Patterns of smokeless tobacco use in a population of high school students

The Use of Smokeless Tobacco among Basic Airmen

The use of smokeless tobacco, including both snuff and chewing tobacco, is enjoying a resurgence in popularity in the United States, particularly among teenage males. In order to assess the prevalence of these habits among young Air Force recruits, we administered a questionnaire to a random sample of 1,954 basic airmen at Lackland Air Force Base, Texas, to obtain information on frequency, types, intensity, and duration of smokeless tobacco use in this population. We found that 14.9 percent of the males reported using snuff for an average of 104 minutes per day. Chewing tobacco was reported among 11.1 percent of males with an average daily exposure of 72.1 minutes. The average duration of use of both snuff and chewing tobacco prior to entry into the Air Force was four years. Highest usage for both products was seen among Caucasian males. Users of both types of smokeless tobacco products were also more likely to be cigarette smokers than those who did not use either product.

Curtailing tobacco use among youth: evaluation of project 4-health

This article reports the development and evaluation of Project 4-Health, a theory-driven, research-based program to prevent tobacco use among youth enrolled in 4-H clubs throughout California. Additional goals were to involve youth in discouraging others' tobacco use and to develop youth leadership for tobacco control. To assess program effectiveness, 72 clubs were matched and randomly assigned to the program or control condition. Of 1,853 eligible club members, 88.6% completed the pretest. Of these, 79.5% completed a posttest 4 months after conclusion of program delivery, and 77.6% completed a second posttest 2 years later.Short-term effects were found on 7 of 24 outcome measures, indicating changes in knowledge, attitudes, and behavioral intention, but not in social influence variables or behaviors. No long-term effects were observed. Discussion considers how the challenges of designing, delivering, and evaluating the intervention influenced results and implications for preventing tobacco use through community-based youth groups.

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

We examined the prevalence of smokeless tobacco use, and its relationship to other risky behaviors in Connecticut school children in grades four through 12 (n=31,861). Less than one per cent of students in grades 4-8, and four per cent of those in grades 9-12, used smokeless tobacco. Eighty-two percent of all users were white males. Among high school males, the prevalences of risk-taking behaviors and feelings of stress and depression were significantly higher among users than non-users. Among high school males, the highest prevalences of risky behaviors and stress indicators were reported by joint users of cigarettes and smokeless tobacco.

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.

Trends in oral cancer mortality in Japan: 1950-1993

OBJECTIVES

To investigate trends in mortality rates of oral cancer patients in Japan between 1950 and 1993 by sex, age and cancer site, and compare the results with previous studies to determine whether there are any common characteristics of oral cancer patterns between Japan and European countries.

MATERIAL AND METHODS

The mortality data obtained from the Japanese Vital Statistics were analyzed using the 5-year moving average method, and the mortality rates were adjusted to the 1990 world population by age and sex. Age-specific mortality rates were analyzed by birth cohort.

RESULTS

The age-standardized mortality rates among the males increased from 1.14 per 100,000 person--years in 1952 to 1.84 in 1991, whereas the corresponding rate among females changed little over the same period. Cancer of the tongue was the most common cause of death in Japan among the five studied oral regions: lip, tongue, floor of the mouth, major salivary glands and oropharynx, males aged under 54 born in 1920 or later were found to have an increased risk of such disease.

CONCLUSION

Further epidemiological investigations are necessary to clarify the etiology of oral cancer in Japan.

Smokeless tobacco and oral cancer: an assessment of evidence derived from laboratory animals

