Stages of adolescent cigarette smoking acquisition: Measurement and sample profiles

A stage model of adolescent cigarette smoking acquisition was developed and an instrument to measure the stages was created. Internal validity was obtained based on principal component analysis, item analysis, and coefficient alpha. Three distinct components were labeled precontemplation, decision-making, and maintenance. The scales had reliability coefficients ranging from .86 to .94. External validity was obtained by relating the scale scores to measures of smoking behavior and intent to smoke. A cluster analysis resulted in nine distinct clusters, including profiles representing precontemplation, contemplation, decision-making, action, and maintenance stages. Further validity was obtained for the clusters by comparing groups on the perceived positive and negative consequences of smoking, and the derived pleasure from smoking.     

Is 'stage of change' related to knowledge of health effects and support for tobacco control?

We examine the heterogeneity among current and former smokers categorized by 'stage of change' with respect to their perceptions about tobacco and tobacco control. Current and former smokers (n = 846) from a general population sample of adults in Ontario, Canada, were subdivided according to the stages of change categories (precontemplation, contemplation, preparation, action, maintenance, and termination) and compared on measures of knowledge, attitudes, and support. Multivariate analyses were conducted adjusting for sociodemographic covariates. Adjusted overall increases across the six stages were observed for seven of eight knowledge items and for all attitude and support items. Among current smokers, adjusted increases across the three stages were detected for a majority of items. However, statistically significant differences from one stage to the next, across all three current smoker stages, were detected only for one item. Among former smokers, adjusted increases across the three stages were observed for a minority of items. The stages of change classification was useful for differentiating subgroups of current smokers with regard to knowledge, attitudes, and support for tobacco control measures.     

The social image of smokeless tobacco use in three different types of teenagers

The current study used an unobtrusive methodology to describe the social image associated with smokeless tobacco use and with cigarette smoking in three "types" of teenage models--an athlete, a cowboy, and an average teenager. As in previous research, the social image associated with smokeless tobacco use was more positive than that associated with cigarette smoking, suggesting that adopting smokeless tobacco use may have perceived social image benefits for adolescent males. The image conveyed by smokeless tobacco use was similar across the three different types of adolescent. Relations between social image factors and tobacco use behavior were examined, and implications for tobacco use prevention are discussed.     

Tobacco Use Prevalence and Factors Associated with Tobacco Use in New U.S. Army Personnel

ABSTRACT

This study examined the prevalence of tobacco use and factors associated with pre-military service cigarette and smokeless tobacco use. From January 2000 to December 2006, military students arriving for Advanced Individual Training at the U.S. Army Ordnance School completed a questionnaire that asked about their use of tobacco products. The prevalence of smokeless tobacco use from 2000 to 2006 for women generally decreased, as did the number of cigarettes smoked per day by men. For men and women, factors associated with cigarette use included younger age, Caucasian race, and use of smokeless tobacco. Factors associated with smokeless tobacco use among men included younger age, Caucasian race, and cigarette use. For women, cigarette use was the only factor associated with smokeless tobacco use. The identified factors in this study could be used to establish strategies in the future to reduce tobacco use in the military.     

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.     

Adolescents' first and most recent use situations of smokeless tobacco and cigarettes: similarities and differences

This study compared first and most recent use situations of adolescent smokeless tobacco experimenters with those of adolescent cigarette experimenters. Structured, open-ended interviews were conducted with 320 seventh and tenth grade youths in 16 Southern California schools. Students were categorized as nonusers (those who had never experimented with any tobacco product), minimal experimenters (those who had experimented with smokeless tobacco or cigarettes between 1 and 9 times), and persistent experimenters (those who had experimented with smokeless tobacco or cigarettes 10 or more times). The situations reported by smokeless tobacco were similar to those reported by cigarette experimenters. The most important differences between the two groups are highlighted. In particular, smokeless tobacco users seemed less concerned about negative social consequences of use than cigarette smokers. In addition, nonusers' observations of use and implications for prevention and cessation are discussed.     

