Prevalence and correlates of smokeless tobacco use in a sample of Connecticut students

Exclusive and concurrent use of cigarettes and alternative tobacco products among Hong Kong adolescents

INTRODUCTION

The use of alternative tobacco products (ATPs) is becoming increasingly popular among the youth. This study aimed to assess cigarette-only smoking, exclusive ATP use, and concurrent use (cigarettes and ATPs) among adolescents in Hong Kong.

METHODS

We analyzed data of the Hong Kong School-based Survey on Smoking among Students 2012/13 from a representative sample of 45 857 secondary school students. Weighted prevalence of cigarette-only smoking, exclusive ATP use, and concurrent tobacco use were calculated. Multinomial logistic regression examined correlates of exclusive ATP use and concurrent use relative to cigarette-only smoking. Among current (past-30-days) cigarette smokers, multivariable logistic regression assessed whether ATP use was associated with nicotine dependence, quit intention and quit attempt.

RESULTS

Overall, 5.8% of adolescents reported current tobacco use (2.1% cigarette-only smoking, 2.5% exclusive ATP use and 1.2% concurrent use). Compared with cigarette-only smoking, exclusive ATP use and concurrent tobacco use were associated with younger age, higher perceived family financial status, absence of cigarette smoking peers, poor knowledge about smoking and more frequent alcohol use. Among current cigarette smokers, ATP use was negatively associated with cigarette quit intention and quit attempt.

CONCLUSIONS

ATP use was as prevalent as cigarette smoking among adolescents, and ATP users were different from cigarette smokers in many demographic and psychosocial factors. Tobacco control programs among youth should target different types of tobacco users and address all forms of tobacco products.

Examining vulnerability to smokeless tobacco use among adolescents and adults meeting diagnostic criteria for major depressive disorder

Smoking prevalence is unevenly distributed in the U.S. population, with those with mental illness, other substance use disorders, and lower socioeconomic status being especially vulnerable. Less research has been conducted on the association between these same vulnerabilities and smokeless tobacco (ST) use. The present study examined cigarette and ST use among adolescents and adults who met diagnostic criteria for major depressive disorder in the National Survey on Drug Use and Health (NSDUH). Utilizing the most recent (2011) NSDUH, we compared odds for current cigarette smoking and ST use among adolescents and adults meeting criteria for past-year major depressive disorder to the general population, after adjusting for potential confounding influences of sociodemographic and other substance use characteristics. Analyses were conducted to examine sex as a moderator of the relation between major depressive disorder and tobacco use. Odds for current cigarette smoking among those classified with major depressive disorder were increased among adolescents (OR = 1.33, 95% CI [1.05, 1.69], p = .021) and adults (OR = 1.70, 95% CI [1.47, 1.97], p < .0005), and odds for current ST use did not differ among adolescents (OR = 0.90, 95% CI [0.54, 1.49], p = .678) and were lower among adults (OR = 0.68, 95% CI [0.51, 0.91], p = .010). Sex was not a significant moderator in adolescents or adults. Major depressive disorder is associated with increased risk for smoking but not ST use among adolescents and adults further demonstrating heterogeneity in predictors of vulnerability to use of different tobacco products.

Alternative tobacco use among college students: who is at highest risk?

OBJECTIVE

To examines smoking status, substance use, sociodemographics, and psychosocial characteristics in relation to alternative tobacco use among college students.

METHODS

Current tobacco use (cigarettes, cigar-like products, hookah, chew, snus) and correlates (sociodemographics, sensation-seeking, attitudes toward tobacco and smokers, social factors) were assessed among students aged 18-25 at 6 Southeastern US colleges using an online survey.

RESULTS

Those who were younger, male, black, cigarette and marijuana users, and demonstrating at-risk psychosocial factors were at increased risk of alternative tobacco product use (p < .001). Among current smokers, never daily nondaily smokers were 3 times as likely as former daily non-daily smokers and daily smokers to use alternative tobacco products (p < .001).

CONCLUSIONS

Important risk factors for alternative tobacco use included important sociodemographic and psychosocial characteristics.

Cigar, cigarillo, and little cigar use among current cigarette-smoking adolescents

INTRODUCTION

Cigar, cigarillo, and little cigar (CCLC) use is prevalent among adolescents, particularly among those who smoke cigarettes.

METHODS

Using data from a longitudinal study of smoking patterns among adolescents, we examined differences between CCLC users (ever and past 30 days) and nonusers (never and not in the past 30 days) among adolescents who smoked a cigarette in the last month (n = 486).

