The role of race and ethnic status on the psychosocial correlates of smokeless tobacco use in adolescent males

Predictors of Smokeless Tobacco Susceptibility, Initiation, and Progression Over Time Among Adolescents in a Rural Cohort

BACKGROUND

Use of smokeless tobacco (ST, moist snuff and chewing tobacco) is elevated among male rural youth, particularly participants in certain sports, including baseball.

OBJECTIVES

This study aimed to assess factors associated with adolescent male athletes' ST-related behaviors over time, including: baseline use, initiation, and progression in use intensity in a school-based longitudinal cohort.

METHODS

Baseline and one-year follow-up questionnaires assessed sociodemographic characteristics, environmental factors, and tobacco-related perceptions and behaviors among 9- to12th-grade interscholastic baseball players in 36 rural California schools. Population characteristics were compared among ST use categories (never, experimental, and experienced users). Multivariable models using generalized estimating equations were estimated for outcomes among baseline ST never-users (ST susceptibility and future initiation) and experimenters (ST expectations and progression in ST use).

RESULTS

Of 594 participants, over half (57%) had ever tried a tobacco product and the most common products tried were ST (36%) and electronic cigarettes (36%). Being older, perceiving less ST harm, being Non-Hispanic White, using alcohol or other tobacco products, having family or friends who use ST, and being receptive to advertising were associated with greater baseline ST use. Baseline alcohol consumption, lower perceived ST harm, peer use, and susceptibility and expectations were predictive of ST initiation and/or progression at one-year follow-up. Conclusion/Importance: Certain environmental, socio-demographic, cognitive, and behavioral factors predict ST susceptibility and later initiation and progression in use. Interventions addressing these factors have potential to prevent ST uptake and continued use within this high-risk adolescent population.

Spit (Smokeless) Tobacco Intervention for High School Athletes: results after 1 year

OBJECTIVE

To determine the efficacy of a spit tobacco (ST) intervention designed to promote ST cessation and discourage ST initiation among male high school baseball athletes.

METHODS

This study was a cluster-randomized controlled trial. Forty-four randomly selected high schools in rural California were randomized within strata (prevalence of ST use and number and size of baseball teams) to either the intervention or the control group. Ninety-three percent of eligible baseball athletes participated, yielding 516 subjects in 22 intervention schools and 568 subjects in 22 control schools. Prevalences of sustained ST cessation and ST use initiation over 1 year were assessed by self-report. Multivariate logistic regression models for clustered responses were used to test the null hypotheses of no association between group and the two outcomes, adjusted for the stratified design and baseline imbalances between groups in significant predictors of ST use.

RESULTS

Prevalence of cessation was 27% in intervention high schools and 14% in control high schools (odds ratio (OR)=2.29; 95% confidence interval (CI), 1.36-3.87). The intervention was especially effective in promoting cessation among those who, at baseline, lacked confidence that they could quit (OR=6.4; 95% CI, 1.0-4.3), among freshmen (OR=15; 95% CI, 0.9-260), and among nonsmokers (OR=3.2; 95% CI, 0.9-11). There was no significant difference between groups in the prevalence of ST initiation.

CONCLUSIONS

This intervention was effective in promoting ST cessation, but was ineffective in preventing initiation of ST use by nonusers.

Cigarette smoking in multicultural, urban high school students

PURPOSE

To profile patterns of cigarette use among a multiethnic population of high school students, and identify important factors associated with cigarette use by ethnicity, in order to plan effective health promotion strategies.

METHODS

This cross-sectional study involved the completion of a lifestyle questionnaire by 1236 Grade 9-13 students (86% response rate) from 62 randomly selected classrooms in three urban high schools in Toronto. Chi-square analysis of the association between tobacco use and other variables took account of the clustered sample using CSAMPLE in Epi Info.

RESULTS

The students self-identified their ethnicity as follows: 388 Canadian, 269 European, 171 East Indian, 137 Asian, 76 West Indian, and 194 "other." Students who identified themselves as Canadians were significantly more likely to be current smokers (29%) than students reporting other ethnicities (13%). There was no apparent increase in smoking rates for immigrants after 2 or more years in Canada. Current drinking, sexual activity, and especially friends smoking was most strongly associated with current smoking for most ethnic groups, although the relative importance of these variables was not identical for all groups.

CONCLUSIONS

Prevention programs may benefit from a focus on the influence of peer smoking and on the grouping together of lifestyle factors associated with smoking for students in all ethnic groups in this multicultural city.

Spit (smokeless) tobacco use by high school baseball athletes in California

OBJECTIVE

To describe the prevalence, patterns, and correlates of spit (smokeless) tobacco (ST) use in a sample of high school baseball athletes in California.

DESIGN

This cross sectional study was a survey of 1226 baseball athletes attending 39 California high schools that were randomly selected from a list of all publicly supported high schools with baseball teams. At a baseball team meeting, athletes who agreed to participate and had parental consent completed the study questionnaire. To enhance the accuracy of self reported ST use status, a saliva sample was collected from each subject. The questionnaires and saliva samples were coded and salivary cotinine assay was performed on a random subsample of 5% of non-users who also were non-smokers. Biochemical assay indicated that 2% tested positive for cotinine inconsistent with self reported ST non-use.

RESULTS

Overall, 46% had ever used ST and 15% were current users. Odds ratios and 95% confidence intervals (CI) suggested that, among high school baseball athletes, age, living in a rural area, being white, smoking cigarettes, drinking alcohol, not knowing about the adverse effects of ST, perceiving little personal risk associated with ST use, and believing that friends, role models, teammates, and same age baseball athletes in general used ST, increased the likelihood of being an ST user.

