Smokeless tobacco use in Australia

Introduction and Aims. There has been little research published on the use of smokeless tobacco (SLT) in Australia. This study aimed to determine the prevalence of SLT use and the potential for harm reduction in current SLT users and smokers. Design and Methods. We undertook secondary analysis of data from a national household survey of drug use and surveyed 108 Australian SLT users about their patterns of SLT use and tobacco smoking. Results. The low prevalence of SLT use in the past year in Australia (0.57%; 95% confidence interval 0.48–0.66) might reflect the difficulty in importing these products. Prevalence of recent use was highest among males aged 18–29 who were current weekly smokers. US style oral snuffs were the most popular SLT products in Australia. Most of those surveyed were introduced to SLT by a personal contact and about half had used SLT to quit smoking. Australians who import SLT pay per can AU$21.30 on average and face substantial delays before receiving the product. Discussion and Conclusions. Cost and poor access present a substantial barrier to SLT use as a tobacco harm reduction measure for Australian smokers. Permitting low nitrosamine varieties of SLT to be sold in Australia might reduce harm in current SLT users and provide a viable alternative to cigarettes for some current smokers. [Gartner CE, Hall WD. Smokeless tobacco use in Australia. Drug Alcohol Rev 2009]     

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.     

Smokeless tobacco consumption and stillbirth: Population‐based case–control study in rural Bangladesh

Introduction and Aims. To investigate the association between smokeless tobacco consumption (STC) during pregnancy and risk of stillbirth. Design and Methods. We conducted a population‐based case–control study of 253 cases and 759 randomly selected control women in Madaripur, Bangladesh. We conducted a survey of two rural local government areas, including 8082 women, and identified cases based on self‐report of a stillbirth outcome of each participant's first pregnancy. All were asked about STC during their first pregnancy and a range of risk markers and known confounders. Demographic and maternal variables associated either with stillbirth or STC were included in logistic regression models. Results. Of the 241 cases and 757 controls with complete exposure data, 32 cases (13.2%) and 18 controls (2.4%) reported STC during pregnancy [odds ratio 6.28; 95% confidence interval (CI) 3.45, 11.4]. After adjustment for education, household income, age at first pregnancy, vaccination during pregnancy, complications, exposure to arsenic in drinking water, place of delivery and antenatal care, excess risk was attenuated but remained significant [adjusted odds ratio (aOR) 2.87; 95% CI 1.36, 6.08]. There was a dose–effect association, with women who used smokeless tobacco >5 times daily during their first pregnancy at greater risk of having a stillbirth (aOR 5.89; 95% CI 1.70, 20.3) than less frequent users (aOR 1.67; 95% CI 0.65, 4.29). Estimates were robust to extreme assumptions about missing exposure data. Discussion and Conclusions. STC during pregnancy was associated with an increased risk of stillbirth. This finding adds to the urgency of need for smokeless tobacco control strategies to be implemented in South Asia. [Hossain MS, Kypri K, Rahman B,Milton AH. Smokeless tobacco consumption and stillbirth: Population‐based case–control study in rural Bangladesh.     

Cigarette,smokeless tobacco,and alcohol use among transgender adults in the United States

BackgroundResearch suggests that sexual minority adults face disparate risks for poor health outcomes. However, prior research on transgender populations has been limited by small and nonprobability samples and has potentially masked important differences between transgender subgroups. We examined disparities in cigarette, smokeless tobacco, and alcohol consumption by transgender and cisgender adults.Methods2014–2017 Behavioral Risk Factor Surveillance System data were used. Multivariable logistic regressions examined differences in cigarette, smokeless tobacco, and alcohol use between cisgender adults and transgender sub-identities: male to female (MTF), female to male (FTM), and gender nonconforming.ResultsCigarette and smokeless tobacco use were higher among transgender adults. The gender nonconforming subgroup reported more binge and heavy drinking. In a multivariable logistic analysis, higher odds of smokeless tobacco use were found for all transgender sub-identities compared to cisgender females. The gender nonconforming group had higher odds of heavy drinking (AOR = 2.09, 95% CI 1.14–3.82) and binge drinking (AOR = 1.94, 95% CI 1.25–3.02) compared to cisgender females. The MTF subcategory was more likely to binge drink (AOR = 1.88, 95% CI 1.44–2.46) compared to cisgender females. The FTM subcategory had lower odds of binge drinking (AOR = 0.49, 95% CI 0.33-0.73) compared to cisgender males.ConclusionsSignificant heterogeneity in smokeless tobacco and alcohol use were found among transgender subgroups, particularly when compared to cisgender females. Our findings demonstrate that it is important to consider sub-identities in both the transgender population and in the reference cisgender population.     