Urinary cotinine levels of smokeless tobacco (Maraş powder) users

Smokeless tobacco is used in various forms in some countries of the world. "Mara? otu" is a kind of smokeless tobacco usage in the Southeastern region of Turkey. The use of smokeless tobacco causes nicotine addiction and dependence. Moreover this type of smokeless tobacco usage is one of the risk factors for oral cancers and genotoxic damages for users. Cotinine is widely used as a biomarker of tobacco consumption and intake of nicotine. Therefore, urine samples were collected from people who are using Mara? powder and smoking cigarettes, and passive smokers, and the levels of cotinine investigated. The purpose of this study is to determine the cotinine levels of Mara? powder users and to compare the results with cigarette smokers and passive smokers. Urinary cotinine levels of subjects were determined by using capillary gas chromatography with FID detection. The mean (+/- SD) urinary cotinines have been determined as 6467.35+/-3198 microg/g creatinine for 26 Mara? powder users, 1943.92+/-1443 microg/g creatinine for 26 cigarette smokers and 198.62+/-420.82 microg/g creatinine for 26 passive smokers. A significant difference has been found between cotinine levels of Mara? powder users and cigarette smokers, which is three times higher in Mara? powder users (p<0.001). The present study suggests that smokeless tobacco poses a threat to public health and it should not be viewed as a safe alternative to cigarettes.     

Comparing college smokers' and dual users' expectancies towards cigarette smoking

Background

As no agreed upon definition exists for dual use (i.e., individuals who concurrently use more than one form of tobacco), this population remains largely unstudied in the substance use literature, despite increases in smokeless tobacco use among young adults. Individuals 18–25 years of age report the highest rates of smokeless tobacco use, dual use, and cigarette use. The current study compared the smoking outcome expectancies of college student dual users to those who reported only smoking cigarettes.

Methods

The Short Form of the Smoking Consequences Questionnaire was used to examine potential differences in positive or negative expectations regarding cigarette use.

Results

Data from this study suggest that smokers believe that smoking will lead to greater positive consequences (“cigarettes taste good”), negative reinforcement (“cigarettes help me deal with anger”), and weight/appetite reduction (“smoking controls my appetite”) when compared to dual users. Conversely, dual users believed that smoking would lead to greater negative consequences (e.g., “smoking is taking years off of my life”).

Discussion

These results may help to explain why some smokers choose not to use smokeless tobacco products for harm reduction or smoking cessation purposes, as well as why increases are being observed in smokeless tobacco rates among young adults.     

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.     

Associations between tobacco and nicotine product use and depressive symptoms among college students in Texas

BackgroundThere is a well-established link between cigarette smoking and depression; less is known about the potential association between alternative tobacco products, such as hookah, cigars, smokeless tobacco, and electronic cigarette (e-cigarette use) with depression. The Food and Drug Administration (FDA) is now regulating tobacco products and is interested in tobacco product use among those with mental health problems and other special populations such as college students.MethodsCross-sectional statewide convenience sample study of 5438 college students in 24 colleges and universities in Texas. Past 30-day use of hookah, cigar, smokeless tobacco, cigarette, and e-cigarette use were measured by self-report. Depressive symptoms were measured by the 10-item short form of the Center for Epidemiologic Studies scale.ResultsOnly e-cigarette use was positively associated with depressive symptoms, even after accounting for all other tobacco products and socio-demographics. There were no significant interactions between race/ethnicity or gender with each of the tobacco products on depressive symptoms.ConclusionsE-cigarette use was positively associated with depressive symptoms among college students in Texas. Further research is needed to determine causality, which may inform FDA regulatory planning.     

Personality and smokeless tobacco use

Smokeless tobacco use and personality factors associated with smokeless tobacco use were examined in a broad, representative sample of 8th and 10th graders from central and south-central Florida (n = 1413). Current, occasional, or ex-users of smokeless tobacco accounted for 51% of the males and 9% of the females. Smokeless tobacco users, as compared to non-users, had significantly higher Trait Anger, and Angry Temperament and Angry Reaction subscale scores on the State-Trait Personality Inventory, suggesting a possible role in the initiation of smokeless tobacco use. There were no differences in Trait Anger, Anxiety, or Curiosity scores between the three user groups, suggesting that trait personality does not play a role in the maintenance of smokeless tobacco use.     

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.     

