Changing trends of tobacco use in a teenage population in western Pennsylvania

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.

Causes of the decline in cigarette smoking among African American youths from the 1970s to the 1990s

Adult cigarette smoking prevalence trends among African Americans (AAs) and Whites are similar. However, during the decline in youth smoking that occurred between the mid-1970s and the early 1990s, the drop in smoking rates among AA adolescents was more than double that among Whites. We examined the evidence for potential explanations for this phenomenon. On the basis of our findings, we propose that racial differences in parental attitudes, religious ties, negative perceptions and experiences of the health effects of smoking, worsening poverty, increased use of food stamps, and price sensitivity were major factors contributing to the more rapid decrease in and continued lower rates of smoking among AA youths.

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

Examined adolescents' perceptions of cigarette smokers and smokeless tobacco users. Participants were 562 middle school students in rural Florida who viewed 1 of 6 videotapes of a hypothetical peer (i.e., actor) who would soon be attending their school. The videotapes differed only as a function of sex (boy or girl) and tobacco condition (no tobacco, cigarette, smokeless tobacco). After viewing the videotape, participants completed 2 measures designed to assess attitudes and behavioral intentions toward the peer. Results indicated that (a) the actor in the no-tobacco condition was rated more favorably than actors in the other two conditions, although the actor in the smokeless-tobacco condition was rated more favorably than the actor in the cigarette condition; (b) girls viewed the actor in smokeless-tobacco condition more favorably than did boys; (c) compared to nonsmokers, adolescents with a cigarette use history provided more favorable ratings for the actor in the cigarette condition. Taken together, results suggest that different types of tobacco use may have a different impact on social image within the young adolescent population.

Laryngeal carcinoma in younger patients

During the period 1976-1988, 988 patients were treated surgically for laryngeal cancer of whom 61 were below the age of 40 years. In 29 patients the tumour was localized in the supraglottis, and in 32 in the glottis. T1 tumour was present in 32 (52.46 per cent), and T2 tumour in six (9.84 per cent) patients. Advanced T3 and T4 tumours were present in 13 (21.31 per cent), and (16.39 per cent) patients respectively. The majority had clinically negative findings in the neck (N0). Conservative or reconstructive surgery was applied in 39 (63.93 per cent), and radical in 22 (36.07 per cent) patients. Planned post-operative radiotherapy was carried out in 28 (45.90 per cent) patients. The five-year survival rate of the studied patients was 83.61 per cent (51/61). The five-year survival rate of the patients with laryngeal carcinomas within the same period was 68.32 per cent (675/988). There was no significant difference in survival rate: X2 = 0.018, DF = 1, p > 0.05.

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.

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.

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.

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.

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.

Youthful smoking: patterns and relationships to alcohol and other drug use

Smoking patterns were examined in a large sample of New York State junior and senior high school students. Smoking was more prevalent among girls than boys. Whites were smoking more than members of minority groups. Marijuana use was the best single predictor of whether a student smoked or not. Heavy drinking was the best predictor of quantity smoked among smokers.

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.

Understanding and deterring tobacco use among adolescents

This article discusses the addictiveness of tobacco and the health consequences of chronic tobacco use. Personality, environmental, and behavioral factors that promote the initiation of cigarette smoking by adolescents are identified. Age-specific interventions are suggested.

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.

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.