RESULTS

In our sample, 76.7% reported ever trying CCLC and 40.7% reported past month CCLC use. Bivariate analyses showed that CCLC users differed from nonusers in terms of demographics, other forms of tobacco use, other substance use, and mental health. Multivariate logistic regression analyses found that both ever and past 30-day CCLC use were strongly associated with being male and concurrent use of hookah. Ever CCLC use was also strongly associated with recent use of alcohol, and past 30-day CCLC use was strongly associated with antisocial behavior. After controlling for the number of days on which cigarettes were smoked in the past 30 days, past 30-day CCLC use was associated with most other forms of tobacco use, other substance use, and mental health, but not with number of cigarettes smoked in the past month and nicotine dependence.

CONCLUSIONS

Results suggest that CCLC use is high among adolescent cigarette users and is associated with a variety of negative correlates. Importantly, many of these relationships are not accounted for by the adolescent's level of cigarette use. Further characterizing CCLC use will be important for developing more targeted and tailored interventions.

Smokeless tobacco use among operating engineers

Workers in blue collar occupations have been shown to have higher rates of smokeless tobacco (ST) use compared to other occupational groups. Guided by the Health Promotion Model, the purpose of this study was to understand various factors that predict ST use in Operating Engineers. A cross-sectional design was used to determine variables related to ST use among Operating Engineers. Engineers (N = 498) were recruited during their 3-day apprentice certification course to participate in the study. Logistic regression was used to assess the associations between personal, psychological and behavioral characteristics associated with ST use. Past month ST use was reported among 13% of operating engineers surveyed. Multivariate analysis showed that younger age and lower rates of past month cigarette use were significantly associated with ST use, while higher rates of problem drinking were marginally associated with ST use. Operating Engineers are at high risk for using ST products with rates in this sample well over the national average. Work site interventions, which have shown promise in other studies, may be useful in decreasing ST use among this population.

Smokeless tobacco use and its relation to panic disorder, major depression, and posttraumatic stress disorder in American Indians

INTRODUCTION

Rates of nicotine use are high in American Indians. Anxiety and depression tend to be associated with cigarette use, but the association of anxiety and depression with smokeless tobacco (ST) is less clear. We asked if panic disorder, major depression, and posttraumatic stress disorder (PTSD) are related to lifetime ST use in 2 American Indian tribes.

METHODS

Logistic regression analyses examined the association between lifetime panic disorder, major depression, and PTSD and the odds of lifetime ST use status after controlling for sociodemographic characteristics, smoking status, and alcohol use disorders in 1,506 Northern Plains and 1,268 Southwest tribal members.

RESULTS

Odds of lifetime ST use was 1.6 times higher in Northern Plains tribal members with a lifetime history of PTSD after controlling for sociodemographic variables and smoking (95% CI: 1.1, 2.3; p = .01). This association remained significant after further adjustment for panic disorder and major depression (odds ratio [OR] = 1.5; 95% CI: 1.0, 2.2; p = .04) but was diminished after accounting for alcohol use (OR = 1.3; 95% CI: 0.9, 1.9; p = .23). In the Southwest, lifetime psychiatric disorders were not associated with lifetime ST use status. Increasing psychiatric comorbidity was significantly linked to increased odds of ST use in both tribes.

CONCLUSIONS

This study is the first to examine psychiatric conditions and lifetime ST use in a large, geographically diverse American Indian community sample. Although approximately 30% of tribal members were lifetime users of ST, the association with lifetime psychiatric disorders was not as strong as those observed with cigarette smoking. Understanding shared mechanisms between all forms of tobacco use with anxiety and depressive disorders remains an important area for investigation.

Who uses snus? A study of Texas adolescents

INTRODUCTION

Snus, a smokeless tobacco product, was introduced in the United States in 2006. Because it is available in a variety of flavors and is relatively easy to conceal, snus might be particularly attractive to adolescents. Yet, no studies have examined snus use in U.S. adolescents. This brief report examined (a) differences between adolescent snus users and non-snus users on a variety of demographic, behavioral, and intrapersonal factors and (b) prevalence of snus use among current users of various other tobacco products versus nontobacco users.

METHODS

Participants were 8,472 6th- to 12th-grade students who voluntarily completed the 87-item Texas Youth Tobacco Survey during class time.

