Smokeless tobacco use among adults in the Northern Province of South Africa: qualitative data from focus groups

The aim of this study was to investigate perceptions on the use of smokeless tobacco in the Northern Province, South Africa. Ten focus groups were conducted in 1999 with two heterogeneous groups (5 with middle-aged and 5 with the aged). They were mainly Northern Sotho speaking. From 72 participants 16 women and 8 men admitted to using snuff. The most popular types of smokeless tobacco used were homemade snuff and only a few used "commercial" snuff. The basic ingredients for homemade snuff were tobacco and other plant leaves. Snuff was found to have important functions and to be socially acceptable in the groups studied mainly for ceremonial and medicinal use and to a lesser degree for relaxation and pleasure. Generally, positive and medicinal effects were noted for snuff use. Most participants agreed that it is addictive, but only a few acknowledged the negative effects in terms of causing cancer.     

Personality profiles associated with smokeless tobacco use patterns

The purpose of this study was to examine the personality characteristics of male dippers and chewers of smokeless tobacco. The study objective was to determine any differences in personality characteristics between dippers and chewers of smokeless tobacco and nonusers. A survey at a southeastern university provided a sample of 289 males, of which 55 (19%) were smokeless tobacco users. Each subject was administered a demographic data sheet and Cattell's Sixteen Personality Factor Questionnaire (16 PF). Smokeless tobacco users were categorized as snuff dippers or tobacco chewers, and comparisons of personality characteristics were made between persons who exclusively dipped, persons who exclusively chewed, persons who dipped and chewed, and persons who did neither. The results of the study indicated that smokeless tobacco use is primarily a White male habit; very few Blacks or other racial groups consumed smokeless tobacco among this population. Significant (p less than 0.05) personality differences between snuff dippers and tobacco chewers were noted. Snuff dippers were more socially outgoing, enthusiastic, imaginative and group dependent than chewers. Chewers were found to be more uncompromising, critical in outlook and practical and less easily influenced by others than dippers.     

Pacific Northwest Native American Youth and Smokeless Tobacco Use

This study examined snuff and chewing tobacco use among Alaska Native and American Indian adolescents. Results show frequent and early use of smokeless tobacco products. Almost one fifth of all females and close to one half of all males had used snuff or chewing tobacco on more than 20 occasions. Weekly smokeless tobacco use was reported by 34% of all females and by 42.6% of all males. By product type, 32.6% of all subjects had used snuff and 27.8% had chewed tobacco in the past week. Among females, over one half of all subjects had used snuff or chewing tobacco before age 10 years. Among males, nearly one half of the subjects first used smokeless tobacco prior to 8 years of age. Few subjects had used cigarettes or other smoked tobacco products.

Smokeless tobacco use by young Americans is drawing increased attention (Chassin et al., 1985; Christen, 1985; Edmundson et al., in press; Glover, O'Brien, and Holbert, in press). Among those at highest risk for early and frequent smokeless tobacco use are Native American youth (Schinke et al., 1986). Though Alaska Native and American Indian people enjoy the lowest smoking rates of any U.S. ethnic-racial group, smokeless tobacco use by Native adolescents may antecede health problems and later cigarette use (Beauvais, Oetting, and Edwards, in press). In 1986 we studied the prevalence, onset, and relationship to smoking of snuff and chewing tobacco use among a sample of Alaska Native and American Indian youth.     

Use of tobacco products among rural older adults: Prevalence of ever use and cumulative lifetime use

Tobacco use is a well-documented contributor to morbidity and mortality in the US and worldwide. Information on the comprehensive use of tobacco products is lacking, particularly smokeless tobacco in its various forms. Data from 635 older (≥ 60 years) African American, American Indian and White adults in rural North Carolina were analyzed to assess current and lifetime use of cigarettes, cigars, pipe, snuff and chewing tobacco. Participants were classified as being current, former or never users of each product. Lifetime use of each product was determined by asking about typical intensity of use per day and length of time the product has been used. About 70% of participants were current or former users of any tobacco product, and about one-third of participants currently used at least one product. Variations in use were observed by ethnicity and sex, particularly for cigarettes, snuff and chewing tobacco. Variations were also seen according to other demographic and health characteristics. These data add to a limited body of literature on lifetime use of smoked and smokeless tobacco products, and are useful in identifying the impact of these products on morbidity and mortality, particularly for vulnerable populations.     