No carcinogenic activity was observed when snuff was inserted into the cheek pouch of the hamster or spread over the oral mucosa. This negative result was obtained in a number of experiments whether snuff was applied once only and left in place for several months or inserted repeatedly for up to 2 years. In the rat, a few tumours were observed when snuff was inserted into the artificial lip canal. The insertion appeared to cause a considerable reaction in the surrounding tissue so it is plausible to assume that trauma plays an important role in the development of these tumours. An extract of snuff applied to the oral mucosa of the rat did not produce any tumours, but an extract enriched by the addition of 10 times the naturally-occurring amounts of NNN and NNK produced a few benign tumours at the site of application. A higher incidence of tumours was produced when an equivalent amount of an aqueous solution of these two nitrosamines was applied directly to the oral mucosa, suggesting, according to the authors, that snuff inhibits the carcinogenic activity of TSNAs. Initiation/promotion studies were carried out on snuff in the rat in order to explore further its carcinogenic potential. The results were consistent with the conclusion that snuff does not possess any promotional activity. No increase in tumour incidence was observed in mice when snuff was given in the diet at concentrations of 25% gradually decreasing to 5% in a 14 month study. A negative result was also obtained in the rat given snuff at a concentration of 5% for 18 months. In hamsters given snuff at a concentration of 20% for 2 years, forestomach tumours occurred. A comparable incidence of this type of tumour occurred in animals given 20% cellulose. The result of this study does not provide valid evidence of carcinogenicity. HSV and snuff applied orally in the hamster produced a high incidence of squamous cell carcinomas. The sustained high level of squamous cell hyperplasia generated by the experimental design could account for the development of these tumours. Despite the defects in some of the earlier studies, the sum total of this experimental work suggests that snuff is not carcinogenic to the oral mucosa of the hamster or the rat. It is also unlikely to cause tumours in other tissues in these species. These results give some degree of reassurance that snuff is not likely to be carcinogenic to the human oral mucosa. The interaction of snuff and HSV viruses is, at the moment, questionable and requires further investigation.

Comparison of selected health risk behaviors between adolescents in public and private high schools in South Carolina

This study examined differences in selected health risk behaviors among 5,517 students attending public high schools (PUBHS) and 1,089 students attending private high schools (PVTHS) in South Carolina. The 1995 CDC Youth Risk Behavior Survey was used to collect self-report information on adolescent risk behaviors. Chi-square analyses were performed for comparing public and private students on selected risk behaviors. Both PUBHS and PVTHS students reported substantial involvement in most of the risk-taking behaviors examined. PUBHS students, in general, were more likely to report higher prevalence rates than PVTHS students for most of the selected health risk behaviors. However, PVTHS students reported even higher prevalence rates than PUBHS students for alcohol use, driving after drinking, and binge drinking; smoking cigarettes (past 30 days); chewing tobacco (males only); marijuana use during the past 30 days (females only); and use of alcohol or other drugs before last act of sexual intercourse. Results suggest attendance at a private high school is not a panacea for protection against adolescent risk behaviors, and that all high school students could benefit from a coordinated school health program.

Relationship between physical activity level and cigarette, smokeless tobacco, and marijuana use among public high school adolescents

This study analyzed the association between physical activity level and cigarette, smokeless tobacco, and marijuana use among a selected group of public high school students from South Carolina (N = 4,800). The 1993 CDC Youth Risk Behavior Survey was used to collect self-report information on physical activity, substance use, and other risk-taking behaviors. Multiple logistic regression analysis for weighted data (SUDAAN) was used for data analysis. Adjusted analysis showed significant associations (p < .05) among White males for use of cigarettes, smokeless tobacco, and marijuana, where higher levels of physical activity were inversely associated to use of these substances. Results from the study substantiate the importance of physical activity for adolescents, and demonstrate the need for future research to clarify the causal relationship between physical activity and substance use behaviors.

Correlates of exclusive or combined use of cigarettes and smokeless tobacco among male adolescents

Past studies which examined correlates of smokeless tobacco or cigarette use have investigated use of one tobacco product regardless of use of the other product. Thus, the etiology of exclusive use of the two tobacco products is not clear. The present study investigated the relationship of problem-prone-related variables to exclusive versus overlapping use of smokeless tobacco and cigarettes. Two samples of southern California male students (eighth-grade and high school) were divided into groups according to their tobacco use status: neither product, cigarettes only, smokeless tobacco only, or both tobacco products. Generally, triers and monthly users of both tobacco products reported a higher risk-taking preference, greater susceptibility to peer social influence to use tobacco products, and greater likelihood to have tried marijuana and alcohol than did subjects who were not users of either tobacco product. Adolescents who used either product, but not both, reported similar scores on most of the variables examined, which fell in between combined or nonuse categories. These results suggest that the number of tobacco products used, not the specific product, is associated with problem-prone attributes.

Knowledge, intent to use, and use of smokeless tobacco among sixth grade schoolchildren in six selected U.S. sites

Questionnaires on smokeless tobacco use were completed by 781 sixth grade students in 15 schools at six locations in the United States. The students were both American Indian-Alaska Native and non-American Indian-Alaska Native. The Indian and Alaska Native schoolchildren were experimenting with and regularly using smokeless tobacco at higher rates that non-Indian schoolchildren. At Indian Health Service sites, 28.1 percent of the children reported current use of smokeless tobacco, compared with 3.3 percent of the children elsewhere. For girls reporting smokeless tobacco experimentation, the comparison was 68.9 percent at Indian Health Service sites and 8.7 percent at non-Indian sites; for boys, it was 79.1 percent from the Indian sites and 35.4 percent from the non-Indian sites. For those students who had tried smokeless tobacco, more than half also reported having tried cigarettes. The majority of all sixth grade students surveyed were aware of the health risks of smokeless tobacco use in that it is an increased risk for cancer. Additional research is needed to determine appropriate interventions.