RESULTS

Overall, 7.1% of students reported ever trying snus; of these, 77% were male, 68% were in high school, and 46% were White. Mixed-effects regression models indicated that the prevalence of cigarette, chew, cigar, and alcohol use was higher among snus users than among non-snus users. Compared with non-snus users, snus users performed more poorly in school and perceived snus, cigarettes, chew, and cigars to be less dangerous. Finally, current users of cigarettes, chew, and cigars had a higher prevalence of snus use than did their peers who did not use the respective products.

CONCLUSIONS

Among U.S. adolescents, snus use may be part of a constellation of health compromising behaviors. Additional research is needed to determine who is using snus and identify the determinants and consequences of snus use, all of which can inform interventions and policies aimed at decreasing tobacco use among youth.

Tobacco use among Alaska Native people in the EARTH study

INTRODUCTION

While aggregate rates of tobacco use for Alaska Native (AN) and American Indian people are high, use rates vary among populations and factors associated with use are not fully understood. For AN people living in three regions of Alaska, we present prevalence of tobacco use as well as factors associated with use.

METHODS

Using data from 3,828 participant questionnaires, associations with tobacco use are examined with chi-square tests and multivariate logistic regression. Covariates investigated include demographic factors, identification with tribal tradition, language spoken in the home, binge drinking, and depression screening results.

RESULTS

Current smoking was more prevalent among men. In multivariate analysis, higher likelihood of current smoking was found for participants with these characteristics: younger, unmarried, low income, and increased frequency of binge drinking. For women, additional characteristics included no high school diploma and positive depression screening. Participants from southeastern Alaska were less likely to be current smokers. Current smokeless tobacco use rates were similar across gender. Higher likelihood of current smokeless use was found in southwestern Alaska and among those with positive depression screening. Women with low income and who reported at least some identification with tribal tradition had increased odds of current smokeless use. More than 20% of smokeless tobacco users reported initiating by age 10.

DISCUSSION

Rates of tobacco use by AN people continue to be higher than other U.S. populations. Tobacco initiation prevention efforts targeting AN youth at an early age are recommended, given the early age of initiation demonstrated in this study.

Depressive symptoms and health-related risk-taking in adolescence

This study investigated the relation between symptoms and a variety of health-related risk-taking behaviors during adolescence. A survey of 20,745 adolescents from the National Longitudinal Study of Adolescent Health provided data for analysis. Adolescents who reported more depressive symptoms were found to wear seatbelts less often, wear bike-helmets less often, and drive while drunk more frequently. Depressive symptoms did not correlate with reported condom use. The found relations were all mediated by reported levels of hopelessness. Reported levels of anhedonia and suicidality also mediated some of the found relations. Therefore, adolescents experiencing depressive symptoms, especially those reporting hopelessness, should be considered at jeopardy for a variety of health-related risk-taking behaviors.

How are lifetime polytobacco users different than current cigarette-only users? Results from a Canadian young adult population

Current cigarette smoking combined with ever use of other tobacco products (lifetime polytobacco use) is important to examine as users may be at greater risk for illicit drug use, nicotine addiction, and adverse health outcomes. We determined estimates and patterns of lifetime polytobacco use and conducted multivariable analyses to determine demographic, family and friend, psychosocial, and lifestyle factors associated with use among a sample of Canadian young adults. Overall prevalence was 36.3% for current cigarette use; 10.1% for current cigarette use only and 26.2% for lifetime polytobacco use. Among polytobacco users, current cigarette use and ever cigar use was most frequent (67.2%). For males, the final model contained demographic, family and friends, and lifestyle factors. For females, the final model also included psychosocial factors. Illicit drug use was the strongest significant predictor for lifetime polytobacco use among males. We found gender specific differences when comparing lifetime polytobacco users to current cigarette-only users, in particular; male lifetime polytobacco users were more likely to use drugs and alcohol. Interventions focusing on individual substances should consider addressing combinations of use.

Review of epidemiologic data on the debate over smokeless tobacco's role in harm reduction

Some tobacco researchers have argued that the European Union should remove its ban on a form of low-nitrosamine smokeless tobacco referred to as Swedish 'snus'. This argument has developed in to an international debate over the use of smokeless tobacco as a measure of harm reduction for smokers. Leading authorities in the USA have firmly stated that there is no safe tobacco - a message which does not allow for any discussion of comparative tobacco risks. This commentary is intended to review the origin of the controversy over Swedish 'snus', to examine briefly the meta-analysis on cancer risks by Peter Lee and Jan Hamling (published in July in BMC Medicine) and to discuss the anticipated direction of the debate on tobacco-harm reduction in the USA. We anticipate that much of the debate will shift from the discussion of epidemiologic data to the discussion of the marketing, health communication and economics of smokeless tobacco. While the Food and Drug Administration's newly approved authority over tobacco will undoubtedly affect the smokeless products, it may not be the sole determinant of harm reduction's fate in the USA. See associated research article by Lee and Hamling: http://www.biomedcentral.com/1741-7015/7/36.