The association of smokeless tobacco use and pack-years of smokeless tobacco with age-related macular degeneration in Indian population

Aim: To explore the association of use versus no use and the influence of pack-year use of smokeless tobacco with that of early and late age-related macular degeneration (AMD) in rural and urban south Indian population. We hypothesized that the use and pack-years of use would be significantly associated with both early and late AMD. We therefore sought to examine subjects who gave a history of using smokeless tobacco and we quantified the usage as pack-years, to examine the association with that of early and late AMD.

Materials and methods: This was part of Sankara Nethralaya: Rural–Urban Age-related Macular degeneration study (SN-RAM study), which was conducted between 2007 and 2010. Subjects aged 60 years or older or those turning 60 in the present calendar year, with a history of using smokeless tobacco were noted along with duration and number of packs used per day. Smokeless tobacco was defined as chewed-tobacco (loose leaves) and/or snuff (finely chopped tobacco). Subjects underwent detailed ophthalmic evaluation including cataract grading using the Lens Opacities Classification System (LOCS III), 45° 4-field stereoscopic fundus photography and AMD evaluation. Pack-years of smokeless tobacco use was stratified as <15, 15–34 and ≥35 years; the association of tobacco use and pack-years of use with that of early and late AMD was examined. A p value of Results: The number of smokeless tobacco users was significantly higher in rural (n?=?767) than in urban groups (n?=?281), p?p?=?0.756 or that between AMD and no AMD, p?=?0.562. Use of smokeless tobacco compared with no use was significantly associated with late AMD, OR=?3.178, 95%CI: 1.095, 9.227, p?=?0.033, when adjusted for age, gender, rural-urban differences, presence of diabetes, socioeconomic status, systolic and diastolic blood pressure, total cholesterol, low-density and high-density lipoprotein levels. The association was not significant for early AMD, p?=?0.582. The pack-years of use did not show a statistically significant association with early or late AMD. Furthermore, out of the 1048 subjects, 547 reported as using areca nut. Of which, 415 (75.8%) subjects had no AMD, 119 (21.7%) showed evidence of early AMD and 13 (2.4%) had late AMD. There was no significant association between the use of areca nut and early AMD, (X² (1, N?=?930)?=?2.345, p?=?0.126) or with that of late AMD (X² (1, N?=?761)?=?0.075, p?=?0.785).

Conclusions: Smokeless tobacco use compared with no use, is associated with late AMD, regardless of the pack-years of use. Tobacco use is a modifiable risk factor. Efforts to reduce or stop the use of smokeless tobacco is indicated in an effort to prevent vision loss with respect to late AMD.     

Prevalence of alternative forms of tobacco use in a population of young adult military recruits

Recent evidence suggests that the popularity of certain alternative forms of tobacco may be increasing in adolescents. Little is known, however, about the use of these products among young adults. This study examined the use of alternative tobacco products including bidis, cigars, kreteks (clove cigarettes), pipes, and smokeless tobacco in a large sample of young adult military recruits (N=31107). Overall, 18.5% of participants were using some form of alternative tobacco product prior to entry into Basic Military Training. Results revealed a relatively high prevalence of cigar (12.3%) and smokeless tobacco use (6.7%). Use of other products was less common, including 1.1% for pipes, 2.0% for bidis, and 3.0% for kreteks. With the exception of kreteks, which did not differ by gender, the prevalence of use of alternative tobacco products was greater for males than for females (p<.001). Patterns of use also differed according to other demographic characteristics including race, ethnicity, age, and income. Implications for surveillance and tobacco control efforts are discussed.     

