perceived great risk of harm from smoking, compared to 49.7% of students who smoked about one-half pack per day and 36.1% of pack-a-day smokers. Overall, 52.7% perceived equal risk of harm from using either product, 41.3% perceived greater risk from cigarettes, and 6.1% perceived a greater risk from using ST. Adjusting for sex and race, high school seniors who perceived that smoking conveyed a greater risk for harm than did using smokeless tobacco were significantly more likely to be smokers than were those who perceived equal risk from the products (odds ratio [OR] = 1.43; 95% confidence interval [CI] 1.29-1.60). Those who perceived that using smokeless tobacco was riskier than smoking were even more likely to be current smokers (OR = 2.43; 95% CI 1.96-3.01). Effective methods for communicating accurate health risks to young people are needed.     

Understanding tobacco use among Filipino American men.

Although lung cancer is the top cancer killer among Filipino American men, data on tobacco-related knowledge and attitudes, cessation efforts, and preferences for smoking cessation programs among this population are lacking. We interviewed a community sample of 318 Filipino American men (110 current, 108 former, and 100 never-smokers, all immigrants) aged 40-75 years in Los Angeles County in English and Tagalog, to gain a better understanding of their tobacco use as a first step toward developing a culturally tailored smoking cessation program. In our sample, smokers had lower levels of education and income compared with nonsmokers and were less acculturated based on language use and English fluency. Smokers were more likely than nonsmokers to agree that smoking can alleviate stress, depression, and boredom, and that it is part of social interactions, growing up, being a man, and looking mature. These beliefs were summarized in a Smoking Beliefs Scale (Cronbach's alpha = .84), which predicted current smoking in a multivariate analysis, together with perceived risk of getting smoking-related diseases and peer norms. The most preferred smoking cessation intervention formats were educational small group sessions with other Filipino men (32%), followed by one-on-one consultations by a health professional (26%), video (20%), pamphlet (17%), and toll-free telephone number (6%). More than half of the current smokers requested these smoking cessation activities in Tagalog (34%) or a combination of Tagalog and English (24%). Based on these findings, we make specific recommendations for a smoking cessation program for Filipino men.     

Smokeless tobacco use 1992-2002: trends and measurement in the Current Population Survey-Tobacco Use Supplements

Background

As smoking prevalence declines in the United States, it is important to understand if smokeless tobacco (SLT) use is also changing and if so, among what groups.

Methods

We examine the prevalence of SLT use and smoking, 1992–2002, using the Current Population Survey‐Tobacco Use Supplements (CPS‐TUS), which used US nationally representative samples based on stratified clusters of households.

Results

Consistent with declines in smoking, the prevalence of current SLT use declined over the period 1992–2002 for males and females ages 18 and older. The overall separate declines in SLT use and in smoking are mirrored by a decline in concurrent use of SLT and cigarettes. SLT use is becoming more associated with white males, but use is declining faster among the youngest males.

Conclusions

The findings indicate that relative reductions in smoking prevalence are exceeded by relative reductions in SLT use, with sizeable reductions in concurrent use. These results suggest that the stricter cigarette policies of recent years may not only reduce cigarette use, but also the use of alternative tobacco products. In light of potential policy implications of SLT use as a potential reduced exposure product (PREP), current survey methods require more careful measurement of SLT use in terms of initiation, duration, quantity, and cessation.     

Nicotine lozenges for the treatment of smokeless tobacco use.

Nicotine lozenges have been shown to increase tobacco abstinence rates in cigarette smokers, but they have not been evaluated in smokeless tobacco (ST) users. We conducted an open-label, one-arm, phase II clinical trial to evaluate the efficacy of the 4-mg nicotine lozenge for the treatment of withdrawal and craving associated with tobacco abstinence among ST users. Eligible subjects received 4-mg nicotine lozenges for 6 weeks followed by a 6-week taper. Subjects completed daily tobacco withdrawal diaries, and data on lozenge use, adverse events, and lozenge acceptability were collected. Urine anabasine was collected at 3 and 6 months for biochemical confirmation of self-reported tobacco abstinence. Participants were 30 ST users with a mean age of 35.4 years (SD=6.5) using an average of 4.2 cans or pouches (SD=3.2) of ST per week for a mean of 15.1 years (SD=6.5). Among subjects continuously tobacco abstinent for the first 2 weeks, no significant increases in composite withdrawal symptoms were observed, compared with baseline symptoms, whereas craving decreased significantly. Biochemically confirmed 7-day point-prevalence tobacco abstinence was 53% (95% CI=34%-72%) at 12 weeks (end of treatment) and 47% (95% CI=28%-66%) at 6 months. Few adverse events attributable to the nicotine lozenge occurred, and the lozenge was perceived as helpful in assisting subjects quit ST. The use of the 4-mg nicotine lozenge appears promising for the clinical treatment of withdrawal symptoms and craving associated with tobacco abstinence in ST users. Future phase III clinical trials investigating the efficacy of nicotine lozenges are warranted.     