CONCLUSION

The findings indicate that considerable experimentation with ST products occurs among high school baseball athletes in California, and many are current users. ST interventions targeting this population are needed to stop the transition from experimental ST use to tobacco dependence. Correlates of ST use for consideration in future intervention studies are identified.

A comparison of male and female smokeless tobacco use

This study explored the factors associated with female smokeless tobacco (ST) use and examined gender differences in factors related to use. Interviews were conducted either in person or by telephone with 51 female and 59 male users from the Pacific Northwest. The interview included both quantitative and qualitative items assessing personal, social, and substance use variables. Male and female users were found to be similar in a variety of areas, such as reasons for initiating use, use of ST in response to different mood states, and high rates of experimentation with other drugs. However, female users reported using ST for weight control more extensively, identified a greater influence by other female users, and reported fewer friends knowing about their use. Male users reported using ST more often during sports activities and in the workplace than did female users, and were almost three times more likely to be highly addicted to ST. The implications of the study for the development of prevention and cessation programs are discussed.

Oral spit tobacco: addiction, prevention and treatment

The prevalence of smokeless tobacco is significant and reaches as high as 17% past month use in white males aged 18-25. Smokeless tobacco use is of concern because of the potential for addiction and the associated negative health consequences. This article reviews the basis for addiction to smokeless tobacco, examining the nicotine content in smokeless tobacco products, pharmacokinetics, psychoactive effects, tolerance, and withdrawal. It also explores the negative health consequences which include a number of oral pathologies and increased cardiovascular risk factors. Furthermore, it examines the factors associated with the initiation of smokeless tobacco use, and the current prevention programs that address these factors. Current smokeless tobacco treatment approaches are also discussed as well as predictors for abstinence. Finally, the future directions are discussed in light of the limited amount of research that has been conducted in the smokeless tobacco area, particularly related to prevention and treatment.

Non-ceremonial tobacco use among southwestern rural American Indians: the New Mexico American Indian Behavioural Risk Factor Survey

OBJECTIVES

To ascertain non-ceremonial tobacco use among rural American Indians in New Mexico (United States).

DESIGN

A geographically targeted telephone survey.

SETTING

Rural New Mexico.

PARTICIPANTS

American Indian residents aged 18 years and older.

MAIN OUTCOME MEASURES

Prevalence of ever-smokers and current smokers of cigarettes and ever-users and current users of smokeless tobacco, number of cigarettes smoked, and prevalence of cigarette smoking quitting behaviour.

RESULTS

Of the 1266 respondents, 38.5% (95% confidence interval (CI) = 34.5% to 42.1%) reported ever smoking, and 16.3% (95% CI = 13.5% to 19.0%) reported being current smokers. Current smokers averaged 7.6 (95% CI = 6.0 to 9.3) cigarettes per day. Current smoking prevalence was highest among men and lowest among college graduates. Prevalence of smokeless tobacco use was 24.1% for ever-use and 7.2% for current use and showed a strong male predominance of use.

CONCLUSIONS

The prevalence of current smokers among rural American Indians in New Mexico was lower than among American Indians of other regions in the United States, all New Mexicans, and the national population as a whole. Although smoking prevalence was lower among American Indians in New Mexico, variation by sex and education followed the same patterns as reported among American Indians of other regions.

Trends in tobacco use among high school students in the United States, 1991-1995

This study examined demographic characteristics of tobacco-using high school students in the United States from 1991 through 1995. Data about cigarette smoking and smokeless tobacco use among adolescent were collected in 1991, 1993, and 1995 using the Youth Risk Behavior Survey, part of the Youth Risk Behavior Surveillance System implemented by the Centers for Disease Control and Prevention. Data indicated current smoking increased 26.5% from 1991 to 1995 with one-third [31.2% (+/- 1.7)] of ninth grade students and 38.2% (+/- 3.5) of 12th grade students reporting current smoking in 1995. Smokeless tobacco use remained stable with 11.4% (+/- 1.7) of all students and one-fourth [25.1% (+/- 3.0)] of White male students reporting smokeless tobacco use in 1995. Many students already have begun using tobacco before reaching high school. Thus, interventions should begin well before high school to prevent adolescents from using and becoming addicted to tobacco.

Adult smokeless tobacco use and age of onset

To determine if an earlier age of onset is associated with greater levels of adult smokeless tobacco (SLT) use and to evaluate if this relationship differs by SLT type, 345 current adult SLT users were interviewed to obtain the age at first onset and current frequency of SLT use. The results indicated that more than twice as many SLT users began during adulthood than during preadolescence. Although preadolescent onset was associated with greater chewing tobacco use than adolescent onset, the greatest levels of both chewing tobacco and snuff use were associated with adult onset, suggesting an increased need for SLT prevention programs for young adults.

Use of smokeless tobacco by Mexican-American high school students

A survey of 208 girls and 191 boys attending a public high school in southwestern New Mexico was conducted to examine students' use of smokeless tobacco products. One Mexican-American girl identified herself as a user of chewing tobacco. Of the boys 8% (17) indicated that they used chewing tobacco and 7% (15) reported that they dipped snuff. 6% (12) indicated use of both snuff and chewing tobacco. The boys included 153 Mexican-Americans of whom 7% used smokeless tobacco and 26 Anglo-Americans of whom 34% were users.