Smokeless tobacco impairs the antioxidant defense in liver, lung, and kidney of rats.

The present study was designed to evaluate the effects of long-term use of aqueous extract of gutkha (a form of smokeless tobacco) on the antioxidant defense status and histopathological changes in liver, lung, and kidney of male Wistar rats. Animals were orally administered aqueous extract of smokeless tobacco (AEST) at a low dose (96 mg/kg body weight per day) for 2 and 32 weeks, and at a high dose (960 mg/kg body weight per day) for 2 weeks. High-dose AEST for 2 weeks decreased the hepatic glutathione (GSH) and glutathione peroxidase (GPx), and increased lipid peroxidation (Lpx) by 17%, 19%, and 20%, respectively. Low-dose AEST for 32 weeks significantly decreased (p < 0.05) the antioxidant status in these organs. In liver, AEST decreased GSH levels and the activities of superoxide dismutase (SOD), catalase (CAT), and GPx by 34.6%, 29%, 17.1%, and 17.4%, respectively, but it increased Lpx by 64%. In kidney, GSH, SOD, CAT, and GPx were decreased by 26.6%, 23%, 33%, and 18%, respectively, with an increase of Lpx by 65%. AEST decreased the lung GSH, SOD, CAT, and GPx, and increased lung Lpx by 43%, 28.5%, 37%, 40%, and 24%, respectively. However, no change in the plasma levels of vitamins A, C, and E were observed with AEST treatment. Histopathological findings suggest that administration of AEST at the high dose for 2 weeks or at the low dose for 32 weeks could cause mild to moderate inflammation in liver and lungs. In conclusion, a decrease in the antioxidant defense system and long-term inflammation caused by smokeless tobacco may be risk factors for gutkha-induced pathogenesis.     

Tobacco Use among Adult Muslims in the United States

Background: Compared with the general United States (US) population, Muslims in the US exhibit elevated rates of tobacco use. As a result, they might be at a higher risk for preventive disease and premature death as compared with the general US population. Objective: This study investigated the Social Cognitive Theory (SCT) factors that are associated with tobacco use among a sample of adult Muslims in the US. Methods: Data were collected (November 2016–March 2017) using a cross-sectional, on-line survey from a convenience sample of adult (≥ 18 years) US Muslims. Participants with a lung cancer history were excluded. Associations between SCT factors and tobacco use were investigated with bivariate analyses and multinomial logistic regression models. Results: Eligible participants (n?=?271) from 30 states completed the survey; 52.8% reported current tobacco use. A higher rate of current tobacco use was reported by men (62.8%) as compared to women (41.3%), x²(1, N?=?271) = 12.49, p?<?.001. In terms of cognitive factors, individuals who (1) expected more personal consequences for tobacco use on health, and (2) had more confidence regarding ability to abstain from tobacco use, were less likely to report current tobacco use. In terms of environmental factors, individuals whose family members did not use tobacco were less likely to report current tobacco use. Conclusion: The study findings suggest that family-oriented interventions emphasizing self-efficacy and personal consequences to prevent tobacco use can potentially be effective in reducing tobacco use rates in the adult US Muslim population.     

Factors associated with smokeless tobacco cessation in an Appalachian population

Identifying factors associated with successful tobacco quit attempts may help in the development and targeting of effective cessation strategies. This paper aims to describe factors associated with smokeless tobacco (ST) cessation and compares the results to findings in the smoking cessation literature. Prospective data on 116 men aged 19 to 70 and participating in a ST cessation program were used to examine correlates of successful ST cessation at 1-year post-intervention. Controlling for age, level of education (p=0.002) and daily coffee consumption (p=0.005) had significant independent associations with successful cessation. No ST use variables were significant predictors of cessation success. In a multivariable logistic regression model three factors were significantly associated with cessation: education (p=0.010), coffee consumption (p=0.019), and age (p=0.029). Factors associated with successful ST cessation in this sample are consistent with predictors of smoking cessation reported in the literature. Based on its widespread use and the strength of its association with successful quitting, the role of caffeine consumption in ST cessation merits further study.     