First,tell the truth: a dialogue on human rights,deception, and the use of smokeless tobacco as a substitute for cigarettes

The use of smokeless tobacco as a substitute for cigarettes raises many scientific and ethical issues, as the fictitious discussion below reveals.     

Effect of high-dose nicotine patch therapy on tobacco withdrawal symptoms among smokeless tobacco users.

No pharmacotherapies have been shown to increase long-term (> or = 6-month) abstinence rates among smokeless tobacco (ST) users. Available evidence suggests that underdosing may occur with standard-dose nicotine replacement therapy (NRT) in ST users. We investigated the effect of high-dose nicotine therapy on tobacco withdrawal symptoms among ST users in a randomized, controlled clinical pilot study. A total of 42 ST users using at least 3 cans or pouches per week were randomized to nicotine patch doses of 63, 42, or 21 mg/day or placebo for 8 weeks. Multiple daily assessments of tobacco withdrawal and nicotine toxicity were obtained with an electronic diary. During the first week of nicotine patch therapy, we observed a dose-response relationship such that higher nicotine patch doses were associated with less decreased arousal (chi2 = 6.87, p = .009), less negative affect (chi2 = 3.85, p = .05), and less restlessness (chi2 = 3.90, p = .048). During the second week, higher nicotine patch doses were associated with less decreased arousal (chi2 = 6.77, p = .009). Overall, the frequency of nicotine toxicity symptoms did not differ by dose group. Of specific symptoms, nausea was observed to be more frequent in the 63 mg/day dose group compared with placebo (p = .035). In conclusion, high-dose nicotine patch therapy resulted in a greater reduction of tobacco withdrawal symptoms among ST users using at least 3 cans per week. High-dose nicotine patch therapy is safe and well tolerated in this population of tobacco users.     

Relationship between smokeless tobacco use and body weight in young adult military recruits.

Long-time cigarette smokers tend to weigh less than nonsmokers, and those who quit smoking typically gain weight. Little is known, however, about the relationship between smokeless tobacco and body weight. The present study investigated the association between smokeless tobacco use and body weight among 22,974 Air Force recruits (27.4% female, mean age=20.2 years, body mass index=22.7) undergoing basic military training. Current, former, and experimental smokeless tobacco users weighed significantly more than recruits who had never tried smokeless tobacco (p values <.05). Logistic regression analysis also indicated that the likelihood of being classified as overweight was significantly greater for daily (OR=1.29, 95% CI=1.07-1.54), occasional (OR=1.50, 95% CI=1.17-1.93), former (OR=1.33, 95% CI=1.05-1.67), and experimental (OR=1.13, 95% CI=1.02-1.24) smokeless tobacco users relative to never-users (p values <.05). These results suggest that smokeless tobacco use does not have significant weight-attenuating effects, at least in the short term. Furthermore, using chewing tobacco or snuff may be associated with a greater body weight among young adults.     

Nicotine delivery capabilities of smokeless tobacco products and implications for control of tobacco dependence in South Africa

Objectives: Smokeless tobacco (SLT) use is popular among black South African women and children. The study sought to determine the nicotine delivery capability of popular industrialised and traditional SLT brands in South Africa, and to provide information for policy action by regulatory authorities.

Design: Laboratory chemical analysis of four industrialised and one traditional SLT products commercially available, using previously published analytical methods. Potential for dependence was inferred from nicotine delivery capabilities determined by the percentage free base nicotine.

Measurements: Moisture, pH, total nicotine, and percentage free base nicotine.

Results: Total nicotine content was between 6–16 mg/g. The pH varied between 7–10 and this correlated with percentage free base nicotine, which ranged between 10–99%. The nicotine delivery capability of the traditional product was lower than that of the industrialised products except for the recently introduced portion bag snus, which had comparable total nicotine but the lowest pH and percentage free base nicotine. The most popular SLT brands showed the highest percentage free base nicotine ever reported for any industrialised SLT or cigarette brands. Small cans contained higher nicotine than the large cans of the same brand tested. Findings from the study support a potential for limited "product graduation" by users.