The prevalence of oral lesions in smokeless tobacco users and an evaluation of risk factors

BACKGROUND

The widespread use of smokeless tobacco (ST) has prompted concern in regard to the development of oral lesions in long-term users.

METHODS

For inclusion in the current study, a subject must have used an ST product, either snuff or chewing tobacco, for at least 6 months. The subjects were recruited by advertising, and none was referred for the evaluation of an oral lesion. The following were performed on all subjects: assessment of exposure to ST, cigarettes, and alcohol; examination of the oral cavity; a biopsy, if an oral lesion was found; and analysis of a blood sample for beta-carotene. The dietary intake of most of the subjects was analyzed.

RESULTS

Of the 347 ST users, all of whom were white male subjects, 45 (13.0%) had an oral lesion. Thirty-five of the lesions were hyperkeratosis and 10 were epithelial dysplasia.

CONCLUSIONS

Snuff exposure was associated significantly with the presence of an oral lesion (P < 0.0001). A decreased vitamin C intake also was found among the ST users with oral lesions (P < 0.01). The ST users with epithelial dysplasia, as compared with those with hyperkeratotic lesions, were slightly older, had a lower intake of vitamin C (P < 0.05), and were more likely to have used chewing tobacco than snuff.

Soft tissue sarcoma and tobacco use: data from a prospective cohort study of United States veterans

A report of an increased risk of soft tissue sarcoma (STS) among users of smokeless tobacco led us to evaluate this association and the role of other types of tobacco in a prospective cohort mortality-study of United States veterans. A total of 248,046 veterans provided tobacco-use histories on a mail questionnaire in 1954 or 1957. Data on subsequent tobacco use were not collected. By 1980, 119 deaths from STS had occurred among the cohort members. Veterans who had ever chewed tobacco or used snuff had a nonsignificant 40 percent excess of STS (95 percent confidence interval [CI] = 0.8-2.6; 21 deaths) in comparison with veterans who had never used any tobacco products. Risk was limited to former users (relative risk [RR] = 1.5) with no excess seen among current users (RR = 0.9). Frequent former users had higher risk (RR = 1.9) than infrequent users (RR = 1.3). Risk was slightly higher in persons who started using smokeless tobacco at younger ages, but did not increase with duration of use or with late age at cessation of use. Most veterans who used chewing tobacco or snuff also used some other form of tobacco. No STS deaths occurred among the 2,308 veterans who used smokeless tobacco only. An unexpected finding of the study was the significant excess of STS deaths among cigarette smokers (RR = 1.8, CI = 1.1-2.9). Risk was higher among ex-smokers (RR = 2.2) than among current smokers (RR = 1.5) and was not related to number of cigarettes per day, age started smoking, duration, or pack-years.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of risk factors in smokeless tobacco-associated oral lesions

Smokeless tobacco (ST) users and nonusers were recruited to evaluate the contribution of various risk factors (ST use, cigarettes, alcohol, and diet) in the development of oral mucosal lesions. Ninety-eight ST users with no lesion, 29 ST users with an oral lesion, and 33 nonusers were enrolled in the study. ST users with lesions, when compared with users with no lesion, were more likely to have used snuff than chewing tobacco (p = 0.01) and to have used more ST (p less than 0.01). Alcohol consumption, dietary intake of beta-carotene, and serum levels of beta-carotene were not related to an increased risk of lesion development. Our findings showed that the only significant risk factor for ST-associated oral lesions was the extent of ST exposure. Of 127 ST users, 29 (22.8%) had an oral lesion at the time of examination. Of these lesions, 23 (79.3%) were hyperkeratotic and 6 (20.7%) were epithelial dysplasia.

