Smokeless tobacco and cigarettes: differential attitudes and behavioral intentions of young adolescents toward a hypothetical new peer

A Risk-Continuum Categorization of Product Use Among US Youth Tobacco Users

INTRODUCTION

To examine prevalence and correlates of five mutually exclusive tobacco-use patterns among US youth tobacco users.

METHODS

A nationally representative sample of tobacco users (N = 3202, 9-17 years) was classified into five product-use patterns. Weighted multinominal and multivariate logistic regression models were used to examine prevalence of product-use patterns by gender, race and ethnicity, and grade level; and associations between product-use patterns and perceived accessibility of tobacco products, exposure and receptivity to pro-tobacco marketing, social benefits of smoking, and tobacco-associated risks.

RESULTS

Dual use (ie, use of two product categories) was the most prevalent pattern (30.5%), followed by non-cigarette combustible only (26.7%), polytobacco (ie, use of three product categories; 17.5%), cigarette only (14.9%), and noncombustible only (10.4%) use. Product-use patterns differed by gender, race, and ethnicity. Compared to cigarette only users, dual and polytobacco users were more likely to be exposed to and be receptive to pro-tobacco marketing, and were less likely to acknowledge tobacco-use related risks (Ps < .05).

CONCLUSIONS

Curbing tobacco use warrants research on users of more than one tobacco-product categories according to the risk-continuum categorization.

IMPLICATIONS

We present a risk-continuum categorization of product-use patterns among tobacco users not older than 17 years. We classify tobacco users into five mutually exclusive product-use patterns: cigarette only users, non-cigarette combustible only users, noncombustible only users, dual use, and polytobacco use. This categorization overcomes limitations in current literature on tobacco-use patterns, which include exclusion of certain products (eg, e-cigarettes) and product-use patterns (eg, exclusive users of non-cigarette products), and inconsistent classification of tobacco users. It is parsimonious yet complex enough to retain differential characteristics of sub-tobacco users based on number (single, dual, polytobacco) and categories (cigarettes, non-cigarette combustibles, noncombustibles) of tobacco products consumed.

Contrasting smokers' and snus users' perceptions of personal tobacco behavior in norway

INTRODUCTION

In Norway, snus use and cigarette smoking are at different developmental stages as described by the diffusion of innovation model. Concomitant with declining smoking rates, the use of snus is increasing. In light of these differences in use trends, we assumed that snus users and cigarette smokers would have different perceptions of their personal tobacco use.

METHODS

A total of 4,852 smokers and snus users were recruited from a large sample of online panelists (n = 62,000) and a postal database (n = 15,000). The responses to 16 evaluative statements assessing perceptions about tobacco use were compared between exclusive snus users and exclusive smokers and within dual users. The statements concerned self-evaluative emotions, moral judgments, social disapproval, and benefits of quitting.

RESULTS

The perceptions of personal tobacco use differed greatly between exclusive smokers and exclusive snus users, even after controlling for age and sex. Smoker's perceptions were more negative compared with snus users' perception. The differences between smoking and snus use were particularly large for indices of social disapproval (Cohen's d = 1.56) and benefits from quitting use of the product (Cohen's d = 1.47) between exclusive users. Dual users exhibited a similar pattern.

CONCLUSIONS

Smokers have a more negative perception of their own use compared to snus users. Dual users also devaluated smoking in comparison to their snus use. This finding may have important values for prevention strategies targeting smokers, snus users, and dual users.

The development and psychometric evaluation of the Smokeless Tobacco Expectancies Scale (STES)

Expectancies regarding the effects of various psychoactive substances are important predictors of the initiation and maintenance of substance use. Although measures of outcome expectancies exist for several addictive substances, there is currently no measure to assess smokeless tobacco (ST) expectancies in an adult population. This article presents 2 studies leading to the development and psychometric evaluation of the Smokeless Tobacco Expectancies Scale (STES). Initially, 155 individuals listed all outcomes they expected to occur if they were to use ST products. From these responses, an initial pool of potential STES items was identified. The STES was then administered to 2 samples totaling 813 individuals (265 ST users, 270 cigarette smokers, and 278 nontobacco users). The first study included 315 participants who completed a 68-item measure. An exploratory factor analysis identified 10 items that may account for individuals' ST expectancies. Items loaded on 2 factors: Negative Health Consequences and Positive Reinforcement. A confirmatory factor analysis on an independent sample (n = 498) supported the proposed factor structure. Furthermore, in both samples, the STES accurately discriminated ST users from smokers and nonusers. Findings are discussed in terms of the potential uses of the STES for advancing the understanding of ST use.

The changing marketing of smokeless tobacco in magazine advertisements

INTRODUCTION

Concerns about secondhand smoke, increasing indoor smoking bans, and health concerns regarding cigarettes are contributing to the development of new smokeless tobacco (ST) products by the tobacco industry and the repositioning of traditional ST products. The objective of this research was to systematically document the changing advertising strategies and themes of the ST industry.

