Showing papers on "Smokeless tobacco published in 2000"

US college students' use of tobacco products: results of a national survey.

Abstract: ContextAdults aged 18 to 24 years, many of whom are in college, represent the youngest legal targets for tobacco industry marketing. Cigarette smoking has been described among college students, but little is known about noncigarette tobacco use by college students or cigar use by adults of any age.ObjectivesTo assess the prevalence of all forms of tobacco use (cigarettes, cigars, pipes, and smokeless tobacco) among US college students and to identify student- and college-level factors associated with use of each product.DesignThe Harvard College Alcohol Survey, a self-administered survey conducted in 1999.SettingOne hundred nineteen nationally representative US 4-year colleges.SubjectsA total of 14,138 randomly selected students (60% response rate).Main Outcome MeasuresSelf-report of current (in the past 30 days), past-year, and lifetime use of cigarettes, cigars, pipes, smokeless tobacco, and all tobacco products.ResultsNearly half (45.7%) of respondents had used a tobacco product in the past year and one third (32.9%) currently used tobacco. Cigarettes accounted for most of the tobacco use (28.5% current prevalence), but cigar use was also substantial (37.1% lifetime prevalence, 23.0% past-year prevalence, and 8.5% current prevalence) and combinations of the 2 were common. Total tobacco use was higher in men than in women (37.9% vs 29.7%; P<.001), despite nearly identical current cigarette smoking rates between the sexes (28.5% for women vs 28.4% for men), because of greater use of cigars (current prevalence, 15.7% vs 3.9%; P<.001) and smokeless tobacco (current prevalence, 8.7% vs 0.4%; P<.001) by men. Tobacco use was significantly higher among white students (P<.001), users of other substances (alcohol and marijuana) (P<.001), and students whose priorities were social rather than educational or athletic (P<.05). Among students who had used both cigars and cigarettes, only 8.9% smoked cigars at an earlier age than they had smoked cigarettes.ConclusionOur study indicates that tobacco use is common among college students and is not limited to cigarettes. College appears to be a time when many students are trying a range of tobacco products and are in danger of developing lifelong nicotine dependence. National efforts to monitor and reduce tobacco use of all types should expand to focus on college students and other young adults.

The role of tobacco, snuff and alcohol use in the aetiology of cancer of the oesophagus and gastric cardia

Abstract: While tobacco and alcohol are established risk factors for oesophageal squamous-cell carcinoma, their roles in the aetiology of the increasingly common oesophageal adenocarcinoma remains uncertain. We tested the association between tobacco, snuff and alcohol use and the risk of oesophageal and cardia cancer in a nationwide, population-based case-control study in Sweden. Face-to-face interviews were conducted with 618 (81% of all eligible) patients (189 oesophageal adenocarcinoma, 262 cardia adenocarcinoma and 167 oesophageal squamous-cell carcinoma) and 820 control subjects. Odds ratios (OR) were calculated by logistic regression with multivariate adjustments for potential confounding. The risk of oesophageal adenocarcinoma was not associated with snuff or alcohol use, and the association with smoking was weak or absent. Gastric cardia adenocarcinoma was dose-dependently associated with smoking (OR=4.2, 95% CI=2.5-7.0 among heavy smokers compared with never-smokers), but not with alcohol or snuff use. Oesophageal squamous-cell carcinoma was strongly associated with tobacco, moderately with alcohol, but not with snuff use; combined use of tobacco and alcohol entailed a strongly increased risk (OR=23.1, 95% CI=9.6-56.0 among heavy users compared with never-users). We conclude that tobacco smoking, a strong risk factor for oesophageal squamous-cell carcinoma and cardia adenocarcinoma, does not play an important role in the aetiology of oesophageal adenocarcinoma. None of the studied exposures can explain the increasing incidence of oesophageal adenocarcinoma.