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

From a stratified, random sampling of non-urban high schools in the Southeast, survey data were obtained from 5374 adolescent males. Over half reported trying smokeless tobacco, and approximately one third of these reported a regular, substantial level of use. The average age at initial use was 12.2 yr. and was negatively correlated with the level of use. Factor analysis of the psychosocial items resulted in four factors: substance use/deviant style, modeling, perceived negative consequences, and health behavior. Discriminant analysis of initial use indicated that substance use and modeling influences were the strongest predictors of trying smokeless tobacco. Regression analysis of level of smokeless tobacco use indicated that substance use, modeling, and perceived negative consequences were equivalent in their contribution. Separate analyses were performed for American Indian, Black, and White males. Although predictors of initial use were similar, level of smokeless tobacco use was most associated with the use of other substances in Blacks and with modeling influences in Whites.

Use of smokeless tobacco among conscripts: a cross-sectional study of Norwegian army conscripts

In a cross-sectional study of 2,112 Norwegian army conscripts ages 18 to 25 years, 10% reported daily use of wet snuff, while 23% were occasional users. Nearly half of the snuff users had started or increased their consumption during the military service. Cigarette smoking, alcohol consumption, and having a best friend using snuff were positively correlated with starting to use snuff. Daily use was associated with high physical activity. Use of snuff did not vary significantly with length of education when adjusting for other variables. Nearly all subjects believed prolonged snuff use to be a hazard to health. Forty percent of the snuff users believed they would give up snuff after the military service. Giving up during the service was statistically associated with having a steady relationship with a girlfriend and with length of time served. The relatively high percentage of occasional users and the high rate of stopping and starting reflect the novelty of snuff use among Norwegian youth. The widespread intention to give up seems to indicate that a large proportion of snuff users have ambivalent attitudes toward their own behavior. Therefore, future intervention measures in the armed forces could have a substantial impact on young males' use of smokeless tobacco.

Smokeless tobacco use in adolescent females: prevalence and psychosocial factors among racial/ethnic groups

From a stratified, random sampling of Southeastern, nonurban high schools, survey data on smokeless tobacco use and potential psychosocial risk factors were obtained from 5683 adolescent females. Of the 15.3% who reported trying smokeless tobacco, most (75%) reported only experimental use. Factor analysis of the psychosocial items resulted in four factors: perceived negative consequences, substance use, modeling, and active lifestyle. Discriminant analysis on use indicated that modeling influences and use of other substances were the strongest predictors of initial smokeless tobacco use. Level of use, however, was most strongly associated with lower perceived negative consequences for use and the use of other substances. Separate analyses on American Indian, Black, and White subgroups suggested that factors associated with initial use were similar but that substantial differences exist between subgroups on risk factors for level of smokeless tobacco use.

Attitudes and behaviors of dental hygienists concerning tobacco use

This study surveyed a proportionate random sample of licensed dental hygienists in five states and the District of Columbia, to assess their antitobacco use behaviors and attitudes. The response rate was 79.4 percent. Descriptive data as well as chi-square, analysis of variance (ANOVA), and Duncan's multiple range test statistical results were reported. Only 6.9 percent of the hygienists sampled currently smoked. These hygienists appeared to exhibit significantly different aggregate attitudes and select clinical practice behaviors than their nonsmoking counterparts. Years of employment and geographic location showed no significant relationship to aggregate clinical practice behaviors or attitudes, although each was related to individual behaviors and attitudes. Overall, dental hygienists appeared committed to involvement in both individualized and community-based antitobacco-use efforts. Measures to coordinate hygienists' involvement at both of these levels need to be enhanced.

Patterns of cigarette and smokeless tobacco use among children and adolescents

Although cigarette and smokeless tobacco use are recognized as major problems among school-age youth, few nationwide or statewide data exist on the prevalence and patterns of use. To determine the patterns of tobacco use among children and adolescents in Missouri, self-report information was obtained from a representative sample of 5,431 students in grades 5, 8, and 12. Both cigarette smoking and smokeless tobacco use were more common among males than females for each grade level except the 12th, where 30% of females and 28% of males had smoked during the previous week. Smoking prevalence was considerably lower among blacks than whites. Smokeless tobacco use was rare among both blacks and females. Smokeless tobacco use was more common than cigarette smoking in rural areas, where 17% of 8th-grade males and 31% of 12th-grade males had used smokeless tobacco during the previous week. The mean age at first use of cigarettes was slightly lower in the rural than the urban area, whereas the mean age of initial smokeless tobacco use was more than a year earlier in the rural area. Data regarding the perceived difficulty of quitting smoking and quit rates suggested that adolescent females have more difficulty quitting smoking than males. Male smokeless tobacco users appeared to be more addicted than male cigarette smokers. Smokeless tobacco brand preference indicated that users may switch to progressively stronger types of smokeless tobacco as they get older and a nicotine tolerance is developed. The current study emphasizes the urgent need for carefully targeted tobacco prevention and cessation efforts among school-age youth.