Use of snuff, chewing tobacco, and cigarettes among adolescents in a tobacco-producing area

This study describes the prevalence and patterns of smokeless tobacco and cigarette use among adolescents with a specific focus on those living in a high tobacco production area. The subjects were 582 male and 485 female students in grades 7 through 12, with 54% living in a rural (nonmetro) area and the remainder living in an urban (metro) area. Self-reports of tobacco usage were validated using biochemical tests. High smokeless tobacco usage rates were found among nonmetro males--90% had tried one or more smokeless tobacco products and 33% had used at least one of the products in the last 6 days. Students' tobacco usage increased dramatically as the degree of personal involvement in raising tobacco increased. Of senior high boys who had household involvement in tobacco, 100% had tried snuff and 42% had used it in the last 6 days; 80% had tried cigarettes and 53% had used them in the last 6 days. Some other results were: (1) use of snuff was more popular than chewing tobacco, (2) the average grade for initiation to tobacco was the fourth grade for nonmetro students and the fifth grade for metro students, and (3) a large number of male smokeless users also reported cigarette use. Students from tobacco-raising households are at high risk for tobacco use. Future research should focus on effective prevention methods for high-risk students.     

Effects of smokeless tobacco and tumor promoters on cell population growth and apoptosis of B lymphocytes infected with epstein-barr virus types 1 and 2.

The effects of smokeless tobacco purified products 4-(N-methyl-N-nitrosamine)-1-3-pyridinyl)-1-butanone (NNK) and N-nitrosonornicotine (NNN), smokeless tobacco extracts (dry snuff, moist snuff, and loose leaf), and the tumor promoters 12-O-tetradecanoyl phorbol-13-acetate (TPA) and n-butyrate on cell population growth, cell death, and apoptosis were studied in B lymphocyte cell lines harboring Epstein-Barr virus (EBV) type 1 (Raji and X50-7) or type 2 (HR-1K and AG876) and in an EBV-uninfected control lymphocyte cell line (Ramos). Spontaneous apoptosis was present in all EBV-infected cell lines, but at varying levels. Spontaneous and induced apoptosis were generally greater by Student-Newman-Keuls tests in cells harboring EBV type 2 compared to EBV type 1. The greatest effects on cell population growth, cell death, and apoptosis on cells harboring lytic EBV type 1 (X50-7) was with each of the three smokeless tobacco extracts. The greatest effects on cells harboring EBV type 2 was with TPA and n-butyrate. There were no effects of smokeless tobacco extracts on the Raji cell line that harbors EBV type 1 incapable of lytic replication. Smokeless tobacco purified products, NNN and NNK, had no discernible effects. At the concentrations used in these experiments, there appears to be an EBV type-specific response to chemical induction, with greater susceptibility of lytic EBV type 1 to smokeless tobacco extracts and lytic EBV type 2 to TPA and n-butyrate. This EBV type-specific susceptibility to the effects of smokeless tobacco extracts is another phenotypic difference between EBV types. The use of smokeless tobacco products may affect B lymphocytes infected with replication-capable EBV in the oropharynx. The absence of significant effects with NNK and NNN suggests that these properties reside with other compounds present in tobacco extracts.     

Differential use of other tobacco products among current and former cigarette smokers by income level

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.     

Evaluation of the effect of smokeless tobacco purified products and extracts on latent Epstein-Barr virus.

Numerous chemical tumor promoters induce latent Epstein Barr virus (EBV) to active replication. The effect of smokeless tobacco purified products N-nitrosonornicotine (NNN), 4-(N-methyl-N-nitrosamine)-1-3-pyridinyl)-1-butanone (NNK), benzo(a)pyrene (BaP), and smokeless tobacco extracts (dry snuff, moist snuff, and loose leaf tobacco) was tested for induction of latent EBV in Raji cells using fluorescence-activated cell sorter flow cytometry detection of the restricted component of EBV early antigen (EA-R). Concentrations of smokeless tobacco purified products or preparations were used that have carcinogenic effects in animal cell lines. There was no discernible effect for the 6-7-day duration of treatment on viability of Raji cells, or on induction of latent EBV in Raji cells. Results were comparable using paraformaldehyde- or acetone-fixed cells. There does not appear to be an in vitro effect of smokeless tobacco constituents on EBV-infected lymphocytes that may contribute to development of oral cancers.     