Early-onset depressive disorders predict the use of addictive substances in adolescence: a prospective study of adolescent Finnish twins

AIMS

To explore the developmental relationships between early-onset depressive disorders and later use of addictive substances.

DESIGN, SETTING AND PARTICIPANTS

A sample of 1545 adolescent twins was drawn from a prospective, longitudinal study of Finnish adolescent twins with baseline assessments at age 14 years and follow-up at age 17.5 years.

MEASUREMENTS

At baseline, DSM-IV diagnoses were assessed with a professionally administered adolescent version of Semi-Structured Assessment for Genetics of Alcoholism (C-SSAGA-A). At follow-up, substance use outcomes were assessed via self-reported questionnaire.

FINDINGS

Early-onset depressive disorders predicted daily smoking [odds ratio (OR) 2.29, 95% confidence interval (CI) 1.49-3.50, P < 0.001], smokeless tobacco use (OR = 2.00, 95% CI 1.32-3.04, P = 0.001), frequent illicit drug use (OR = 4.71, 95% CI 1.95-11.37, P = 0.001), frequent alcohol use (OR = 2.02, 95% CI 1.04-3.92, P = 0.037) and recurrent intoxication (OR = 1.83, 95% CI 1.18-2.85, P = 0.007) 3 years later. ORs remained significant after adjustment for comorbidity and exclusion of baseline users. In within-family analysis of depression-discordant co-twins (analyses that control for shared genetic and familial background factors), early-onset depressive disorders at age 14 predicted significantly frequent use of smokeless tobacco and alcohol at age 17.5.

CONCLUSIONS

Our results suggest important predictive associations between early-onset depressive disorders and addictive substance use, and these associations appear to be independent of shared familial influences.

Nicotine dependence and mental disorders among adults in the USA: evaluating the role of the mode of administration

BACKGROUND

To investigate the association between nicotine dependence (ND), by cigarette smoking and use of smokeless tobacco (UST), and mental disorders.

METHOD

Face-to-face surveys (n=43 093) were conducted in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Nicotine use, ND, and mental disorders were assessed using DSM-IV criteria.

RESULTS

UST-ND was associated with a significantly increased likelihood of any anxiety disorder, specific phobia, alcohol abuse and dependence. Consistent with previous findings, cigarette smoking-ND was associated with an increased likelihood of all mental disorders examined. Among those without ND, cigarette smoking was specifically associated with panic attacks and panic disorder; non-dependent UST was not associated with mental disorders.

CONCLUSIONS

Our findings suggest that the association between ND and mental disorders is relatively specific to the mode of nicotine administration. Among those who are nicotine dependent, cigarette use is associated with most major psychiatric disorders, whereas UST is associated with dysthymia and specific phobia. Among those who use tobacco but are not nicotine dependent, cigarette use is associated with dysthymia and panic disorder; UST is not associated with any major mood or anxiety disorders. The link between mental disorders and nicotine is complex, and is associated primarily with dependence, and not with non-dependent use.

Characteristics of users of cigars, bidis, and kreteks and the relationship to cigarette use

BACKGROUND

In the 1990s, youth use of alternative tobacco products including cigars, bidis, and kreteks increased. This article discusses the prevalence of youth use of cigars, bidis, and kreteks, and characteristics of users.

METHODS

The Cigar Use Reasons Evaluation (CURE)-a questionnaire assessing alternative tobacco use and associated attitudes and behaviors-was administered to middle and high school students from 12 school districts across Massachusetts.

RESULTS

Males were more likely to use all forms of alternative tobacco and females more likely to smoke cigarettes. Hispanics were less likely to smoke kreteks or use smokeless tobacco. Urban students were more likely to smoke bidis or use smokeless tobacco than suburban or rural youth. Most smokeless and alternative tobacco users were lifetime cigarette smokers. There was, however, a significant group of cigar smokers, associated with higher parental education, who were not current cigarette smokers.

CONCLUSIONS

Use of alternative tobacco poses a risk to the success of tobacco control efforts. While many alternative tobacco users smoke cigarettes, some alternative tobacco users are current cigarette smokers. Cigar use thus constitutes a potential serious risk for youth who otherwise might not be exposed to tobacco.

