Nicotine and smokeless tobacco

The following may be concluded about nicotine and smokeless tobacco use: Systemic absorption and levels of nicotine are similar in users of smokeless tobacco and cigarette smokers. Data from the few studies performed to date suggest that smokeless tobacco users develop a dependency similar to that for cigarette smokers. Effective treatment strategies to help smokeless tobacco users quit need to be developed. Smokeless tobacco use in young people also poses a concern for later development of dependence on cigarettes. The health hazards known to be caused by cigarette smoking and suspected to be related to chronic nicotine exposure are expected to be a hazard of habitual use of smokeless tobacco. A major concern in young males is accelerated coronary artery disease. Information about the potential health hazards of nicotine, as well as oral pathology, may be incorporated into educational programs to help discourage the use of smokeless tobacco, with a resultant decrease in the associated cancer risk.     

Parent characteristics, perceived health risk, and smokeless tobacco use among white adolescent males

The results of this study indicate that father education, father use of smokeless tobacco, and adolescent risk perception contribute to the use of smokeless tobacco by white males 12 to 14 years of age. However, risk perception does not account for the correlation between parent characteristics and child behavior. Father education and child smokeless tobacco use are inversely related if the father does not use it, and they are directly related if the father does; this finding is consistent with theories of modeling but is contrary to the common observation that the use of some abusive substances is relatively low among adolescents in higher social and economic levels. We concluded that father characteristics should be considered in research and in programs pertaining to the use of smokeless tobacco by white adolescent males.     

A systematic review of cancer risk among users of smokeless tobacco (Swedish snus) exclusively,compared with no use of tobacco

The main objective of this systematic review was to assess cancer risk, and mortality after cancer diagnosis, for exclusive users of Swedish snus, compared with non-users of tobacco. We followed international standards for systematic reviews and graded our confidence in the risk estimates using the GRADE approach. Our search gave 2450 articles, of which 67 were assessed in full text against our inclusion criteria. Of these, 14 cohort-studies and one case-control study were included in the review. The studies investigated risk of cancer in the oral cavity or oropharynx (3 studies), esophagus (1 study), stomach (1 study), pancreas (2 studies), colorectum (2 studies), anus (1 study) and lung (1 study), as well as malignant lymphoma (1 study), leukemia and multiple myeloma (1 study), melanoma (1 study), any cancer (1 study) and mortality after cancer diagnosis (4 studies). Cancer risk could only be evaluated in men as there was a general lack of data for women. All included studies were evaluated to have a moderate risk of bias, mostly related to validity of exposure information. An increased risk of cancer of the esophagus, pancreas, stomach and rectum as well as an association between use of snus and increased mortality after a cancer diagnosis was reported. Our confidence in the various risk estimates varied from moderate through low to very low.     

Mutagenicity of smoke condensates from cigarettes, cigars and pipe tobacco.

Smoke condensates from cigarettes, cigars and pipe tobacco were mutagenic on Salmonella typhimurium TA100 and TA98 when activated with rat liver microsomal system. Mutagenicity of a unit weight of smoke condensate was rather high in cigars, low in pipe tobacco and intermediate in cigarettes. Specific mutagenic activity was almost comparable among smoke condensates from low- to high-tar cigarettes, although some variations were observed depending upon the country producing the cigarettes. Marked mutagenicity of cigarette smoke condensate could not be explained by the benzo (a) pyrene or nitroso compounds it actually contained, suggesting the presence of other very potent mutagens in tobacco smoke condensates.     

Black (air-cured) and blond (flue-cured) tobacco and cancer risk I: Bladder cancer

Four case-control studies in different Latin countries have reported risks of bladder cancer 2–3 times higher for smokers of black (air-cured) than for smokers of blond (flue-cured) tobacco. This observation is interesting in the light of a higher concentration of arylamines in black tobacco. The relative risk dropped very rapidly after discontinuation of smoking, and there was also an effect of age at start, with higher risks associated with earlier onset of the habit. Overall, black tobacco seems to act both on early and late stages of bladder carcinogenesis.     

