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Xie C, Jeffers AM, Winickoff JP. Categorizing Vaping Intensity Among Youth. Nicotine Tob Res 2024; 26:984-990. [PMID: 38227762 DOI: 10.1093/ntr/ntae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 11/25/2023] [Accepted: 01/02/2024] [Indexed: 01/18/2024]
Abstract
INTRODUCTION Increasing electronic cigarette use among youth has led to a need for a novel intensity measure of e-cigarette use and its association with nicotine addiction variables. AIMS AND METHODS Using a cross-sectional study of the 2018-2019 PATH Wave 5 Youth survey, a new intensity metric of e-cigarette use, the average number of puffs per month as a function of frequency (days of use per month), number of uses per day and number of puffs per use, was developed for adolescent e-cigarette users. Using logistic regression, standard addiction measures were tested for association with higher quartile (Q) of e-cigarette intensity: Q1 (1-5 puffs), Q2 (6-50 puffs), Q3 (51-528 puffs), and Q4 (529 + puffs). RESULTS Among 1051 current youth e-cigarette users, cravings were associated with greater intensity of use (Q2: aOR = 1.90, 95% CI: 0.94-3.87; Q3: aOR = 6.91, 95% CI: 3.25-14.69; and Q4: aOR = 21.48, 95% CI: 10.03-45.97). Craving associations exceeded the corresponding aORs for the identical regression using the frequency of use. Higher intensity was significantly associated with being an older adolescent (aOR = 1.85), best friend use (aOR: 3.35), not thinking about quitting (aOR: 2.51), and lower perceived addiction (aOR: 1.95). CONCLUSIONS This study found that an intensity metric (puffs per month) was strongly associated with cravings, best friend use, harm perception, and lack of intention to quit. This metric provides a more accurate picture of the intensity of youth e-cigarette use than other commonly used measures and may be important for understanding the current and future impact of the youth e-cigarette epidemic. IMPLICATIONS Adolescent addiction to e-cigarettes affects learning, memory, and attention. However, it is unknown whether the intensity of use, puffs per month, differs from frequency, days of use per month, and in relation to addiction measures. This study provides evidence that high-intensity use characterized by puffs per month has a stronger association with cravings compared to frequency, which suggests puffs per month may be a better measure of nicotine exposure. This new intensity metric may give insights into youth e-cigarette use patterns, addiction, and appropriate treatment of intense but intermittent users.
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Affiliation(s)
- Catherine Xie
- Department of Biology, University of Rochester, Rochester, NY, USA
| | - Abra M Jeffers
- Division of General Academic Pediatrics, Massachusetts General for Children, Boston, MA, USA
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Jonathan P Winickoff
- Division of General Academic Pediatrics, Massachusetts General for Children, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Tobacco Consortium, American Academy of Pediatrics, Itasca, IL, USA
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Ahmadi A, Rahimi A, Wardak MF, Ahmadi H, Lucero-Prisno DE. Tobacco harm reduction in Afghanistan: a recipe for improving smokers' health. Subst Abuse Treat Prev Policy 2023; 18:7. [PMID: 36683028 PMCID: PMC9867861 DOI: 10.1186/s13011-023-00517-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 01/16/2023] [Indexed: 01/23/2023] Open
Abstract
Tobacco Harm Reduction (THR) offers a promising approach to addressing the significant burden of smoking in Afghanistan. Over three million Afghans smoke daily, making it a leading cause of preventable deaths in the country. While the previous Afghan government implemented various tobacco cessation policies and strategies, these measures were only partially effective in reducing the number of smokers or smoking-related deaths. In 2021, community-based initiatives in Kabul and Herat started advocating for Tobacco Harm Reduction (THR) as a novel, realistic, and practical approach proven to promote smoking abstinence and minimize tobacco harm. However, implementing THR strategies in Afghanistan faces numerous challenges, including a lack of governmental support, funding issues, unfavorable market conditions, the high cost-effectiveness of THR products, and misconceptions about these products. To effectively promote THR in Afghanistan and overcome these challenges, it will be necessary to implement THR policies that support THR products for smokers, regulate the market for these products, produce them locally with healthcare professional oversight, conduct more engaging advocacy campaigns, and secure domestic sponsors.