Smokeless nicotine administration does not result in hypertension or a deterioration in glucose tolerance or insulin sensitivity in juvenile rats

We have previously reported that smokeless nicotine resulted in hypertension, but not a deterioration in glucose tolerance or insulin action in young adult male rats. To evaluate the effect of nicotine in juvenile animals, we studied 6-week-old male and female Sprague-Dawley rats and implanted 25-mg nicotine (N) or placebo (P) pellets. Weight gain was controlled by chow restriction in all 4 groups of rats. Males were generally heavier than females, both before and after N or P placement; there was no difference in weight between N and P groups for each sex. Systolic blood pressure, measured noninvasively, increased modestly, but not significantly, after N placement in both male and female rats. Glucose tolerance and insulin action were assessed by an oral glucose tolerance test (OGTT). Areas under the curve (AUC) were calculated for glucose (AUC(GLU)), insulin (AUC(INS)), and free fatty acids (FFA) (AUC(FFA)). Insulin action was calculated by several indices, which have correlated with more invasive studies. None of these metabolic parameters were significantly impacted by nicotine treatment, consistent with our observations in adult male rats. In summary, smokeless nicotine at this dose has no significant effect on observed cardiovascular or metabolic parameters in sexually immature male and female rats.

Snuff use and smoking in U.S. men: implications for harm reduction

BACKGROUND

Encouraging smokers to switch to snuff may have unintended public health implications. This study examined the associations between snuff use and smoking in a representative sample of U.S. men.

METHODS

Subjects were males aged >or=18 years in the National Health Interview Survey (N=13,865). The data analysis was conducted between August 2001 and April 2002. Multiple logistic regression modeling was used to examine the association between using snuff and quitting smoking.

RESULTS

In 1998, 26.4% of U.S. men smoked, 3.6% used snuff, and 1.1% used both products. Adjusting for age and race/ethnicity, current smoking was most prevalent among males who used snuff on some days (38.9%) and lowest among those who used snuff every day (19.2%). Daily snuff users were significantly more likely than never-users to have quit smoking in the preceding 12 months (odds ratio [OR]=4.23; 95% confidence interval [CI]=2.16-8.28). However, U.S. men were more likely to be former snuff users who currently smoked (2.5%) than to be former smokers who currently used snuff (1.0%). Occasional snuff users (some day users) were more likely than never users to have tried to quit smoking in the preceding year (OR=1.69; 95% CI=1.04-2.76) but tended to be less likely to succeed (OR=0.50; 95% CI=0.19-1.33).

CONCLUSIONS

Some men may use snuff to quit smoking, but U.S. men more commonly switch from snuff use to smoking. Some smokers may use snuff to supplement their nicotine intake, and smokers who also use snuff are more likely than nonusers to try to quit smoking but tend to have less success.

Dual Tobacco use among Native American adults in southeastern North Carolina

OBJECTIVE

While patterns of smokeless tobacco (ST) use and cigarette smoking are well documented, the epidemiology of simultaneous use of both tobacco products is less well studied, particularly among Native American populations. This study examines correlates of dual tobacco use among Lumbee Indian adults in southeastern North Carolina.

METHODS

A telephone survey among 400 adult Lumbee Indians in Pembroke, North Carolina, collected information on demographics, current tobacco use, amounts of tobacco used, and tobacco related attitudes.

RESULTS

Total of 241 (60.3%) individuals did not currently use tobacco, 104 (26%) currently smoked, 74 (18.5%) currently used ST, and 19 (4.8%) used both products. Thus, 19 of 104 (18.3%) current smokers and 19 of 74 (25.7%) current ST users reported dual tobacco use. Compared to exclusive users of either tobacco product, dual tobacco users were intermediate in age and frequency of church attendance, had lower levels of education, and were the highest proportion of subjects reporting no friends and few close relatives. There was no difference by gender or marital status by tobacco use categories. While exclusive cigarette smokers reported smoking more cigarettes per day than dual tobacco users, overall, dual tobacco users had higher estimated daily nicotine exposure levels. Logistic regression analysis showed that younger age and infrequent church attendance predicted exclusive cigarette smoking, while older age and less education predicted exclusive ST use. Dual tobacco use was predicted only by less education.

CONCLUSIONS

Simultaneous use of ST and cigarettes is comparatively more common among Lumbee Indian adults than the general population and has an epidemiology distinct from either exclusive cigarette smoking or ST use. These data are the first to explore social support as well as tobacco-related attitudes among dual tobacco users in a Native American population. Recognition of these patterns of dual tobacco use would be important in any future tobacco intervention among Lumbee Indian adults.