Bimodal initiation of smokeless tobacco usage: implications for cancer education

One hundred fifty (150) randomly chosen adult male subjects (average age 37) drawn from a university general dental clinic were classified by self-report into three equal categories of fifty smokeless tobacco users, fifty cigarette smokers (non-smokeless tobacco users), and fifty non-tobacco users. According to questionnaire results, a bimodal curve was exhibited among smokeless tobacco users with the two peaks of initiation at ages 12 and 18 compared to a unimodal age of initiation for cigarette smokers at age 16. Two different cohorts of smokeless tobacco users based on age of initiation were observed with differences reported in level of education, urban versus rural origin, average length of time in using smokeless tobacco, and the type of smokeless tobacco product used. Young initiators appeared to be primarily from rural communities having a strong parental or familial influence when initiating smokeless tobacco usage, whereas older initiators appeared to be primarily from more urbanized regions with peer influences as the most significant for initiating smokeless tobacco usage. Other characteristics associated with one or the other cohort were also reported, pointing to different educational measures that may be necessary for prevention and intervention, based on the age of initiating smokeless tobacco usage, as well as place of residence.     

Advertising and promotion of smokeless tobacco products

This paper is focused on the approaches used to advertise and promote smokeless tobacco products during the early to mid-1980s. These included traditional motifs that featured rugged-looking masculine models in sporting and outdoor settings as well as an expanded white-collar appeal. Smokeless tobacco was not affected by the ban on broadcast advertising of cigarettes that went into effect in 1971, and, until 1986, both print and broadcast media were used to advertise it. Promotional activities ranged from sponsorship of sporting events to offers for clothing bearing smokeless tobacco product logos. Despite the claims of manufacturers that advertising and promotional efforts were not targeted to youth, smokeless tobacco companies sponsored tobacco-spitting contests with teenage participants, a college marketing program, and college scholarships. In efforts that appeared designed to bolster their public image in the face of growing concern over the consequences of smokeless tobacco use by young people, companies like U.S. Tobacco Company contributed to major social programs, including, ironically, alcohol- and drug-abuse prevention programs. Spurred by public health groups, federal legislation was passed in 1986 that banned television and radio advertising of smokeless tobacco products and required manufacturers to include warning labels on their products on the potential health hazards of smokeless tobacco use.     

Carcinogenic components of smokeless tobacco and tobacco-free cigarettes

The investigation deals with an assessment of carcinogenicity and mutagenicity of samples of smokeless tobacco now on the Russian market as well as ash from alternative cigarettes made of aromatic herbs. Our data showed that the levels of polycyclic aromatic hydrocarbons, volatile and tobacco-specific N-nitrosoamines complied with the standards in the producer-countries. Smokeless tobacco extracts failed to show (Ames) any mutagenic effects such as the "read-out frame shift" or "base-pair replacement" patterns. No tobacco-specific N-nitrosoamines were identified in herbal cigarettes. However, polycyclic aromatic hydrocarbons and volatile N-nitrosoamines content appeared to be identical to that of tobacco. Herbal cigarette smoke extracts mutagenicity induced by side-effects of carcinogenic substances was of similar magnitude as well.     

Bladder cancer: epidemiology and risk factors in Bulawayo,Zimbabwe

The incidence of bladder cancer, and the importance of some selected risk factors in its etiology, were estimated from the data collected in the cancer registry of Bulawayo, Zimbabwe, during the period 1963–77. Cancer cases were interviewed with a standard questionnaire, and more than 70 percent of these were complete. Incidence rates in the urban population of Bulawayo in the first 10-year period were relatively high, with age standardized rates of 17.9 per 100,000 in men and 9.5 in women. Risk-factor distribution was compared in 680 bladder cancer cases (494 males, 186 females) and a control group comprising other cases with non-tobacco-related cancers (8,201). Seventy-one percent of bladder cancer cases were squamous cell carcinomas. The presence of schistosomiasis, evaluated from past history of bilharzia or hematuria, was associated with a significantly increased risk of bladder cancer in both genders (odds ratio [OR]=3.9 for men, 5.7 for women), a result reflected in the differing risk by province of residence, which correlated with the prevalence of infection among cancer cases. The proportion of bladder cancer attributable to schistosomiasis was estimated to be 28 percent. Social status, as reflected by education level, also influenced risk (ORs for literatecf illiterate males=0.6), but tobacco smoking in men had no effect on the risk of squamous cell tumors. For transitional cell carcinomas or adenocarcinomas, there was a nonsignificant increased risk of 2.0 in the highest smoking categories (15 g of tobacco per day), compared with non smokers.     

