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.     

Self-help cessation programs for smokeless tobacco users: long-term follow-up of a randomized trial.

This paper presents long-term outcomes of the largest clinical trial of smokeless tobacco (SLT) cessation reported to date. SLT users in five northwestern states were recruited to call a toll-free number, and 1,069 users were randomized to one of two self-help conditions: either a manual-only condition or an assisted self-help condition, which included the manual, a targeted video, and two support phone calls. Significant between-group differences were not found for either the 12- or 18-month point-prevalence measure of abstinence from either SLT only or all tobacco products using outcomes based on either the responder or intention-to-treat outcomes. However, using a repeated point-prevalence measure across all three assessment points, we found that significantly more assisted self-help participants reported abstinence, compared with manual-only participants. Compared with manual-only participants, those in the assisted self-help condition were significantly more likely to use recommended cessation techniques. Results demonstrate that low-cost, minimal interventions delivered by mail and phone can help a sizable proportion of individuals quit using SLT.     

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.     

Cost-effectiveness of self-help smokeless tobacco cessation programs.

This study assessed the cost-effectiveness of two low-intensity programs for quitting smokeless tobacco, based on results of a randomized trial with 1,069 volunteer participants. Cost data were collected for two levels of intervention: manual only (a self-help manual) and assisted self-help (the manual plus a videotape and two supportive phone calls from tobacco cessation counselors). Incremental cost-effectiveness ratios were calculated for assisted self-help vs. quitting on one's own, using the manual-only quit rate and data from another study as alternative proxies for no intervention. A threshold analysis was conducted to determine the spontaneous quit rate at which the manual-only intervention becomes more cost-effective than assisted self-help. The cost to provide and receive the assisted self-help intervention averaged US $56 per participant vs. $20 for the manual-only intervention (societal perspective, Year 2000 dollars). Estimates for incremental cost per quit for the assisted self-help intervention ranged from $922 to $1,758, depending on the proxy used for no intervention. The manual-only intervention was more cost-effective than assisted self-help if quitting among motivated chewers who do not receive treatment does not exceed 3.4%. Support from a wife or partner added little cost to a quit attempt for male chewers ($3-$4). Providing a manual, video, and brief phone counseling to smokeless tobacco users who want to quit is a reasonable use of health care resources. The self-help quitting guide also may be a cost-effective treatment, but it remains to be demonstrated whether it is more effective than quitting on one's own.     

Use of smokeless tobacco is a risk factor for cigarette smoking.

This study assessed the risk of smoking uptake over 2 years in adolescent boys (in grades 7 and 9) who had used smokeless tobacco (ST). We used logistic regression to determine whether the odds of adolescent boys taking up regular smoking over a period of 2 years were greater among initial nonsmokers who used ST, compared with nonusers of ST, after accounting for six well-established predictors of smoking. Initiation of weekly smoking 2 years after baseline was associated with ST use at baseline, even after including dichotomous measures of parent, sibling, or close friend smoking; low academic grades; 30-day alcohol use; and a scale measure of deviant behavior. With these other predictors included in the model, the odds ratio for the association of ST use with weekly smoking after 2 years was strong and significant (OR = 2.55, 95% CI 1.45-4.47, p<.001). The use of ST in the 7th and 9th grades is a significant risk factor for subsequent smoking even when controlling for other factors.     

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.     

Sensitivity and specificity of somatic cell count and California Mastitis Test for identifying intramammary infection in early lactation

Associations between values for the somatic cell count (SCC) or the California Mastitis Test (CMT) and intramammary infection (IMI) were studied in 131 dairy cows from three herds during the first 10 d post-calving. Intramammary infection was defined as the presence of one or two bacterial species in one or both quarter milk samples taken within 12 h of calving and at d 3 postcalving. Quarter milk samples identified IMI in 36% of glands. Values for SCC declined at a significantly faster rate over the first 10 d postcalving in non-infected quarters than in infected quarters. The usefulness of quarter milk SCC and CMT for screening was evaluated by calculating the sensitivity and specificity for various threshold values and days postcalving. A SCC threshold of 100,000 cells/ml for quarter samples evaluated on d 5 postcalving had the maximal sensitivity and specificity for detecting IMI. Evaluation of the CMT samples taken on d 3 postcalving using a threshold reaction of greater than zero had the highest sensitivity and specificity for detecting IMI. With this CMT sampling scheme, the sensitivities for detecting IMI with any pathogen, IMI with a major pathogen, and IMI with a minor pathogen were 56.7, 66.7, and 49.5, respectively. The CMT could have a useful role in dairy herd monitoring programs as a screening test to detect fresh cows with IMI caused by major pathogens.     