Psychosocial factors in the use of smokeless tobacco and their implications for P.L. 99-252

This article briefly reviews the prevalence of smokeless tobacco use by males in the United States, the relationship of smokeless tobacco use to cigarette use, and patterns of use that include dosage, topography, products, and function of use. The primary focus of the article is to describe the concurrent and predictive factors associated with onset, use, and cessation of smokeless tobacco. The implications of P.L. 99-252, the Comprehensive Smokeless Tobacco Act of 1986, are discussed in the context of what is known about the psychosocial variables associated with the use of smokeless tobacco.

P.L. 99-252--implications for dentists and their clinical practice

This paper is one of a series attempting to determine the impact of Public Law 99-252, the Comprehensive Smokeless Tobacco Health Education Act of 1986, on decreasing smokeless tobacco use. Potential indicators are discussed that could be used by the dental profession to determine the efficacy of the profession's involvement in existing and future prevention and cessation efforts relative to this law. In this review, six major areas are considered for measuring declines in smokeless tobacco use relative to the role of the dental health practitioner. These areas encompass the following: (1) the dental profession's knowledge of smokeless tobacco health hazards, (2) dental practitioners' involvement in measuring changes in use patterns, (3) the influence dentists have with their patients and community in decreasing smokeless tobacco use, (4) the general attitude and intention to quit on the part of dental patients, (5) active governmental involvement efforts, and (6) health effects of smokeless tobacco that might be used for identifying decreasing smokeless tobacco use. Within each of these six broad categories, more specific indicators for measuring the impact of P.L. 99-252 relative to the dental profession were considered.

An in-depth analysis of male adolescent smokeless tobacco users: interviews with users and their fathers

Male adolescent smokeless tobacco (ST) users (N = 191) were extensively interviewed, then followed over a 6-month period with monthly telephone interviews. In addition, their fathers (N = 137) were interviewed by telephone. Based on these data, ST use appears similar to cigarette smoking with respect to onset, patterns of use, social influences, attempts to quit, and indications of addiction. Onset and continued use of ST largely occur in a social context. Parents are reportedly aware (73%) of their sons' ST use but appear tolerant. The great majority of S's (92%) believe that there is some health risk associated with ST use. Over half report noticing ST-related changes in their oral cavities, although their dentists generally had not discussed ST use with them. Over one-third of the current users report unsuccessful quit attempts. ST use appears to be part of a more general pattern of substance use, including marijuana and alcohol.

Typology and correlates of smokeless tobacco use

The incidence, use patterns, and correlates of smokeless tobacco have become increasingly important as usage rates rise and harmful health effects become established. The present study assessed the incidence of smokeless tobacco use in a Southeastern U.S. sample and selected correlates of use. From the responses of 3725 high school students, 19.9% reported trying smokeless tobacco products (35.5% for males, 5.8% for females). Most agreed that tobacco use has harmful health consequences. Those disagreeing with these health beliefs were more likely to use smokeless tobacco. Cigarette smoking was strongly associated with initial use. Of those reporting any use of smokeless tobacco, most used it for less than an hour per day, but 18% reported 3 or more hours of use per day. Forty-four percent reported a first use of smokeless tobacco before 13 years of age. Early initial use was associated with greater frequency and duration of use. Early initial users also reported greater influence from family and advertisements. Encouragement from friends, however, appeared to be the major factor regardless of age at initial use. Of particular concern is that 8.4% of those having any experience with smokeless tobacco felt they were addicted to the substance. Finally, 27.9% reported swallowing the substance or spittle, suggesting the need for further research on the potential health implications of this behavior.

Georgia pharmacists' attitudes toward cigarettes and smokeless tobacco

To determine the degree to which pharmacists might cooperate with other health-care providers in reducing tobacco use, the authors surveyed 500 Georgia pharmacists on their knowledge, attitudes, and sales practices regarding cigarettes and smokeless tobacco (ST). Analysis of the 152 questionnaires (30.3%) returned showed that respondents' knowledge of the effects of tobacco use, especially cigarettes, was high. Overall, pharmacists believe that pharmacies should not sell cigarettes and ST; sales to minors and radio and television advertising of tobacco should be prohibited; and ST is not a safe alternative to cigarettes. More employee pharmacists than managers sold cigarettes when they did not believe they should, citing the reason that higher management makes the decision. Managers who didn't believe they should sell tobacco products said they did so because they felt the public should be free to choose. These findings may reflect a tendency of pharmacists to accept employment without control over conditions, and suggest that encouraging pharmacists to use their influence to discourage tobacco use might be acceptable to practitioners.