Comparative effectiveness of the nicotine lozenge and tobacco-free snuff for smokeless tobacco reduction

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 (p < .001) ST use in cans/week and dips/day from baseline which was sustained through the end-of-study. The observed biochemically-confirmed abstinence rates at week 26 were similar between groups (12% vs. 12%, one-tailed p = .615). The 4-mg nicotine lozenge and the tobacco-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.     

Smokeless tobacco and cigarette use among black secondary school students in South Africa

This study was conducted in 2001 with the aim of providing data on black South African secondary school students' tobacco use status, knowledge, and attitudes. The sample included 330 Grade 10 and 382 Grade 12 secondary school pupils chosen at random from six rural secondary schools in one of the regions in the Northern Province of South Africa. Results show a prevalence of 9.1% current smokers among boys and 5% among girls, and 8.4% current snuff users among girls and 3.9% among boys. The mean age of onset to take snuff was 12.5 years and that for smoking cigarettes 14.8 years. Adolescents who reported that some family member or their peers used tobacco were more likely to be users of tobacco. Two-thirds of the current snuff users believed that using snuff was safer than smoking cigarettes. Knowledge was found to be related to attitude but not with tobacco use behavior. Awareness of the adverse effects of such tobacco habits was poor and intervention programs to curb tobacco use is required.     

Smokeless Tobacco and Cigarette Use Among Black Secondary School Students in South Africa

This study was conducted in 2001 with the aim of providing data on black South African secondary school students’ tobacco use status, knowledge, and attitudes. The sample included 330 Grade 10 and 382 Grade 12 secondary school pupils chosen at random from six rural secondary schools in one of the regions in the Northern Province of South Africa. Results show a prevalence of 9.1% current smokers among boys and 5% among girls, and 8.4% current snuff users among girls and 3.9% among boys. The mean age of onset to take snuff was 12.5 years and that for smoking cigarettes 14.8 years. Adolescents who reported that some family member or their peers used tobacco were more likely to be users of tobacco. Two-thirds of the current snuff users believed that using snuff was safer than smoking cigarettes. Knowledge was found to be related to attitude but not with tobacco use behavior. Awareness of the adverse effects of such tobacco habits was poor and intervention programs to curb tobacco use is required.     

Extracts of smokeless tobacco induce pro-inflammatory changes in cultured human vascular endothelial cells

Habitual use of smokeless tobacco leads to accumulation of inflammatory leukocytes at the site of placement, which may contribute to tissue damage. Recruitment of leukocytes is facilitated by the endothelial lining of blood vessels, which can be activated to express adhesion molecules and to produce chemoattractants. The ability of aqueous extracts of chewing tobacco, dry snuff, and moist snuff to stimulate such changes was investigated using cultured human umbilical vein endothelial cells (HUVEC). All three extracts caused HUVEC to express the adhesion molecule E-selectin and to produce the chemokines interleukin-8 and monocyte chemoattractant protein-1. Neutrophils migrated avidly across HUVEC monolayers that had been previously exposed to the extracts, whereas migration across unstimulated monolayers was negligible. The smokeless tobacco extracts contained relatively high concentrations of bacterial lipopolysaccharide (LPS). Although LPS appeared to be the major stimulatory component in extracts of chewing tobacco, it accounted for only part of the activity found in extracts of moist and dry snuffs. These observations suggest that smokeless tobacco may induce inflammatory changes in vivo by activating endothelium in a manner that promotes recruitment of leukocytes.     

Proposed definition of a smokeless tobacco user based on “potential” nicotine consumption

This study examined and operationally defined "light," "moderate," and "heavy" users of smokeless tobacco according to the potential amounts of nicotine consumed per week from chewing tobacco and/or snuff products. Fifty adult male smokeless tobacco users ranging in ages from 18-85 were tested to determine nicotine content of smokeless tobacco products consumed. The smokeless tobacco products were blindly analyzed by gas chromatography to determine nicotine content. Mean nicotine yield per week was calculated by multiplying the number of cans and/or pouches used per week and placed on a normal probability distribution. The mean nicotine yielded 238 mg/wk and the categories emerged as "light" less than or equal to 87 mg/wk, "moderate" 88-388 mg/wk and "heavy" users greater than or equal to 389 mg/wk. Differences regarding type of user (light, moderate, heavy) were crossed tabbed with educational levels, years of smokeless tobacco use, age the habit was initiated, perception of harm and whether habit forming, and reason for using smokeless tobacco.     