METHODS

Using descriptive content analysis, this study analyzed 17 nationally circulated magazines for ST advertisements (ads) from 1998-1999 and 2005-2006, recording both magazine and advertisement characteristics (e.g., themes, selling proposition, people portrayed, and setting/surroundings.) Ninety-five unique ads were found during the two time periods-occurring with total frequency of 290 ad placements in 816 issues. One hundred ninety-one ads were found in the 2005-2006 sample, while 99 were found in the 1998-1999 magazines.

RESULTS

Significant differences in ST ads were identified between time periods and magazine types. A greater percentage of ads were found in the latter time period, and the average number of ads per issue increased (0.24 in 1998-1999 and 0.49 in 2005-2006, p < .001). More recent magazines and general adult magazines contained a greater proportion of flavored products, "alternative to cigarette" messages, and indoor settings when compared with earlier magazines and men's magazines, respectively.

CONCLUSIONS

While continuing to advertise in men's magazines with themes appealing to men and "traditional" ST users, the ST industry appears to be simultaneously changing its message placement and content in order to include readers of general adult magazines who may not currently use ST.

Under the radar: smokeless tobacco advertising in magazines with substantial youth readership

OBJECTIVES

In light of the Smokeless Tobacco Master Settlement Agreement (STMSA) and the fact that smokeless tobacco advertising has received little attention, we examined industry data to assess smokeless tobacco advertising in popular magazines. Of particular interest was the level of advertising in magazines with high youth readership and the amount of reach and frequency that was generated among readers aged 12 to 17 years.

METHODS

We used readership data from Mediamark Research Inc, advertising expenditure data from TNS Media Intelligence, and Adplus, a media planning program from Telmar to document the composition of adult and youth readership of magazines in which smokeless tobacco products were advertised, industry expenditures on advertising, and adolescents' exposure to smokeless tobacco advertising.

RESULTS

The STMSA appears to have had a limited effect on the advertising of smokeless tobacco products to youth; both before and after the agreement, smokeless tobacco companies advertised in magazines with high adolescent readership.

CONCLUSIONS

Popular magazines with smokeless tobacco advertising reach a large number of adolescents through a combination of both youth-oriented and adult magazines. These exposure levels have generally increased since the STMSA.

"Not lighting up": a case study of a woman who quit smoking

PURPOSE/OBJECTIVES

To review the prevalence, incidence, and risks of smoking by American women; to outline services, treatments, and educational options for smoking prevention and cessation; and to present the conceptual link between the epidemiologic and research literature and experiences of one individual in the target population--an adult female former smoker with a 30-year habit who began smoking during her teenage years.

DATA SOURCES

Published literature, expert opinion, and an interview with a former smoker--a female healthcare professional who had a 30-year habit.

DATA SYNTHESIS

Literature was reviewed and the content was evaluated for relevance, accuracy, and timeliness. The relevant content was augmented with the author's practical experience and applied to the case study to make recommendations.

CONCLUSIONS

Oncology nurses may use a number of strategies to assist people to never start or to stop using tobacco products. The most effective strategy begins with collaboration between healthcare professionals and patients and a combination of instruction, counseling, and emotional support. Oncology nurses can participate in grassroots efforts to educate the public about addiction related to tobacco use, provide counseling for patients who smoke, and become actively involved in legislative solutions to the problem of tobacco use.

IMPLICATIONS FOR NURSING

Oncology nurses may intervene to affect positive behavioral change and participate in grassroots efforts to educate the public. Substantial resources are available to professionals and patients who wish to quit smoking or prevent tobacco use by friends and relatives. Nurses should take every opportunity to support smoking cessation and tobacco use prevention.

Evidence that smokeless tobacco use is a gateway for smoking initiation in young adult males

BACKGROUND

This study was designed to test the hypothesis that smokeless tobacco (SLT) serves as a gateway drug for smoking among young adult males. Methods. A cohort (n = 7,865) of U.S. Air Force recruits who claimed to have never smoked cigarettes was followed prospectively for 1 year. The participants were male, 32.9% were ethnic minorities, and their average age was 19.84 years (SD = 2.29). Among recruits entering basic military training, 403 (5.1%) reported current SLT use and 198 (2.5%) reported a past history of SLT use.

RESULTS

At the 1-year follow-up current SLT users were 233% more likely to have initiated smoking than nonusers (odds ratio = 2.33, 95% CI = 1.84-2.94). Similarly, recruits who reported past SLT use were 227% more likely to begin smoking than participants who had never used SLT (odds ratio = 2.27, 95% CI = 1.64-3.15). SLT use remained a potent predictor of smoking initiation in a multivariate logistic model that included demographic factors and other risk factors for initiation.

CONCLUSIONS

SLT use appears to be an important predictor of smoking initiation among young adult males. This study suggests that smoking prevention and cessation programs should also include strategies related to SLT use.