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Affiliation(s)
- Attaullah Ahmadi
- École des Hautes Études en Santé Publique, Paris, France
- Medical Research Center, Kateb University, Kabul, Afghanistan
| | - Ali Rahimi
- Medical Faculty, Herat University, Students Street, Herat, 3001 Afghanistan
| | | | | | - Don Eliseo Lucero-Prisno
- Faculty of Management and Development Studies, University of the Philippines Open University, Los Banos, Laguna Philippines
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Sparrock LS, Phan L, Chen-Sankey J, Hacker K, Ajith A, Jewett B, Choi K. Nicotine Pouch: Awareness, Beliefs, Use, and Susceptibility among Current Tobacco Users in the United States, 2021. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2050. [PMID: 36767414 PMCID: PMC9915420 DOI: 10.3390/ijerph20032050] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
Little is known about awareness, beliefs, and use of nicotine pouches (NPs). Data from 1583 U.S. adult (age ≥ 21 years) current tobacco users were collected in 2021. Respondents self-reported NP awareness, beliefs, use, and susceptibility as well as current tobacco product use and socio-demographics. We used weighted logistic and multinomial regression models to explore the associations between these variables. Overall, 46.6% of U.S. adult current tobacco users were aware of, 16.4% had ever used, and 3.0% currently used NPs. Younger individuals (vs. 61+ years) were more likely to have ever heard of NPs, while Black individuals (vs. White) were less likely to have ever heard of NPs. Individuals younger than 45 years (vs. 61+ years) and those using smokeless tobacco products (vs. non-users) were more likely to have ever used NPs. Additionally, younger than 45 years (vs. 61+ years) and current use of certain tobacco products (e.g., smokeless) were associated with current NP use. Holding favorable beliefs about NPs was associated with susceptibility to and more advanced NP use statuses (p < 0.05). Continuous surveillance of NP use and beliefs is important.
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Affiliation(s)
| | - Lilianna Phan
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20892, USA
| | - Julia Chen-Sankey
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ 08901, USA
- School of Public Health, Rutgers Biomedical and Health Sciences, Piscataway, NJ 08854, USA
| | - Kiana Hacker
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20892, USA
| | - Aniruddh Ajith
- University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
| | - Bambi Jewett
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20892, USA
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20892, USA
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Fahey MC, Little MA, Klesges RC, Talcott GW, Richey PA, Mehmet K, Krukowski RA. Use of Tobacco for Weight Control across Products among Young Adults in the U.S. Military. Subst Use Misuse 2020; 56:153-161. [PMID: 33183122 PMCID: PMC8058943 DOI: 10.1080/10826084.2020.1846196] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Approximately 17% of young adults currently use tobacco, most commonly cigarettes and/or electronic cigarettes (e-cigarettes), followed by other products (i.e., cigarillos, pipe/hookah, smokeless tobacco). Cigarettes have been historically used to control weight. Little is known about use of non-cigarette products for weight control, particularly among non-college young adults. Tobacco use in the military is higher than civilians, and personnel have increased motivation for weight control due to military fitness standards. This population might be vulnerable to use tobacco for this purpose. Purpose: Exploring prevalence, as well as demographic and behavioral correlates, of using tobacco products for weight control, among a large, diverse sample of military young adults. Methods: U.S. Air Force recruits (N = 24,543) completed a questionnaire about tobacco use. Among users of tobacco products, recruits reported if they had ever used that product to maintain their weight. Results: Smokeless tobacco was most commonly used for weight control (12.2%), followed by cigarettes (7.3%), e-cigarettes (5.5%), cigarillos (3.3%), and hookah/pipe (3.2%). Using tobacco for weight control was associated with fewer harm beliefs and more regular use of that product. Among e-cigarette users, having a higher BMI and a lower educational background was associated with ever using this product for weight control. Conclusions: The belief that a tobacco product helps control one's weight might increase the prevalence, and frequency of use, of that product among military young adults. Tobacco cessation programs should assess for this motivation of use and provide education about tobacco harm and alternative strategies for weight maintenance.