Advertising Receptivity and Youth Initiation of Smokeless Tobacco

Background: Cross-sectional data suggests that adolescents’ receptivity to the advertising of smokeless tobacco is correlated with use of chewing tobacco or snuff. Lack of longitudinal data has precluded determination of whether advertising receptivity precedes or follows initiation of smokeless tobacco. Objectives: The objective of this study was to test for the association between advertising receptivity and subsequent initiation of smokeless tobacco among adolescent males. Methods: Adolescent males from the 1993–1999 Teen Longitudinal California Tobacco Survey were selected at the baseline survey for never having used smokeless tobacco. Separate longitudinal analyses corresponded to two dependent variables, ever use of smokeless tobacco (1993–1996; N = 1,388) and use on 20 or more occasions (1993–1999; N = 1,014). Models were adjusted for demographic variables, risk factors for smokeless tobacco use, and exposure to users of smokeless tobacco. Results: Advertising receptivity at baseline was predictive of ever use by late adolescence (RR(95% CI) = 2.0 (1.5, 2.8)) and regular use by young adulthood (RR(95% CI) = 3.7 (2.1, 6.7)) in models that were adjusted for covariates. Conclusions/ Importance: The findings challenge the tobacco industry's assertion that tobacco marketing does not impact youth initiation. This is particularly relevant to tobacco control in the United States because the 2009 Tobacco Control Act places fewer restrictions on smokeless tobacco products compared to cigarettes.     

Smokeless tobacco use among United States Air Force trainees

Background: The prevalence of smokeless tobacco use in the United States Air Force (USAF) exceeds civilian use rates. The prevalence and correlates of smokeless tobacco use were assessed and evaluated in a sample of USAF trainees. Methods: We conducted a cross-sectional survey of USAF technical training school personnel at Joint Base San Antonio-Lackland and Fort Sam Houston (N = 14,810). Survey completion rate was 78%. Logistic regression was used to analyze the associations between demographic variables, tobacco use, and social factors for both regular and infrequent smokeless tobacco (e.g., chewing tobacco, snuff) users. Results: Overall, 16% of Airmen had ever used smokeless tobacco and 10% regularly used smokeless tobacco. In multivariate analyses, men had greater odds than women of regular smokeless tobacco use (adjusted odds ratio [OR] = 15.2; 95% confidence interval [CI]: 10.8–21.5) and infrequent smokeless tobacco use (adjusted OR = 4.2; 95% CI: 3.1–5.7). Smokeless tobacco use was associated with participation in high school sports (adjusted OR = 1.9; 95% CI: 1.6–2.3 for regular users; adjusted OR = 1.4; 95% CI: 1.1–1.7 for infrequent users), smoking cigarettes (adjusted OR = 4.3; 95% CI: 3.6–5.1 for regular users; adjusted OR = 4.0; 95% CI: 3.2–5.0 for infrequent users), or living with someone who used smokeless tobacco (adjusted OR = 2.2; 95% CI: 1.9–2.6 for regular users; adjusted OR = 1.4; 95% CI: 1.1–1.7 for infrequent users). Black or African Americans were less likely than whites to be regular (adjusted OR = 0.3; 95% CI: 0.1–0.4) or infrequent (adjusted OR = 0.3; 95% CI: 0.2–0.4) users of smokeless tobacco. Conclusions: Smokeless tobacco use among incoming Air Force recruits is common and negatively impacts the Air Force's goal to be tobacco-free. Understanding sociodemographic characteristics perpetuating smokeless tobacco use in the Air Force population can inform the development of health promotion interventions.     