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.     

烟叶中多菌灵胶体金定量试纸条的研制及应用

为了建立烟叶中残留的多菌灵的快速定量检测方法,利用胶体金免疫层析技术并配套胶体金读数仪,确定更适用于现场检测的多菌灵试纸条的产品形式,明确温度对胶体金试纸条定量结果的影响,用恒温孵育器控制检测温度,基于胶体金读数仪绘制标准曲线。结果表明:①研制的定量胶体金试纸条检测限为0.017 mg/kg,检测范围为0.020~2.0 mg/kg,定量范围为0.020~0.50 mg/kg,加标回收率为95.6%~128.9%,批内变异系数为6.2%~11.2%;②与高效液相色谱-串联质谱法的检测结果相比,阴性样品检测结果准确率大于95%,阳性样品的检测结果在定量范围0.020~0.50 mg/kg内线性关系良好;③对于与多菌灵结构相似的药物,试纸条与其无交叉反应,可特异性定量检测烟叶中残留的多菌灵。本研究中研制的多菌灵定量试纸条具有操作简便、检测速度快、准确性高、稳定性好等优点,适用于基层实验室的大批量样品检测及现场快速检测。      

无烟气烟草制品技术发展现状及趋势研究

为把握国外无烟气烟草制品研发的技术特点和发展趋势,借助Thomson Innovation 专利分析工具对1985 ～ 2014 年间无烟气烟草制品技术专利进行分析,系统揭示近30 年来无烟气烟草制品的研发现状与态势、研发热点以及技术分布。分析结果表明:专利申请变化趋势受政策影响较大;中国和美国是无烟气烟草制品技术专利申请的主要国家;3 类无烟气烟草制品技术研发热点各有不同;以跨国烟草公司为代表的企业通过收购与并购成为无烟气烟草制品技术研发的主导力量。      

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.

     

无烟气烟草制品中TSNAs的分析研究

用100 mmol/L乙酸铵溶液萃取样品后,用0.22μm水相针式过滤器过滤,采用液相色谱-电喷雾串联质谱(LC-ESI MS/MS)测定烟草特有N-亚硝胺,建立了无烟气烟草制品中4种烟草特有N-亚硝胺(TSNAs)的同时测定方法。利用建立的方法测定了72个不同品牌种类的无烟气烟草制品中TSNAs的含量。结果表明,N-亚硝基降烟碱(NNN)、4-(亚硝基甲氨基)-1-(3-吡啶基)-1-丁酮(NNK)、N-亚硝基新烟草碱(NAT)和N-亚硝基假木贼碱(NAB)的检出限分别是0.03、0.08、0.03和0.02 ng/mL,回收率在93.17%-105.25%之间,精密度在2.03%-4.80%之间。方法的检测限低,特异性好,适合于无烟气烟草制品中TSNAs的检测。实验发现不同品牌的无烟气烟草制品TSNAs的含量差别较大,TSNAs的总含量范围从0.54μg/g到31.91μg/g,相差59倍,平均含量为5.06μg/g。     

Effect of smokeless tobacco (snus) on smoking and public health in Sweden

Method: Narrative review of published papers and other data sources (for example, conference abstracts and internet based information) on snus use, use of other tobacco products, and changes in health status in Sweden.

Results: Snus is manufactured and stored in a manner that causes it to deliver lower concentrations of some harmful chemicals than other tobacco products, although it can deliver high doses of nicotine. It is dependence forming, but does not appear to cause cancer or respiratory diseases. It may cause a slight increase in cardiovascular risks and is likely to be harmful to the unborn fetus, although these risks are lower than those caused by smoking. There has been a larger drop in male daily smoking (from 40% in 1976 to 15% in 2002) than female daily smoking (34% in 1976 to 20% in 2002) in Sweden, with a substantial proportion (around 30%) of male ex-smokers using snus when quitting smoking. Over the same time period, rates of lung cancer and myocardial infarction have dropped significantly faster among Swedish men than women and remain at low levels as compared with other developed countries with a long history of tobacco use.

Conclusions: Snus availability in Sweden appears to have contributed to the unusually low rates of smoking among Swedish men by helping them transfer to a notably less harmful form of nicotine dependence.