Tobacco and pregnancy

This paper will review the epidemiology of the impact of cigarette smoking and other forms of tobacco exposure on human development. Sources of exposure described include cigarettes and other forms of smoked tobacco, secondhand (environmental) tobacco smoke, several forms of smokeless tobacco, and nicotine from nicotine replacement therapy. Exposure is immense and worldwide, most of it due to smoking, but in some parts of the world and in some populations, smoking is exceeded by smokeless tobacco use. Nicotine and carbon monoxide exposure are of large concern, but cigarette smoke contains over 4000 chemical constituents and additives including known carcinogens, toxic heavy metals, and many chemicals untested for developmental toxicity. The impact of tobacco on human development will be reviewed. Fertility, conception, survival of the conceptus, most phases and aspects of development studied to date, as well as postnatal survival and health are adversely impacted by maternal tobacco use or exposure. Effects in surviving offspring are probably life-long, and are still being elucidated. It is hoped that this review will serve to keep a focus on the critical and continuing problem of tobacco use impacting human development.     

Smokeless tobacco use in a population of young adults.

The current study examined characteristics of smokeless tobacco users in a large population of Air Force recruits. In addition, smokeless tobacco users were compared to non-tobacco users, to cigarette smokers, and to users of both smokeless tobacco and cigarettes. Participants were 32,144 individuals who entered Basic Military Training from August 1995 to August 1996. A 53-item questionnaire assessed demographics, tobacco use history, risk taking, and other health-risk factors. Those who both chewed and smoked scored considerably higher on a number of risk factors than did those who limited their tobacco consumption to either cigarettes or chew. Cigarette smokers in turn tended to score consistently higher on self-reported risk factors than did nontobacco users.     

A multiple motive/multi-dimensional approach to measure smokeless tobacco dependence

Background

Unlike various research studies conducted to address dependence among smokers, only a few studies have examined smokeless tobacco (ST) dependence. The Fagerström Tolerance Questionnaire (FTQ) and Fagerström Test for Nicotine Dependence (FTND) based scales are the most widely used measures of nicotine dependence for both ST users and smokers. These scales were initially developed to measure physical dependence and tolerance and not to assess other salient dimensions of dependence such as craving, compulsion, or withdrawal, as defined by DSM-IV and ICD-10. The aim of this study is to develop and validate a multidimensional scale that has better content coverage, factor structure, and psychometric properties to measure dependence among ST users.

Methods

100 adult male smokeless tobacco users were recruited through email distribution lists and community referral. Participants completed three different nicotine dependence questionnaires and provided information related to their tobacco use and demographic characteristics. They also provided a saliva sample for cotinine measurement. In order to develop the new ST scale, subscales and items were selected based on correlation and factor analysis of the modified WISDM-68. Reliability and validity of the new scale, Oklahoma Scale for Smokeless Tobacco Dependence (OSSTD) were also assessed.

Results

The new ST scale identified seven latent constructs including 23 items to measure ST dependence. Internal consistency as measured by Cronbach's coefficient (α = 0.925) indicated better reliability of OSSTD than FTND-ST. Concurrent validity of OSSTD as evaluated by comparing it with dependence diagnosis and FTND-ST was affirmative. There was a significant correlation between the OSSTD total score and the cotinine levels and tobacco use characteristics among study participants.

Conclusion

OSSTD possesses better psychometric properties and provides an effective and efficient tool to measure ST dependence as a multidimensional construct.     

What are the differences in decisional balance and self-efficacy between Turkish smokers in different stages of change?

This paper reports the results of an examination of decisional balance (pros and cons of smoking), and self-efficacy constructs, sociodemographic and smoking-related variables among smokers from different stages of change as proposed by the transtheoretical model. A convenience sample of 398 smokers completed the research instrument. Almost 60% of the sample were in the precontemplation stage. The results indicated that pros of smoking dropped significantly from precontemplation to contemplation and preparation but then increased again for the action stage smokers. Cons of smoking increased almost linearly from precontemplation to preparation stages and they were the highest for the action stage. Self-efficacy also increased in a linear fashion and preparation and action stages were significantly higher than the precontemplation and contemplation stages. There were also significant differences among stages of change of groups on age, years of education, and smoking duration and number of quit attempts. Results underlined the importance of finding alternatives that may substitute for the pros of smoking and interventions for changing the cognitive evaluations related to cons of smoking. Additionally, smokers may gain from approaches that focus on encouraging and reinforcing self-efficacy during the action and maintenance stages to ensure a long-term positive outcome.     