An interpretative review of smokeless tobacco research in the United States: Part II

This is the second part of a two-part series reviewing the published literature of smokeless tobacco in the United States. The article explores smokeless tobacco as a pharmacologically addicting substance, educational interventions designed to prevent use or help users quit, and outlines areas of future research.

Prevention of tobacco use among adolescents in public schools in San Diego County, U.S.A

Project S.H.O.U.T. (which stands for "Students Helping Others Understand Tobacco") is a tobacco-use prevention project funded by the United States National Cancer Institute for preventing the use of cigarettes and smokeless tobacco (snuff and chewing tobacco) in public schools in San Diego County, California. Based on principles of behavior modification, Project S.H.O.U.T. teaches students how to anticipate and overcome negative peer pressure to use tobacco and reinforces them for having done so. Preliminary results indicate that the prevalence of tobacco use among students receiving peer pressure resistance skills training was somewhat but not statistically significantly lower than the control group after one year of intervention. In addition, students in a third lottery condition, who were reinforced for simply not using tobacco, showed lower prevalence rates compared to controls. Additional support for the efficacy of the intervention program was provided by the refusal skills assessment test, which indicated that students exposed to the intervention were able to refuse tobacco offers more effectively than the control students. Our results indicate that tobacco use prevention experts should do more than provide decision-making and behavioral skills for resisting tobacco use, but should also reinforce the non-use of tobacco.

Applying the theory of reasoned action to early adolescent tobacco chewing

Beliefs and social norms elicited from adolescents were employed in the theory of reasoned action to predict early adolescent males' intention to chew tobacco. About 50% of males had chewed tobacco. Responses of chewing intenders and nonintenders differed in response direction and in response strength. Response differences regarding physical effects (cancer, yellow teeth, habit forming) as well as psychosocial effects (look cool, relax, have a good time with friends) suggested specific educational strategies. Intenders and nonintenders both reported not believing chewing causes cancer, an erroneous belief. Nonintenders reported belief carry over from smoking: chewing will "make my clothes smelly" and chewing will "give me shortness of breath," both unfounded. Nonintenders reported less referent support for chewing. Both groups reported a general unwillingness to comply with their significant others.

Patterns and prevalence of smokeless tobacco use by high school seniors in New York

Patterns and prevalence of smokeless tobacco use by high school seniors in New York state were identified in this study. A questionnaire was administered to a sample of 10% of each senior class in 96 randomly selected public and nonpublic secondary schools in New York; 1,830 students participated. Data analysis included descriptive statistics, t-tests, and chi-square tests. Comparisons were made by gender, hometown status, concurrent use of smokeless tobacco and cigarettes, and smokeless tobacco use versus cigarette smoking. Results revealed a significant difference existed between males and females and between urban and rural smokeless tobacco use (p = .05). Use of chewing tobacco related significantly to use of cigarettes (p = .05). A significant difference existed between prevalence of cigarette smoking and smokeless tobacco use (p = .05). Smokeless tobacco use by high school seniors in New York is predominantly a habit of rural males. Use of chewing tobacco is related to cigarette smoking, and smokeless tobacco was less prevalent than cigarette smoking in the sample (p = .05). Further research on the relationship between smokeless tobacco and cigarette smoking should be conducted. Use of chemical assays or the bogus pipeline to validate self-reported data is recommended. Identified high-risk groups such as rural males should receive particular attention in future research efforts.

The acute effects of smokeless tobacco on transport and barrier function of buccal mucosa

The acute effects of smokeless tobacco (ST) on buccal mucosal transport and barrier function were studied by means of in vivo and in vitro techniques. In humans, in vivo exposure to 0.5 g ST transiently increased the transmural electrical potential difference (PD). However, despite continued exposure, PD returned to baseline within 20 min. The mechanisms for these changes were explored by use of dog buccal mucosa mounted in Ussing chambers. Luminal exposure to a Ringer-extract of ST (EOST) increased PD and short-circuit current (Isc) and decreased electrical resistance (R), with changes reversible upon removal of EOST from the bath. Further, radioisotopic fluxes showed that the increase in Isc in EOST-exposed tissues was accompanied by increased absorption of electrolytes (Na, Cl, and other ions), and the decrease in R was accompanied by increased permeability to mannitol. Light microscopy of tissues exposed to EOST showed no morphological changes after exposure to 0.5 g of ST, but after exposure to 1.5-2.5 g of ST, dilated intercellular spaces were identified. Contact of aqueous media with ST led to the release of electrolytes and other soluble compounds into solution. To determine the effect of electrolyte release on buccal function, we exposed mucosae luminally to a solution with ion composition and/or osmolality similar to EOST or to one with an EOST previously dialyzed against Ringer. Solutions with similar ion composition and/or osmolarity changed PD, Isc, and R in a manner similar to EOST, while dialyzed-EOST had no effect. In addition, luminal nicotine produced effects different from EOST, decreasing PD and Isc and increasing R.(ABSTRACT TRUNCATED AT 250 WORDS)