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Affiliation(s)
- M C Fahey
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | - M A Little
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - R C Klesges
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - G W Talcott
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - P A Richey
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - K Mehmet
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - R A Krukowski
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Helme DW, Oser C, Knudsen HK, Morris E, de la Serna A, Zelaya C. Smokeless Tobacco and the Rural Teen: How Culture and Masculinity Contribute to Adolescent Use. JOURNAL OF HEALTH COMMUNICATION 2019; 24:311-318. [PMID: 30963816 DOI: 10.1080/10810730.2019.1601302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Tobacco use is the leading preventable cause of disease, disability, and death in the United States. Smokeless tobacco (SLT) is primarily used by younger, rural males and often in the presence of other males. This formative study examined how hegemonic masculinity and male norms can lead to initiation and continued use of SLT by rural adolescent males and females. Survey data collected from high school sophomores in 4 rural high schools (n = 293) explores perceptions of masculinity and male norms' contribution to SLT uptake and use. About 22.5% of total sample reported lifetime use (34.4% male, 13.7% female), 10.9% reported past-month use (20.0% male, 4.2% female). Logistic regressions show a one-unit increase in adherence to traditional perceptions of masculinity more than doubled the odds of ever using SLT and significantly increased odds of 30-day use. Having male household family members who uses SLT significantly increased the odds of lifetime and 30-day SLT use for both genders, while having male family members who smoke cigarettes was not a significant correlate. Recognition of health warnings on SLT packaging was negatively associated with SLT use for both genders. Implications for inclusion of masculinity and male role models in SLT prevention intervention strategies are discussed.
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Affiliation(s)
- Donald W Helme
- a Department of Communication , University of Kentucky , Lexington , USA
| | - Carrie Oser
- b Department of Sociology , University of Kentucky , Lexington , USA
| | - Hannah K Knudsen
- c Department of Behavioral Science , University of Kentucky , Lexington , USA
| | - Edward Morris
- b Department of Sociology , University of Kentucky , Lexington , USA
| | - Ana de la Serna
- d Communications Department , California State University , Dominguez Hills , USA
| | - Carina Zelaya
- a Department of Communication , University of Kentucky , Lexington , USA
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Hossain MS, Kypri K, Rahman B, Milton AH. Smokeless tobacco consumption and stillbirth: Population-based case-control study in rural Bangladesh. Drug Alcohol Rev 2017; 37:414-420. [PMID: 28543690 DOI: 10.1111/dar.12566] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 03/31/2017] [Accepted: 04/06/2017] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
| | - Kypros Kypri
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Bayzidur Rahman
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Abul Hasnat Milton
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
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Biswas S, Manna K, Das U, Khan A, Pradhan A, Sengupta A, Bose S, Ghosh S, Dey S. Smokeless tobacco consumption impedes metabolic, cellular, apoptotic and systemic stress pattern: A study on Government employees in Kolkata, India. Sci Rep 2015; 5:18284. [PMID: 26669667 PMCID: PMC4680924 DOI: 10.1038/srep18284] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 10/19/2015] [Indexed: 01/27/2023] Open
Abstract
Smokeless tobacco (SLT) remains a threat amongst a large population across the globe and particularly in India. The oral use of tobacco has been implicated to cause physiological stress leading to extreme toxicological challenge. The study included 47 SLT-users and 44 non-users providing a spectrum of pathophysiological, clinico-biochemical, antioxidant parameters, cell cycle progression study of PBMC and morphological changes of red blood cells (RBC). The expressions of p53, p21, Bax, Bcl-2, IL-6, TNF- α, Cox-2, iNOS were analyzed from thirteen representative SLT-users and twelve non-users. Difference in CRP, random glucose, serum cholesterol, TG, HLDL-C, LDL-C, VLDL-C, neutrophil count, monocyte count, ESR, SOD (PBMC) and TBARS (RBC membrane) were found to be statistically significant (p < 0.05) between the studied groups. The current study confers crucial insight into SLT mediated effects on systemic toxicity and stress. This has challenged the metabolic condition leading to a rise in the inflammatory status, increased apoptosis and RBC membrane damage. The above findings were substantiated with metabolic, clinical and biochemical parameters. This is possibly the first ever in-depth report and remains an invaluable document on the fatal effects of SLT.