非吸烟烟草对BALB/3T3A31-1-13细胞的转化活性的研究

嚼烟与含烟抽提物均可使BALB/3T3细胞发生形态学转化。酸化后的含烟抽提物和亚硝化后的嚼烟油提物的转化活性高於未酸化或未亚硝化者。从转化集落分离出来的细胞具有赘生转化的某些特征。研究结果提示,非吸烟烟草对使用者可能具有致癌危害作用。     

Smokeless tobacco use and salivary cotinine concentration

The objective of the current study was to examine demographic, tobacco-related, and psychosocial factors associated with cotinine concentration in a group of 256 male smokeless tobacco (ST) users living in the Ohio Appalachian region. Participants completed a survey that included questions on: 1) current and past tobacco use behaviors; 2) demographics; 3) tobacco dependence; 4) decisional balance; 5) health behaviors; and 6) perceived stress and depressive symptoms. Saliva samples were obtained for measurement of cotinine. The variables related to salivary cotinine concentration in the multiple regression model were age, marital status, occupation, quit attempts, years of ST use, and tobacco dependence score (adjusted R(2)=0.24). Among the 199 snuff only users, cotinine concentration was positively related to age, being divorced/widowed/separated, no quit attempts in the previous year, dependence score, and brand of snuff (adjusted R(2)=0.29). This is one of the largest studies to examine influences beyond topography on cotinine concentration in a group of rural ST users. These findings suggest that smokeless tobacco users and smokers share some similarities with respect to tobacco dependence.     

The interaction of alcohol and tobacco use in adolescents and young adults: Bogalusa Heart Study

Alcohol and tobacco usage patterns were assessed in 1,811 children and young adults, 12-24 years of age. The prevalence of cigarette smoking and alcohol consumption increased with age in all race and sex groups. Smokeless tobacco use (chewing tobacco and snuff) was primarily seen in white males with the highest prevalence rates in 12-15 year olds. Among white males who reported smokeless tobacco usage, 44% of the 12-17 year olds and 80% of the 18-24 year olds reported concurrent alcohol use. There was a significant interaction between alcohol consumption and cigarette smoking in all four race-sex groups (p less than 0.001). Given the potential synergistic relationship between ethanol and tobacco products on oral and upper gastrointestinal tract cancer, as well as between smoking and cardiovascular disease, the long term effects from these behaviors could be troublesome. Since healthy lifestyles are established in youth, early intervention on alcohol and tobacco use is needed to prevent the future morbidity and mortality from cancer and cardiovascular disease.     

Tobacco and cannabis co-occurrence: Does route of administration matter?

BackgroundQualitative research suggests that a shared route of administration (i.e. via inhalation) for the common forms of both tobacco (i.e. cigarettes) and cannabis (i.e. joints) may contribute to their co-occurring use.MethodsWe used data on 43,093 U.S. adults who participated in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) to examine whether cannabis use and abuse/dependence were associated with smoked (cigarettes, cigars, pipes) versus smokeless (snuff, chewed tobacco) forms of tobacco use, even after controlling for socio-demographic, psychiatric and substance-related covariates.ResultsTobacco smoking was associated with a 3.3–4.5 times increased risk for cannabis use and abuse/dependence respectively. After covariate adjustment, importantly for nicotine dependence, smoking tobacco (but not smokeless tobacco) was still significantly associated with both cannabis use (multinomial odds-ratio (MOR) 1.99) and cannabis dependence (MOR 1.55). In contrast, use of smokeless tobacco was not significantly correlated with elevated rates of cannabis use (MOR 0.96) or abuse/dependence (MOR 1.04).ConclusionsRoute of administration may play an important role in the observed association between tobacco and cannabis use. This may represent a physiological adaptation of the aero-respiratory system and/or index social and cultural influences surrounding the use of smoked versus smokeless forms of tobacco.     

On smokeless tobacco, addictive behavior and warning labels

This article will offer three primary positions: First, it will support the use of a warning label on containers of smokeless tobacco and second, suggest that an alternative to the present warning statement be considered. The Massachusetts Department of Public Health--presently the first state to consider a warning label for smokeless tobacco--proposes a label that would read as follows: WARNING: Use of snuff is addictive and may cause mouth cancer and other mouth disorders. Third, this article will suggest that a warning label will not have any notable impact on the public health. In order to support these positions, the following discussion will briefly examine the relationship between chemical dependency, addictive behavior, tobacco smoking, and the use of warning labels as a deterrant to the use of smokeless tobacco.