A randomised controlled trial of a community intervention to prevent adolescent tobacco use

Abstract: OBJECTIVE—Experimental evaluation of comprehensive community wide programme to prevent adolescent tobacco use. DESIGN—Eight pairs of small Oregon communities (population 1700 to 13 500) were randomly assigned to receive a school based prevention programme or the school based programme plus a community programme. Effects were assessed through five annual surveys (time 1-5) of seventh and ninth grade (ages 12-15 years) students. INTERVENTION—The community programme included: (a) media advocacy, (b) youth anti-tobacco activities, (c) family communications about tobacco use, and (d) reduction of youth access to tobacco. MAIN OUTCOME MEASURE—The prevalence of self reported smoking and smokeless tobacco use in the week before assessment. RESULTS—The community programme had significant effects on the prevalence of weekly cigarette use at times 2 and 5 and the effect approached significance at time 4. An effect on the slope of prevalence across time points was evident only when time 2 data points were eliminated from the analysis. The intervention affected the prevalence of smokeless tobacco among grade 9 boys at time 2. There were also significant effects on the slope of alcohol use among ninth graders and the quadratic slope of marijuana for all students. CONCLUSION—The results suggest that comprehensive community wide interventions can improve on the preventive effect of school based tobacco prevention programmes and that effective tobacco prevention may prevent other substance use. Keywords: smokeless tobacco; primary prevention; intervention studies; adolescent behaviour; community interventions

Cohort study of all-cause mortality among tobacco users in Mumbai, India.

Abstract: INTRODUCTION: Overall mortality rates are higher among cigarette smokers than non-smokers. However, very little is known about the health effects of other forms of tobacco use widely prevalent in India, such as bidi smoking and various forms of smokeless tobacco (e.g. chewing betel-quid). We therefore carried out a cohort study in the city of Mumbai, India, to estimate the relative risks for all-cause mortality among various kinds of tobacco users. METHODS: A baseline survey of all individuals aged > or = 35 years using voters' lists as a selection frame was conducted using a house-to-house approach and face-to-face interviews. RESULTS: Active follow-up of 52,568 individuals in the cohort was undertaken 5-6 years after the baseline study, and 97.6% were traced. A total of 4358 deaths were recorded among these individuals. The annual age-adjusted mortality rates were 18.4 per 1000 for men and 12.4 per 1000 for women. For men the mortality rates for smokers were higher than those of non-users of tobacco across all age groups, with the difference being greater for lower age groups (35-54 years). The relative risk was 1.39 for cigarette smokers and 1.78 for bidi smokers, with an apparent dose-response relationship for frequency of smoking. Women were basically smokeless tobacco users, with the relative risk among such users being 1.35 and a suggestion of a dose-response relationship. DISCUSSION: These findings establish bidi smoking as no less hazardous than cigarette smoking and indicate that smokeless tobacco use may also cause higher mortality. Further studies should be carried out to obtain cause-specific mortality rates and relative risks.

Relationship Between Cigarette, Smokeless Tobacco, and Cigar Use, and Other Health Risk Behaviors Among U.S. High School Students

Abstract: This study examined relationships between tobacco use and use of other substances, intentional injury risk behaviors, and sexual risk behaviors among US high school students. Data about tobacco use and other health risk behaviors were analyzed from the 1997 national Youth Risk Behavior Survey implemented by the Centers for Disease Control and Prevention. One-fourth of students (24%) reported current use of a single tobacco product (ie, cigarettes, smokeless tobacco, or cigars during the 30 days preceding the survey), and 19.5% reported currently using more than one tobacco product. Generally, students who reported current tobacco use also reported engaging in other substance use, intentional injury risk behaviors, and sexual risk behaviors. For many risk behaviors, these results were especially pronounced among students who reported using two or all three tobacco products. Programs designed to prevent tobacco use should consider that such use often occurs concomitantly with other health risk behaviors.

The oral effects of smokeless tobacco.

Abstract: Smokeless tobacco use has increased rapidly in North America. This form of tobacco use has many oral effects including leukoplakia, oral cancer, loss of periodontal support (recession), and staining of teeth and composite restorations. Systemic effects such as nicotine dependence, transient hypertension and cardiovascular disease may also result from smokeless tobacco use. This paper aims to guide dental practitioners in identifying oral lesions that occur due to the use of smokeless tobacco and also offer guidelines on how to counsel patients who express a desire to stop using smokeless tobacco products.

A self-help cessation program for smokeless tobacco users: comparison of two interventions.