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Affiliation(s)
- Sushobhan Biswas
- Department of Physiology, University of Calcutta, 92, A.P.C Road, Kolkata 700009, West Bengal, India
| | - Krishnendu Manna
- Department of Physiology, University of Calcutta, 92, A.P.C Road, Kolkata 700009, West Bengal, India
| | - Ujjal Das
- Department of Physiology, University of Calcutta, 92, A.P.C Road, Kolkata 700009, West Bengal, India
| | - Amitava Khan
- Department of Physiology, University of Calcutta, 92, A.P.C Road, Kolkata 700009, West Bengal, India
| | - Anirban Pradhan
- Department of Physiology, University of Calcutta, 92, A.P.C Road, Kolkata 700009, West Bengal, India
| | - Aaveri Sengupta
- Department of Physiology, University of Calcutta, 92, A.P.C Road, Kolkata 700009, West Bengal, India
| | - Surajit Bose
- Department of Physiology, University of Calcutta, 92, A.P.C Road, Kolkata 700009, West Bengal, India
| | - Saurabh Ghosh
- Human Genetics Unit, Indian Statistical Institute, 203 B.T. Road, Kolkata 700 108, West Bengal, India
| | - Sanjit Dey
- Department of Physiology, University of Calcutta, 92, A.P.C Road, Kolkata 700009, West Bengal, India
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Hossain MS, Kypri K, Rahman B, Arslan I, Akter S, Milton AH. Prevalence and correlates of smokeless tobacco consumption among married women in rural Bangladesh. PLoS One 2014; 9:e84470. [PMID: 24416234 PMCID: PMC3885568 DOI: 10.1371/journal.pone.0084470] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 11/20/2013] [Indexed: 11/24/2022] Open
Abstract
Objective To estimate the prevalence and identify correlates of smokeless tobacco consumption among married rural women with a history of at least one pregnancy in Madaripur, Bangladesh. Materials and Methods We conducted a cross-sectional survey using an interviewer administered, pre-tested, semi-structured questionnaire. All women living in the study area, aged 18 years and above with at least one pregnancy in their lifetime, who were on the electoral roll and agreed to participate were included in the study. Information on socio-demographic characteristics and smokeless tobacco consumption was collected. Smokeless tobacco consumption was categorized as ‘Current’, ‘Ever but not current’ and ‘Never’. Associations between smokeless tobacco consumption and the explanatory variables were estimated using simple and multiple binary logistic regression. Results 8074 women participated (response rate 99.9%). The prevalence of ‘Current consumption’, ‘Ever consumption but not current’, and ‘Never consumption’ was 25%, 44% and 31%, respectively. The mean age at first use was 31.5 years. 87% of current consumers reported using either Shadapata or Hakimpuree Jarda. Current consumption was associated with age, level of education, religion, occupation, being an income earner, marital status, and age at first use of smokeless tobacco. After adjustment for demographic variables, current consumption was associated with being over 25 years of age, a lower level of education, being an income earner, being Muslim, and being divorced, separated or widowed. Conclusion The prevalence of smokeless tobacco consumption is high among rural women in Bangladesh and the age of onset is considerably older than that for smoking. Smokeless tobacco consumption is likely to be producing a considerable burden of non-communicable disease in Bangladesh. Smokeless tobacco control strategies should be implemented.
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Affiliation(s)
- Mohammad Shakhawat Hossain
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, New Lambton Heights, New South Wales, Australia
| | - Kypros Kypri
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, New Lambton Heights, New South Wales, Australia
| | - Bayzidur Rahman
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Iqbal Arslan
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Shahnaz Akter
- Directorate General of Health Services, Dhaka, Bangladesh
| | - Abul Hasnat Milton
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, New Lambton Heights, New South Wales, Australia
- * E-mail:
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Fisher KJ, Severson HH, Christiansen S, Williams C. Using Interactive Technology to Aid Smokeless Tobacco Cessation: A Pilot Study. AMERICAN JOURNAL OF HEALTH EDUCATION 2013. [DOI: 10.1080/19325037.2001.10603495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Herbert H. Severson
- a Oregon Research Institute , 1715 Franklin Boulevard, Eugene , OR , 97403-1983 , USA
| | | | - Chris Williams
- a Oregon Research Institute , 1715 Franklin Boulevard, Eugene , OR , 97403-1983 , USA
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Helme DW, Cohen EL, Parrish AJ. Health, masculinity and smokeless tobacco use among college-aged men. HEALTH COMMUNICATION 2012; 27:467-77. [PMID: 22007958 DOI: 10.1080/10410236.2011.610257] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Existing work on smokeless tobacco (SLT) often focuses on correlates and predictors of use, ignoring the social and cultural context surrounding initiation and continued use of SLT products. The current study takes a qualitative approach using guided focus groups to examine this unexplored context. The findings show that male SLT users gain social rewards from dipping with other men, and usage is initiated and continued in spite of known potential health consequences. For the men participating in this study SLT use was primarily initiated at social or athletic events with the encouragement of other men and continued for relational maintenance and bonding. Additionally, the men reported that the social rewards received from using SLT far outweighed any potential health consequences or negative social repercussions they might also experience. Implications for future research and health interventions targeting SLT use are discussed.