Conclusions: South African SLT users are mostly exposed to potentially very highly addictive levels of nicotine that may favour tobacco dependence and its consequent health risks. The increasing use of SLT by women of childbearing age support the need for intensified policy action to control its use.

     

The relationship of smoking cessation to sociodemographic characteristics, smoking intensity, and tobacco control policies.

The present study examined the relationship between recent smoking cessation activities and sociodemographic characteristics, smoking intensity, and tobacco control policies among daily smokers in the United States. The study used the U.S. Current Population Survey 1998-1999 Tobacco Use Supplement, supplemented with information on state-level tobacco control policies. The sample was limited to individuals aged 25 years or older who were smoking daily 1 year ago. We estimated frequencies and multivariate logistic equations for making a quit attempt and remaining abstinent at least 3 months. These measures were related to demographic characteristics, smoking intensity, and tobacco control policies. Younger, higher socioeconomic status (SES), and less intense (fewer cigarettes per day) daily smokers were more likely to make quit attempts, but the likelihood of remaining abstinent for those making a quit attempt was greater for older, higher SES, and heavy daily smokers. We found evidence that cessation behaviors were related to higher cigarette prices and the presence of state-level media/comprehensive campaigns, but less clear evidence exists for an association with bans restricting workplace smoking. The results indicate that certain types of smokers are more likely to attempt to quit and to have success and that the characteristics of these smokers differ. Price policies can have an important role in helping daily smokers to quit. Further research is needed regarding the role of quantity smoked.     

Preventing tobacco use among lesbian, gay, bisexual, and transgender youths.

A paucity of information regarding tobacco use among lesbian, gay, bisexual, and transgender (LGBT) youths impedes prevention programs. The aim of the present study was to conduct formative qualitative research regarding subpopulations at risk for tobacco use, protective factors, patterns of use, and approaches to prevention. This report focuses on participants' recommendations for the development of preventive intervention. Purposive sampling and maximum variation sampling were used to select 30 LGBT youths and 30 interactors for face-to-face interviews. NUD*IST6 text software was used for the indexing and thematic analysis of qualitative data, based on a grounded theory approach. All participants offered suggestions for tobacco prevention pertaining to the optimal process of prevention and cessation programs, specific strategies to promote tobacco prevention and cessation, and general strategies to foster nonsmoking. Several key themes regarding prevention emerged: LGBT youth should be involved in the design and implementation of interventions; prevention programs should support positive identity formation as well as nonsmoking; the general approach to prevention should be entertaining, supportive, and interactive; and the public might not distinguish primary prevention from cessation activities. All but one young smoker had attempted to quit at least once; but only one individual had succeeded. By way of implications, prevention programs should involve young people in enjoyable and engaging activities, address the psychosocial and cultural underpinnings of tobacco use, support healthy psychosocial development, and consider offering pharmacological smoking cessation aids.     

Comprehensive tobacco control policies and the smoking behaviour of Canadian adults

OBJECTIVE: To examine the associations of cigarette prices, restrictions on public smoking, and health education with the odds of adult smoking and amount smoked daily. DESIGN: Multi-level analysis of adult (age 25+) smoking patterns in Canada's National Population Health Survey, after adding administrative data on prices, bylaws, and health education according to the survey respondent's place of residence. SETTING/SUBJECTS: Population based sample of Canadians age 25+ in households (n = 14 355). OUTCOME MEASURES: Smoking status, amount consumed daily. ANALYSIS: Logistic regression for smoking status, multiple regression for amount smoked, with controls for age, education, marital status; separate analyses for men and women. RESULTS: Cigarette prices were positively associated with the odds of being a non-smoker and negatively with amount smoked, for adults of both sexes. Per capita health education expenditures were positively associated with the odds of being a non-smoker and negatively with amount smoked--for men but not women. The restrictiveness of municipal bylaws limiting public smoking was positively associated with the odds of being a non-smoker and negatively with amount smoked--for women but not men. These results are independent of age, education, and marital status. CONCLUSIONS: To be effective, tobacco control must comprise a mix of strategies as men and women respond differently to health education and restrictions on public smoking; taxation, reflected in higher cigarette prices, is the only one of these measures related to smoking for both sexes. This model permits calculations of the level of increase in each measure that is required to reduce the prevalence of smoking by a specified amount.     

Tobacco on campus: industry marketing and tobacco control policy among post-secondary institutions in Canada

Objective: Post-secondary institutions provide a unique opportunity to implement and evaluate leading edge tobacco policies, while influencing a key group of young adults. To date, however, we know little about the tobacco control environment at post-secondary institutions outside the USA.