Abstract: While the use of smokeless tobacco products has increased, there has been a paucity of research evaluating interventions to help users quit. This study is the first large-scale randomized trial evaluating two levels of self-help cessation intervention with adult smokeless tobacco (SLT) users. Smokeless users in five Northwest states were recruited to call a toll-free number and 1069 users were randomized to receive one of two interventions, Manual Only (MAN) or Assisted Self-Help (ASH), who received a video and two support phone calls in addition to the manual. The study demonstrated that low-cost minimal interventions done by mail and phone can help a sizable proportion of SLT users quit both SLT and all tobacco use. Follow-up data at 6 months showed that subjects in the ASH condition had a significantly higher quit rate for both smokeless (23.4% vs. 18.4%, p < 0.05) and all tobacco use (21.1% vs. 16.5%, p < 0.05), using an intent-to-treat model. Further analysis revealed that use of the recommended cessation procedures mediated the effect of intervention condition on outcomes. This may be the result of phone counselors getting subjects to carry out behavioral cessation procedures. Public health implications for this intervention are discussed.

Ethnic differences in adolescent smoking prevalence in California: are multi-ethnic youth at higher risk?

Abstract: OBJECTIVE—Although ethnic differences in adolescent smoking have been well documented, smoking among multi-ethnic adolescents has received little research attention This study examined smoking prevalence and tobacco related psychosocial risk factors among multi-ethnic adolescents in California, as compared with white, African American, Asian American, and Hispanic adolescents DESIGN—This study used a cross sectional design Data were obtained from the independent evaluation of the California Tobacco Control, Prevention, and Education Program SETTING—Students completed a paper-and-pencil survey in their classrooms SUBJECTS—Data were collected from a stratified random sample of 5072 eighth grade students (age 13-14 years) in California during the 1996-97 school year The data were weighted by school enrollment in analyses to make the estimates representative of the population of California students attending public schools MAIN OUTCOME MEASURES—Outcome variables included self reported smoking prevalence, susceptibility to smoking, access to tobacco, and related attitudes, beliefs, and behaviours Ethnicity was assessed with a self reported, "check all that apply" question RESULTS—Results indicated that multi-ethnic adolescents were at higher risk than single-ethnic adolescents on several variables, including 30 day cigarette smoking prevalence, lifetime smokeless tobacco use, buying cigarettes, receiving cigarette offers, and expected friends' reaction if the respondent smoked For several other variables (lifetime cigarette smoking prevalence, susceptibility to smoking, and number of friends who smoked), Hispanic adolescents were at higher risk than all other ethnic groups including multi-ethnic adolescents Although susceptibility to smoking was highest among Hispanics, multi-ethnic adolescents scored significantly higher on susceptibility than the three other single-ethnic groups CONCLUSIONS—Multi-ethnic adolescents may be at increased risk for smoking and may have easier access to cigarettes Culturally targeted smoking prevention interventions for adolescents should address the unique social challenges faced by multi-ethnic adolescents that may increase their risk for smoking Keywords: multi-ethnic adolescents; risk for smoking

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

Abstract: OBJECTIVE—To describe the prevalence, patterns, and correlates of spit (smokeless) tobacco (ST) use in a sample of high school baseball athletes in California. DESIGN—This cross sectional study was a survey of 1226 baseball athletes attending 39 California high schools that were randomly selected from a list of all publicly supported high schools with baseball teams. At a baseball team meeting, athletes who agreed to participate and had parental consent completed the study questionnaire. To enhance the accuracy of self reported ST use status, a saliva sample was collected from each subject. The questionnaires and saliva samples were coded and salivary cotinine assay was performed on a random subsample of 5% of non-users who also were non-smokers. Biochemical assay indicated that 2% tested positive for cotinine inconsistent with self reported ST non-use. RESULTS—Overall, 46% had ever used ST and 15% were current users. Odds ratios and 95% confidence intervals (CI) suggested that, among high school baseball athletes, age, living in a rural area, being white, smoking cigarettes, drinking alcohol, not knowing about the adverse effects of ST, perceiving little personal risk associated with ST use, and believing that friends, role models, teammates, and same age baseball athletes in general used ST, increased the likelihood of being an ST user. CONCLUSION—The findings indicate that considerable experimentation with ST products occurs among high school baseball athletes in California, and many are current users. ST interventions targeting this population are needed to stop the transition from experimental ST use to tobacco dependence. Correlates of ST use for consideration in future intervention studies are identified. Keywords: chewing tobacco; spit tobacco; snuff; smokeless tobacco