Smokeless tobacco use among addiction patients: a brief report

INTRODUCTION: The prevalence and treatment outcome of smokeless tobacco (ST) use among hospitalized addiction patients is unclear. METHODS: Using initially a retrospective and then a prospective study design, data were collected about patients who described "other tobacco use." The data examined included demographics, medical disorders, psychiatric conditions, nicotine treatment and outcome. RESULTS: The data from the two samples were consistent. All subjects were Caucasian males, mean age 38.5 years, with daily ST use for at least one year. Most had alcohol dependence. The prevalence rate was 3% retrospectively and 7% prospectively. Interventions included nicotine gum and patches. All subjects abstained from ST use during hospitalization but follow-up data were limited. CONCLUSION: These observations are consistent with reports of ST use being more common in males in the general population and its association with alcohol dependence. Further research is needed into effective long-term treatment for ST use among addiction or psychiatric patients.     

Pharmacy practice in the United States Air Force

The current status of pharmaceutical services in the United States Air Force Medical Service is described. The mission of the USAF Medical Service is to provide medical support to combat forces and to deliver health care to active duty and retired military members and their dependents. The USAF operates 121 medical treatment facilities (MTFs) worldwide. Pharmaceutical services in these MTFs are governed by federal law, recognized standards of professional practice, Department of Defense directives, and Air Force regulations. Ambulatory-care services are emphasized, and clinical services are provided in many MTFs. Pharmaceutical services are supported by the TRIPHARM computer system. In addition to other professional opportunities, USAF pharmacists have the opportunity to pursue graduate-level academic training or residency training under Air Force Institute of Technology sponsorship. The USAF Medical Service will continue to ensure that contemporary pharmaceutical services are available in all MTFs by providing graduate-level training to pharmacists, encouraging the adoption of new technologies, and facilitating the exchange of information among MTFs.     

Tobacco Use,Heavy Use,and Dependence Among Adolescents and Young Adults in the United States

Tobacco involvement among US youth was investigated in a national survey conducted in 2005–2007 of 2,274 respondents aged 14–21, including those not in school. Logistic regressions predicted tobacco involvement. Males had higher rates of tobacco use than females, but males and females had equal rates of heavy use and dependence. Tobacco involvement increased with age. Whites were more tobacco involved than minorities. Tobacco involvement declined with increasing socioeconomic status. Reduced tobacco use was associated with being married and with being a student. Smokeless tobacco use was associated with being male, older, white, and lower socioeconomic status. The implications of these results are discussed.     

Metaphors of smokeless tobacco addiction and cessation

The metaphors that tobacco users employ when trying to quit offer insights into the subjective experience of the cessation process. A review of more than 2100 posts in an online forum for participants in a smokeless tobacco (ST) cessation study revealed metaphors covering themes such as the tobacco product itself, nicotine, addiction, the cessation process, coping with withdrawal symptoms and cravings, fellow study participants, other social relationships, slips and recoveries, and post-cessation self-image. Five metaphor families predominated, with quitting ST represented as a journey, a project, a battle, an escape from captivity, and ending a dysfunctional friendship. Tobacco and nicotine were conceptualized as an enemy, a crafty opponent, a demon, and a betraying friend. Most metaphor use was casual, but some instances were more elaborated, with multiple, apparently deliberate references to the same metaphor family in close proximity. Future research should address whether use of therapeutic metaphors can help facilitate cessation; if so, the finding would have implications both for clinical tobacco cessation services and public health interventions.     