Manufactured and hand-rolled cigarettes and smokeless tobacco consumption in Mozambique: regional differences at early stages of the tobacco epidemic

Background

To describe the use of different types of tobacco (manufactured and hand-rolled cigarettes, and smokeless tobacco) in the adult Mozambican population, across regions.

Methods

A representative sample of 12,902 Mozambicans aged 25-64 years was evaluated in a national household survey conducted in 2003 using a structured questionnaire. The patterns of tobacco consumption were described to highlight the sex-specific differences by age and between urban and rural settings, and between the north, where most of the country's tobacco production is concentrated, and the south of the country, where the wealthiest provinces, closer to the city capital, are located.

Results

The prevalence of current tobacco consumption was 39.9% in men and 18.0% in women. Women consumed predominantly smokeless tobacco (prevalence: 10.1%), especially in the north. Hand-rolled and manufactured cigarettes were the most frequently consumed among men (prevalences: 18.7% and 17.2%, respectively). Additionally, hand-rolled cigarette consumption predominantly occurred in the northern provinces and rural settings, whereas manufactured cigarette consumption predominated in the south and urban areas.

Conclusions

The overall tobacco consumption was higher than expected for an African country with scarce economic resources, mostly due to traditional forms of consumption. The gender and regional specific patterns of consumption identified in Mozambique may contribute to the development of culturally adapted and locally grounded actions for tobacco control, and stress the need of locale-specific surveillance data and public health action in this field.     

Trends in alternative tobacco use among light, moderate, and heavy smokers in adolescence, 1999-2009

ObjectiveTo examine trends in alternative tobacco product (ATP) use (smokeless tobacco, cigars, and bidis/cloves) among a national sample of adolescent cigarette smokers (light, moderate, and heavy) during 1999–2009.MethodA secondary analysis of data from the 1999–2009 National Youth Tobacco Survey was performed to investigate the tobacco behaviors of 6th through 12th graders enrolled in public and private schools in the United States. Long-term trends in ATP use were analyzed using logistic regression – controlling for sex, grade, and race/ethnicity – and simultaneously assessing linear and higher order time effects and their interaction with cigarette smoking status.ResultsDuring 1999–2009, increases in smokeless tobacco use and decreases in bidis/cloves use were observed across all smoking groups. For cigars, declines were observed for heavy and moderate smokers, but levels returned to baseline levels in 2009. Cigar use among light smokers was less variable. Rates of any ATP were highest among heavy smokers and lowest among light smokers.ConclusionTrends in cigarette and SLT use increased dramatically in the past decade, and this increase is evident across all cigarette smoker types. Implications for tobacco surveillance, prevention and cessation programs, and tobacco control policies are discussed.     

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.     

The potential impact of a low-nitrosamine smokeless tobacco product on cigarette smoking in the United States: estimates of a panel of experts

OBJECTIVE: To predict the impact on tobacco use in the US of a "harm reduction" policy that requires that the smokeless tobacco product meet low nitrosamine standards, but could be marketed with a warning label consistent with the evidence of relative health risks. METHODS: Low nitrosamine smokeless tobacco (LN-SLT) and cigarette use are predicted by a panel of experts using a modified Delphi approach. We specify a thought experiment to isolate the changes that would occur after the new LN-SLT policy was implemented. RESULTS: The panel predicted that the new policy would accelerate a decrease in smoking prevalence from 1.3 to 3.1 percentage points over 5 years compared to the current SLT product policy, with greater effects on males than females. Introduction of the new product was also predicted to result in modest additional use of SLT overall, with the greatest increases among males who initiated tobacco use under the new policy. CONCLUSION: An overall consensus was reached that the introduction of a new LN-SLT product under strict regulations would increase SLT use, but reduce overall smoking prevalence. This reduction would likely yield substantial health benefits, but uncertainties surround the role of marketing and other tobacco control policies.