Tobacco Use Characteristics Among Rural Ohio Appalachians

Abstract: Appalachians remain at high risk for cancer, heart and lung disease, in part because of their high prevalence of tobacco use; yet, information about their tobacco consumption patterns is limited. The purpose of this study was to describe tobacco consumption variables among rural adult Appalachian tobacco users. Subjects, aged 18 and older (N = 249), participated in a face-to-face interview about tobacco consumption variables and knowledge regarding the health effects of tobacco at fairs in two rural Ohio Appalachian counties. The majority of participants were categorized as precontemplators, although 21 percent were classified in preparation stage of change. Mean age of initiation was 16.6 years and number of cigarettes smoked per day (cpd) was significantly higher for men, as compared to women. One-third of males reported the use of smokeless tobacco. The majority had not tried to quit for more than a year and the average number of previous quit attempts was low. One-half of the sample had been advised in the past to quit by their physician. Few had used nicotine replacement with past quit attempts but greater than half would consider this approach with future attempts. Knowledge about the health effects of smoking indicated that most were aware of the relationship between smoking and cancer but less than one-half recognized its association with heart disease. Those with less education were less informed about the health effects to self and non-smokers. While a sizeable portion expressed interest in quitting, knowledge about the health effects of smoking is lacking, especially with regard to heart disease and among those with less education.

Oral health in the United States: the post-fluoride generation.

Abstract: ▪ Abstract Tremendous strides have been made in reducing the incidence of tooth decay, periodontal diseases, and associated loss of teeth in adults and children since the inception of community water fluoridation programs. Yet the disadvantaged and poor have not fully shared in the benefits. Other challenges to oral health remain. Oral cancer and related smoking and smokeless tobacco use remain major public health problems. Access to preventive and therapeutic dental care is far from universal. Public health programs similar in commitment to the approach of community water fluoridation programs initiated in the 1950s and 1960s are needed to address neglected oral health needs of underserved and high-risk populations in the United States.

Determinants of youth tobacco use in West Virginia: a comparison of smoking and smokeless tobacco use.

Abstract: Purpose: To identify and compare the determinants of different types of tobacco use among rural youths and discuss the implication of these differences for youth tobacco use cessation. Methods: Ninth grade participants (n = 883) were 95% white, between 13 and 19 years old with a mean age of 14.6 years. Students were classified into four exclusive groups: non–tobacco use, smoking only, smokeless tobacco (ST) use only, and conjoint smoking and ST use. The influences of 14 specific risk factors on tobacco use were investigated for each group using separate multiple logistic regression analyses. Results: Among participants, 20% were smokers only, 6% were ST users only, and 10% were conjoint users. Students who had more friends (odds ratio [OR] =] 2.75) and siblings (OR = 1.96) who smoke, family problems (OR = 1.70), and favorable attitudes toward tobacco use (OR = 1.12) were more likely to smoke than were other students. Among students who used only ST, gender was a primary determinant (95% were male). Exclud...

The California Tobacco Control Program: A Decade of Progress, Results from the California Tobacco Survey, 1990-1999