Smokeless tobacco abstinence effects and nicotine gum dose

There were two experiments on abstinence from smokeless tobacco. The purpose of the first experiment was to determine abstinence effects from smokeless tobacco. The purpose of the second experiment was to examine the effects of different doses of nicotine gum on smokeless tobacco abstinence effects. The subjects were male Copenhagen smokeless tobacco users who underwent 3 days of baseline measurement while continuing to use smokeless tobacco ad libitum, and 5 days of the experimental condition. In the first experiment, the subjects were assigned randomly to one of two groups and compared: continuous smokeless tobacco users (n=10), and deprivation plus no nicotine gum (n=10). In the second experiment, subjects were assigned randomly and in a double-blind fashion to one of three groups and compared: (1) deprivation plus 0 mg nicotine gum (n=20); (2) deprivation plus 2 mg nicotine gum (n=20); and (3) deprivation plus 4 mg nicotine gum (n=20). The first experiment showed significant increases upon abstinence for the following variables: (1) craving; (2) difficulty concentrating; (3) restlessness; (4) excessive hunger; (5) eating; (6) reaction time; (7) variability of reaction time and (8) total withdrawal scores for both the self-rated and the observer-rated forms. The second experiment showed that nicotine gum failed to significantly reduce smokeless tobacco abstinence effects, although those with high cotinine levels may receive some benefit from nicotine gum.Sponsored by the National Institute on Drug Abuse Research Grant No. DA05013     

E-cigarette marketing exposure and combustible tobacco use among adolescents in the United States

E-cigarette advertising has been shown to be associated with use of e-cigarettes, but its association with tobacco use has not been studied. Therefore, we examined the association between e-cigarettes advertisement and tobacco use. Data from nationally representative 22,007 middle and high school students (grades 6–12) were used to conduct the analysis. Logistic regression models estimated the adjusted odds ratios (AOR) of ever and current use of cigarette, hookah, cigar, and polytobacco use. Odds ratios were weighted and adjusted for study design, non-response rates, school level, gender, race/ethnicity, e-cigarette use, and smoking at home. E-cigarette marketing exposure was significantly associated with ever use of cigarettes (AOR: 1.3, 95% CI: 1.1–1.5), hookah (AOR: 1.4, 95% CI: 1.2–1.7), cigars (AOR: 1.5, 95% CI: 1.4–1.6), and polytobacco (AOR: 1.7, 95% CI: 1.5–1.8). Likewise, E-cigarette marketing exposure was significantly associated with current use of cigarettes (AOR: 1.3, 95% CI: 1.1–1.6), hookah (AOR: 1.3, 95% CI: 1.03–1.7), cigars (AOR: 1.3, 95% CI: 1.1–1.6), and polytobacco use (AOR: 1.8, 95% CI: 1.5–2.1). The results suggest that e-cigarette advertisement is associated with use of cigarettes, hookah, cigars, and polytobacco products. These results add to the evidence about the risks of e-cigarette marketing and highlight the need for stricter regulation of e-cigarette advertisements.     

Between Traditions and Health: Beliefs and Perceptions of Health Effects of Smokeless Tobacco Among Selected Users in Nigeria

Objectives: Snuffing or licking of smokeless tobacco (SLT) is one of the oldest traditional practices among the African population. This study aims to investigate the beliefs and practices related to SLT use among users in Nigeria. We also assess the awareness of the health consequences of SLT among users. Methods: A qualitative technique involving an in-depth interview was employed to collect data from SLT users from selected indigenous Nigerian populations in their traditional settings (Saki, Ile-Ife, Ibadan, and Abuja). The locations were purposively selected based on the researchers' knowledge of the prevalent use of SLT in those areas. A snowball sampling technique was employed to select the respondents. The data were imported into the ATLAS.ti computer software for analysis. The data were analyzed using inductive coding, and the results were presented thematically using network diagrams. Results: The findings revealed that the majority of SLT users believed that the practice had the following health benefits, among others: clearing of eyes and nose, aiding in sleep and rest, protecting against colds and nose bleeds and curing headaches. The users believed that SLT helped them ‘feel high’ or bold when afraid. The SLT users also believed that it protected them from evil spirit(s) and dangerous reptiles. The users believed that SLT had no negative health consequences, and SLT was generally preferred to smoking cigarettes. Conclusion: The study concludes that there is a need to focus on the control of SLT because this product is a major alternative to tobacco smoking among indigenous African populations.