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Affiliation(s)
- Donald W Helme
- Department of Communication, University of Kentucky, 239 Grehan Building, Lexington, KY 40506-0042, USA.
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Grier T, Knapik JJ, Canada S, Canham-Chervak M, Jones BH. Tobacco use prevalence and factors associated with tobacco use in new U.S. Army personnel. J Addict Dis 2010; 29:284-93. [PMID: 20635278 DOI: 10.1080/10550887.2010.489445] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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.
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Affiliation(s)
- Tyson Grier
- Directorate of Epidemiology and Disease Surveillance, United States Army Public Health Command, Aberdeen Proving Ground, MD 21010, USA.
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Caria MP, Bellocco R, Zambon A, Horton NJ, Galanti MR. Overweight and perception of overweight as predictors of smokeless tobacco use and of cigarette smoking in a cohort of Swedish adolescents. Addiction 2009; 104:661-8. [PMID: 19215597 DOI: 10.1111/j.1360-0443.2009.02506.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To study the association between measured or perceived overweight in adolescence and subsequent uptake of cigarette smoking and of the Swedish smokeless tobacco 'snus' (oral moist snuff). DESIGN Population-based prospective cohort study with 7 years' follow-up. SETTING Self-administered questionnaires and school nurses' visits. PARTICIPANTS A total of 2922 children of both sexes and mean age 11.6 years at recruitment, resident in the Stockholm region, Sweden. MEASUREMENTS Tobacco use was self-reported at baseline and on six subsequent surveys. Subjects' height and weight were measured by school nurses during the first 4 years, self-reported thereafter. Overweight perception was self-reported at the age of 15 years. FINDINGS Overweight and perception of overweight were not associated with subsequent uptake of either smoking or snus among males. Among females, overweight at baseline was associated with uptake of smoking [adjusted hazard ratio (HR) 1.34, 95% confidence interval (CI) 1.09-1.63], but not of snus. A similar pattern was found with overweight status during follow-up. Among girls with low-educated parents, overweight at baseline predicted the uptake of both snus and smoking. Among 15-year-old females who never used tobacco perceived overweight was associated with subsequent uptake of smoking (adjusted HR 1.71, 95% CI 1.20-2.46), but not of snus. CONCLUSIONS In Sweden, adolescent girls with actual or perceived overweight are at increased risk to start smoking, while indications that this increased risk applies to smokeless tobacco (snus) are limited to girls of low socio-economic status.
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Affiliation(s)
- Maria Paola Caria
- Department of Statistics, University of Milano-Bicocca, Milan, Italy
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13
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Rodu B, Godshall WT. Tobacco harm reduction: an alternative cessation strategy for inveterate smokers. Harm Reduct J 2006; 3:37. [PMID: 17184539 PMCID: PMC1779270 DOI: 10.1186/1477-7517-3-37] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2006] [Accepted: 12/21/2006] [Indexed: 02/07/2023] Open
Abstract
According to the Centers for Disease Control and Prevention, about 45 million Americans continue to smoke, even after one of the most intense public health campaigns in history, now over 40 years old. Each year some 438,000 smokers die from smoking-related diseases, including lung and other cancers, cardiovascular disorders and pulmonary diseases. Many smokers are unable--or at least unwilling--to achieve cessation through complete nicotine and tobacco abstinence; they continue smoking despite the very real and obvious adverse health consequences. Conventional smoking cessation policies and programs generally present smokers with two unpleasant alternatives: quit, or die. A third approach to smoking cessation, tobacco harm reduction, involves the use of alternative sources of nicotine, including modern smokeless tobacco products. A substantial body of research, much of it produced over the past decade, establishes the scientific and medical foundation for tobacco harm reduction using smokeless tobacco products. This report provides a description of traditional and modern smokeless tobacco products, and of the prevalence of their use in the United States and Sweden. It reviews the epidemiologic evidence for low health risks associated with smokeless use, both in absolute terms and in comparison to the much higher risks of smoking. The report also describes evidence that smokeless tobacco has served as an effective substitute for cigarettes among Swedish men, who consequently have among the lowest smoking-related mortality rates in the developed world. The report documents the fact that extensive misinformation about ST products is widely available from ostensibly reputable sources, including governmental health agencies and major health organizations. The American Council on Science and Health believes that strong support of tobacco harm reduction is fully consistent with its mission to promote sound science in regulation and in public policy, and to assist consumers in distinguishing real health threats from spurious health claims. As this report documents, there is a strong scientific and medical foundation for tobacco harm reduction, and it shows great potential as a public health strategy to help millions of smokers.