Abstract: Executive Summary: During the 1990s in California, smoking behavior and attiudes about smoking have changed, as measured from the California Tobacco Surveys (CTS) and other data sources. Some of the most important findings from the CTS are highlighted below. For a more complete summary, see the Key Findings from each chapter of this report, which appear both in this Executive Summary and at the end of each chapter. Throughout this report, results are given with the margin of error (±95% confidence limits) Adult Smoking Behavior Over the decade, per capita cigarette consumption fell by a factor of 57% in California compared to only 27% in the rest of the United States. By the end of 1999, Californians consumed only 4.1 packs of cigarettes per person per month, compared to 9.1 in the rest of the United States. While adult (18+ years) smoking prevalence decreased in the first few years of the decade, after 1994 changes in the prevalence were not statistically significant. The most recent CTS indicated that adult smoking prevalence was 18.3±0.3% in 1999. Despite relatively stable smoking prevalence since 1993, fewer California smokers are heavy daily smokers, and between 1990 and 1999, the prevalence of daily smoking declined by a factor of 18.6%. These findings explain the decline in per capita cigarettes consumption. In 1999, only 13.0±0.3% of Californians were daily smokers. Only 6.4±0.4% of California college graduates were daily smokers. Over the decade, the percent of California smokers making a quit attempt lasting a day or longer in the last year increased by a factor of 25.9% to 60.1±1.5% in 1999. Quitters in 1999 appeared to be as successful as those earlier in the decade. In California, the cigar fad appears to be dissipating, mostly among adults who have never smoked cigarettes. In 1999, most current California cigar smokers only a few cigars a month 83.2Executive Summary: Durig the 1990s in California, smoking behavior and attiudes about smoking have changed, as measured form the California Tobacco Surveys (CTS) and other data sources. Some of the most important findings from the CTS are highlighted below. For a more complete summary, see the Key Findings from each chapter of this report, which appear both in this Executive Summary and at the end of each chapter. Throughout this report, results are given with the margin of error (±95% confidence limits) Adult Smoking Behavior Over the decade, per capita cigarette consumption fell by a factor of 57% in California compared to only 27% in the rest of the United States. By the end of 1999, Californians consumed only 4.1 packs of cigarettes per person per month, compared to 9.1 in the rest of the United States. While adult (18+ years) smoking prevalence decreased in the first few years of the decade, after 1994 changes in the prevalence were not statistically significant. The most recent CTS indicated that adult smoking prevalence was 18.3±0.3% in 1999. Despite relatively stable smoking prevalence since 1993, fewer California smokers are heavy daily smokers, and between 1990 and 1999, the prevalence of daily smoking declined by a factor of 18.6%. These findings explain the decline in per capita cigarettes consumption. In 1999, only 13.0±0.3% of Californians were daily smokers. Only 6.4±0.4% of California college graduates were daily smokers. Over the decade, the percent of California smokers making a quit attempt lasting a day or longer in the last year increased by a factor of 25.9% to 60.1±1.5% in 1999. Quitters in 1999 appeared to be as successful as those earlier in the decade. In California, the cigar fad appears to be dissipating, mostly among adults who have never smoked cigarettes. In 1999, most current California cigar smokers only a few cigars a month (83.2±3.7% smoked <5/month). Cigar smokers who were former cigarette smokers showed the highest level of monthly cigar consumption. Adolescent Smoking Behavior Although California adolescents showed an alarming increase in smoking prevalence (any smoking in the past 30 days) between 1993 and 1996, by 1999 current smoking prevalence had fallen to 7.7±0.8%, significantly lower than prevalence in 1990. Among young adolescents 12-13 years of age, the percentage of committed never smokers rose by a factor of 17.7% between 1996 and 1999 to 65.7±1.9%. In 1999, 79.8±6.4 of current adolescent established smokers reported they had tried to quit sometime in the past. Adolescent use of other tobacco products is highly related to cigarette smoking. In 1999, rates of adolescent ever experimentation with cigars (15.0±1.2%) and bidis (7.0±0.8) were much higher than for chewing tobacco or snuff (3.1±0.5%). Protection of Nonsmokers form Secondhand Tobacco Smoke In 1999, 93.4±0.8% of California indoor workers reported that smoking was not allowed in their workplace, up from 35.0±1.3% in 1990. In 1999, the percentage of nonsmokers exposed to someone smoking in their work area in the past two weeks increased significantly from 11.8±1.5% in 1996 to 15.6±1.4% in 1999. Over the decade, however, exposure to secondhand smoke in the workplace decreased by a factor of 46.2% In 1999, 73.3±1.1% of Californians lived in smokefree homes, up by a factor of 30% since 1993. Further, nearly half (47.2±1.8%) of current California smokers live in smokefree homes, a factor increase of 135% since 1993. Accordingly, the percentage of California children and adolescents protected from secondhand smoke at home increased by a factor of 15.1% since 1993, to 88.6±1.1% in 1999. Other Important Findings While adult California smokers were more concerned about the price of cigarettes after the $0.50/pack excise tax increase in January 1999, about 70% buy their cigarettes at the most expensive outlets, only a few (5.47±0.8%) bothered to seek out untaxed sources, and 58.2±1.139% supported a further tax increase of $0.50 or more. In 1999, less than half (48.0±1.5%) of California’s adolescent never smokers believed that it is easy to get cigarettes, down by a factor of 16% since 1996. Perceived compliance with smokefree school policies increased by a factor of 64% from 1996 to 1999, when 66.6±1.5% of adolescents reported that most of the students who smoke obey the no-smoking rule on school property. In 1999, 9.0±0.9% of adolescents had a tobacco promotional item, a factor decrease of 34.5% since 1996. However, 14.9±1.1% of adolescents said they would be willing to use a promotional item. Few adults (1.2±0.2%) reported ever giving such an item to a child or adolescent, but 7.6±0.6% said they were willing to do so.