Smokeless tobacco on campus

Self-reports on smokeless tobacco consumption were obtained from 438 students attending a small Midwestern liberal arts college. While use among 249 female students was negligible, 9% of 189 male respondents reported routine use of smokeless tobacco products.

An interpretative review of smokeless tobacco research in the United States: Part I

The first part of a two-part series reviewing the published literature of smokeless tobacco in the United States and concomitant health effects associated with its use. This article delineates the current status of its prevalence, behavioral psychosocial factors associated with use, and review of the negative health effects associated with regular use.

Smokeless tobacco use among Ontario students

The use of smokeless tobacco among adolescents has emerged as a public health concern. We report here estimates of use and characteristics of users among a probability sample of 4,267 Ontario (Canada) students aged thirteen to nineteen years. The results indicated that smokeless tobacco use was not common, varying from 1 percent to 3 percent depending upon age and gender, but was more likely to occur among smokers (10% to 32%). The group most prone to use was young smoking males.

The prevalence of smokeless tobacco use among adolescent male athletes

In assessing the prevalence and perceptions of use of smokeless tobacco among adolescent male athletes, several findings have public health implications. Almost a third of the sample had tried smokeless tobacco and 8% were current users. Racial differences between blacks and whites were remarkable. Differences in income strata and urban/rural settings were not significant. Peer influence was the major factor that initiated smokeless tobacco use. Abnormal mucosal findings were much more prevalent in those who had dipped smokeless tobacco than in those who had not. Most significant was a prevalence of oral leukoplakia in 5.2% of those who had ever dipped, which was 50 times that of nondippers. Using smokeless tobacco for more than 2 years or using more than three tins per week seemed to be of possible predictive value regarding the incidence of oral leukoplakia. Fifteen percent of current users had observable leukoplakia. Components necessary for effective intervention/prevention programs were elucidated with an emphasis on an increased role by dentists and other health professionals.

Experimentation with smokeless tobacco and cigarettes by children and adolescents: relationship to beliefs, peer use, and parental use

Experimentation with both cigarettes and smokeless tobacco by children in grades 3-12 in a school district in Pennsylvania was related to peer experimentation, parental use, and personal beliefs about the harm of the product for both males and females. Experimentation with both products had begun as early as the third grade and increased with age, with a major increase in experimentation during junior high school. Nearly half the males in grades 7-12 did not believe smokeless tobacco was harmful.

Use of smokeless tobacco among children and adolescents in the United States

Data collected by National Cancer Institute grantees on the use of smokeless tobacco by youth are reported. Self-reports were collected from over 43,000 students from grades 4 through 11 in 16 locations in the United States and 1 location in Canada. Lifetime and recent use of smokeless tobacco are reported by location, sex, grade level, and ethnic group. Use of smokeless tobacco increased with grade level. Typically, 40 to 60% of males had tried smokeless tobacco, and in most locations, 10 to 20% of older male youths reported recent use. With the exception of Native Americans, rates of use among females were lower than those among males. Use was highest among Native Americans and lowest among blacks and Asians. Smokeless tobacco use by Hispanics was comparable to that by whites. Collectively, the data indicate that large numbers of male youths in many areas of the United States are using smokeless tobacco. In light of recent research on the health consequences of using smokeless tobacco, the health of these youth may be endangered.

Smokeless tobacco use. A dangerous nicotine habit

Much attention has been focused on cigarette smoking and its health implications. Numerous campaigns have been launched to help people stop smoking or prevent them from starting. While smoking has been receiving this attention, use of smokeless tobacco has been increasing at an alarming rate. Smokeless tobacco exposes the user to all the nicotine effects of cigarette smoking. Oropharyngeal cancer and erosive effects on the oral structures are known hazards, but the long-term total-body effects have yet to be determined. Physicians need to identify patients who use smokeless tobacco so that intervention strategies can be employed. Preventive techniques, especially those aimed at children, may be the most effective means of controlling this health threat.