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Affiliation(s)
- Brad Rodu
- Professor of Medicine and Endowed Chair, Tobacco Harm Reduction Research, School of Medicine, University of Louisville, KY, USA
| | - William T Godshall
- Founder and Executive Director, Smokefree Pennsylvania, Pittsburgh, PA, USA
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Vander Weg MW, DeBon M, Peterson AL, Sherrill-Mittleman D, Klesges RC, Relyea GE. Prevalence and correlates of lifetime smokeless tobacco use in female military recruits. Nicotine Tob Res 2005; 7:431-41. [PMID: 16085511 DOI: 10.1080/14622200500125781] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Although considerable research has been conducted on smokeless tobacco (ST) use in males, much less is known about the characteristics of female ST users. The present study examined the prevalence and correlates of lifetime ST use among female Air Force recruits (N=9,087). Participants were surveyed during Basic Military Training regarding their history of tobacco use and other health risk behaviors. Although the prevalence of current ST use was low (<1%; n=34), 6.6% (n=599) had tried ST. Multivariate logistic regression analysis indicated that lifetime ST use was related to ethnicity, with Native Americans and Whites being most likely to have tried ST. Additional correlates of lifetime ST use included post-high-school education (OR=1.26, 95% CI=1.03-1.55); weekly acts of road rage (OR=1.48, 95% CI=1.06-2.06); frequent arguing (OR=1.71, 95% CI=1.18-2.48); daily or near-daily alcohol consumption (OR=1.71, 95% CI=1.03-2.82); current cigarette use (OR=3.80, 95% CI=2.42-5.94); and experimental use of cigars (OR=4.01, 95% CI=3.22-5.01), pipes (OR=2.23, 95% CI=1.64-3.03), and clove cigarettes (OR=1.23, 95% CI=1.01-1.49), all of which were associated with an increased likelihood of ST use. Results suggest that female recruits who have ever used ST engage in a variety of risk behaviors including use of other tobacco products and alcohol, as well as additional harmful behaviors.
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Affiliation(s)
- Mark W Vander Weg
- Mayo Clinic Nicotine Dependence Center Research Programs, Rochester, MN 55905, USA.
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Kozlowski LT, O'Connor RJ, Edwards BQ, Flaherty BP. Most smokeless tobacco use is not a causal gateway to cigarettes: using order of product use to evaluate causation in a national US sample. Addiction 2003; 98:1077-85. [PMID: 12873242 DOI: 10.1046/j.1360-0443.2003.00460.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
AIMS To evaluate non-causal and causal patterns of smokeless tobacco (SLT) and cigarette use; to assess the prevalence of 'non-gateway' and possible 'gateway' patterns of SLT use. DESIGN AND SETTING Data from the Cancer Control Supplement to the 1987 National Health Interview Survey, a representative survey of non-institutionalized adults in the United States. From reported age at first use, participants were categorized by type and sequence of tobacco product use. SUDAAN 8.0.1 was used for statistical analyses. PARTICIPANTS Males aged 18-34 (n = 3454), weighted to provide estimates of the US population. A subsample of males aged 23-34 (n = 2614) was analyzed to minimize the possibility of future product switching. MEASUREMENTS Smoking status, smokeless tobacco (snuff, chewing tobacco, both) use status, age at regular use of cigarettes, age at first use of smokeless tobacco. FINDINGS Of those 23-34-year-olds who had ever used SLT with or without cigarettes, 77.2% (95% CI: 71.3, 83.3) were classifiable as non-gateway users in that 35.0% (95% CI: 29.9, 40.1) had only used SLT and 42.2% (95% CI: 36.8, 47.7) had used cigarettes first. Cigarette use in younger cohorts was less common, despite increased SLT use. Those who used cigarettes before moist snuff were 2.1 times more likely to have quit smoking (95% CI 1.21,6.39) than cigarette-only users. CONCLUSIONS The large majority of SLT users are non-gateway users. Causal gateway effects should be of minor concern for policy. SLT may be more likely to prevent smoking than cause it.
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Affiliation(s)
- Lynn T Kozlowski
- Department of Biobehavioral Health, Pennsylvania State University, PA, USA.
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