The prevalence of oral lesions in smokeless tobacco users and an evaluation of risk factors.

BACKGROUND. The widespread use of smokeless tobacco (ST) has prompted concern in regard to the development of oral lesions in long-term users. METHODS. For inclusion in the current study, a subject must have used an ST product, either snuff or chewing tobacco, for at least 6 months. The subjects were recruited by advertising, and none was referred for the evaluation of an oral lesion. The following were performed on all subjects: assessment of exposure to ST, cigarettes, and alcohol; examination of the oral cavity; a biopsy, if an oral lesion was found; and analysis of a blood sample for beta-carotene. The dietary intake of most of the subjects was analyzed. RESULTS. Of the 347 ST users, all of whom were white male subjects, 45 (13.0%) had an oral lesion. Thirty-five of the lesions were hyperkeratosis and 10 were epithelial dysplasia. CONCLUSIONS. Snuff exposure was associated significantly with the presence of an oral lesion (P < 0.0001). A decreased vitamin C intake also was found among the ST users with oral lesions (P < 0.01). The ST users with epithelial dysplasia, as compared with those with hyperkeratotic lesions, were slightly older, had a lower intake of vitamin C (P < 0.05), and were more likely to have used chewing tobacco than snuff.     

Bladder cancer risk and personal hair dye use

Several cohort and case-control studies have found an increased risk of bladder cancer among hairdressers and barbers who are occupationally exposed to hair dyes. However, the carcinogenic risk associated with personal use of hair dyes remains uncertain since several large case-control and cohort studies did not find an association between personal hair dye use and bladder cancer. To address this question, the authors used data collected on 459 bladder cancer cases and 665 controls who were interviewed as part of a case-control study conducted in New Hampshire between 1994 and 1998. Participants underwent a structured personal interview with regard to history of hair dye use and bladder cancer risk factors. Unconditional logistic regression analysis was used to compute odds ratios that were associated with hair dye use, while controlling for potential confounding factors. A history of any hair dye use was inversely associated with bladder cancer incidence in men [adjusted odds ratio (OR) = 0.5; 95% confidence interval (CI)=0.3-0.8], although risk reductions were not statistically significant for individual dye types. In women, use of permanent (adjusted OR = 1.5; 95%CI = 0.8-2.7) and rinse-type hair dye (adjusted OR = 1.7; 95%CI = 0.8-3.6) were associated with a modestly elevated risk of bladder cancer but with limited statistical precision; no association was found with use of semi-permanent dyes (adjusted OR = 0.7; 95%CI = 0.3-1.4). For permanent hair dye use, odds ratios were most pronounced for younger age at first use, higher frequency and prolonged time since first use; however there were no clear trends in risk by these factors. In light of the prevalence of hair dye use, further studies are needed that address the effects of specific colors and types of hair dyes along with the possible role of individual susceptibility.     

Native youth and smokeless tobacco: prevalence rates, gender differences, and descriptive characteristics

This is a report on smokeless tobacco use among Native American youth from Indian reservations in Washington State. Study findings indicate that snuff and chewing tobacco are used frequently, heavily, and at an early age by Native Americans. Nearly one-half of our subjects had used smokeless tobacco on 11 to 20 or more occasions; close to one-third of all the females had used smokeless tobacco on more than 20 occasions. Weekly users in this study were young. Of those Native subjects who used snuff or chewing tobacco weekly, 72% were under 12 years of age. Among youth who reported weekly smokeless tobacco use, about 74% of all females and 90% of all males had first used snuff or chewing tobacco before they were 10 years old. Study results have implications for efforts toward detection, treatment, and prevention of snuff and chewing tobacco use among Native American adolescents.