Primary prevention: a new look at basic concepts

Personal health and well-being are gaining priority on the American agenda. A renewed interest in health promotion has been facilitated by the need to contain health care costs, realization of the limits of medicine in preventing illness, and a deeply rooted societal ethic of personal responsibility for individual health. Although the health status of Americans has changed significantly for the better during this century, further improvements are necessary, especially among high risk subgroups within the population who have not been effectively reached by traditional health promotion strategies. Past efforts, aimed at individuals modifying their risk factors, have neglected to address environmental factors that contribute to disease risk. This points to the need for an integrated approach where problems are addressed as properties of the systems in which individuals behave. This paper reviews selected health trends in the United States, discusses limitations of the current approach to health promotion, presents a comprehensive definition of prevention, and provides principles for planning that may facilitate improved health status in this country.

Health consequences of using smokeless tobacco: summary of the Advisory Committee's report to the Surgeon General

On March 25, 1986, the Surgeon General of the Public Health Service released a report that detailed the results of the first comprehensive, indepth review of the relationship between smokeless tobacco use and health. This review, prepared under the auspices of the Surgeon General's Advisory Committee on the Health Consequences of Using Smokeless Tobacco, is summarized in this article. In the United States, smokeless tobacco is used predominantly in the forms of chewing tobacco and snuff. During the past 20 years, the production and consumption of these products have risen significantly in marked contrast to the decline in smokeless tobacco use during the first half of the century. National estimates indicate that more than 12 million persons age 12 and older in the United States used some form of smokeless tobacco in 1985, and half of these were regular users. The highest rates of smokeless tobacco use occurred among adolescent and young adult males. Examination of the relevant epidemiologic, experimental, and clinical data revealed that oral use of smokeless tobacco is a significant health risk. This behavior can cause cancer in humans, and the evidence is strongest for cancer of the oral cavity, particularly at the site of tobacco placement. Smokeless tobacco use can also lead to the development of noncancerous oral conditions, particularly, oral leukoplakias and gingival recession. Further, the levels of nicotine in the body resulting from smokeless tobacco can lead to nicotine addiction and dependence.

The reemergence of smokeless tobacco

Smokeless tobacco (snuff and chewing tobacco) is reemerging as a popular form of tobacco, particularly among male adolescents. In different regions of the United States, from 8 to 36 percent of male high-school students are regular users. The use of smokeless tobacco has been shown to cause oral-pharyngeal cancer. The strongest link is with cancers of the cheek and gum. White mucosal lesions (leukoplakia) are found in 18 to 64 percent of users, often at the site where the tobacco was held. Other associations have been suggested for cancers of the esophagus, larynx, and pancreas. Nitrosamines, found in high concentrations in smokeless tobacco, most likely have a role in its carcinogenicity. Other health problems include periodontal disease, acute elevations of blood pressure, and dependence. In early 1986, after action at the state level, Congress enacted a federal law requiring health-warning labels on packages of smokeless tobacco and a ban on electronic advertising. Other regulatory measures under consideration include raising state and federal excise taxes, tightening controls on advertising, and prohibiting sales to minors. In view of the recent growth of this problem, policy makers are taking the opportunity to intervene with preventive measures to protect a new generation of tobacco users.

Smokeless tobacco use among adolescents: demographic differences, other substance use, and psychological correlates

Survey data on smokeless tobacco and other substance use were obtained from 2,926 seventh, ninth, and eleventh graders in Ventura County, California public schools. Patterns of smokeless tobacco use were examined relative to other drug use, particularly cigarette smoking. Few females used smokeless tobacco regularly, as compared to 4.7 percent of the males. The data supported the view that the recent increases in smokeless tobacco use were related to male tobacco users' belief that smokeless tobacco was less harmful to physical health than cigarette smoking. A Guttman scalogram analysis showed that tobacco use, either cigarette smoking or smokeless tobacco use, occurred after marijuana use rather than before. Perceived parental attitudes toward marijuana use predicted both cigarette smoking and use of smokeless tobacco, whereas perceived parental attitudes toward alcohol use was only related to use of cigarettes. Quality of life measures were inversely related to both cigarette smoking and smokeless tobacco use, but mood state measures predicted only cigarette smoking. Implications of the results for a historical hydraulic model of aggregate drug use are discussed with recommendations for improved approaches to the prevention of drug abuse.