Urinary cotinine levels of smokeless tobacco (Maraş powder) users.

Abstract: Smokeless tobacco is used in various forms in some countries of the world. "Maras otu" is a kind of smokeless tobacco usage in the Southeastern region of Turkey. The use of smokeless tobacco causes nicotine addiction and dependence. Moreover this type of smokeless tobacco usage is one of the risk factors for oral cancers and genotoxic damages for users. Cotinine is widely used as a biomarker of tobacco consumption and intake of nicotine. Therefore, urine samples were collected from people who are using Maras powder and smoking cigarettes, and passive smokers, and the levels of cotinine investigated. The purpose of this study is to determine the cotinine levels of Maras powder users and to compare the results with cigarette smokers and passive smokers. Urinary cotinine levels of subjects were determined by using capillary gas chromatography with FID detection. The mean (+/- SD) urinary cotinines have been determined as 6467.35+/-3198 microg/g creatinine for 26 Maras powder users, 1943.92+/-1443 microg/g creatinine for 26 cigarette smokers and 198.62+/-420.82 microg/g creatinine for 26 passive smokers. A significant difference has been found between cotinine levels of Maras powder users and cigarette smokers, which is three times higher in Maras powder users (p<0.001). The present study suggests that smokeless tobacco poses a threat to public health and it should not be viewed as a safe alternative to cigarettes.

Association of Adolescent Cigar Use With Other High-Risk Behaviors

Abstract: Objectives. To describe the association of cigar use with use of cigarettes, smokeless tobacco, and alcohol among adolescents; and to examine the association of self-esteem, physical activity, and use of tobacco promotional items with cigar use. Methods. A cross-sectional study of 7104 girls and 5499 boys 10 to 15 years of age in 1997. Data were collected from self-report questionnaires. Results. The prevalence of cigar use increased with age among both girls and boys. Among 11-year-olds, only 1% of girls and 3% of boys had used a cigar, whereas among 15-year-olds, 11% of girls and 25% of boys had used a cigar. Cigar users were much more likely than nonusers to have experimented with cigarettes (girls, odds ratio [OR]: 23.6; 95% confidence interval [CI]: 17.2–32.3; boys, OR: 21.3; 95% CI: 17.1–26.6), smokeless tobacco (girls, OR: 7.5; 95% CI: 4.5–12.4; boys, OR: 13.0; 95% CI: 9.8–17.4), and alcohol (girls, OR: 6.6; 95% CI: 4.8–9.1; boys, OR: 6.8; 95% CI: 5.3–8.8). There was a strong association between cigar use and binge drinking, especially among boys (girls, OR: 11.6; 95% CI: 7.9–16.9; boys, OR: 34.8; 95% CI: 19.4–62.3). Cigar users reported more hours of weekly physical activity than did nonusers. Additionally, cigar users were more likely to report high social self-esteem and to possess a tobacco promotional item. Conclusions. Adolescents who use cigars are more likely to use other tobacco products and alcohol, to report high social self-esteem, and to possess tobacco promotional items. Health care professionals and teachers should include cigar use in discussions with adolescents addressing substance use.

Evolution of a comprehensive tobacco control programme: building system capacity and strategic partnerships—lessons from Massachusetts

Abstract: BACKGROUND—Since the passage of a voter approved state referendum in 1992 to establish a 25 cent increase on the excise tax on cigarettes and smokeless tobacco, Massachusetts has received an average of $40 million annually for its tobacco control programme. This funding allowed Massachusetts to expand and develop its tobacco control programme to become one of the most comprehensive in the world. OBJECTIVES—The development of the Massachusetts Tobacco Control Program is outlined, focusing on three stages of development: formation, strategic partnership building, and shared leadership. METHODS—The development of management structures, programmatic infrastructure, communication and partnership networks, and advisory structures are tracked throughout the three phases. RESULTS—The use of pre-existing public health resources, implementation of a strong training component, a geographical management structure, the creation of public and private partnerships, and the development of a shared leadership model contributed to building consensus and provided the foundation for coordinated approaches to tobacco control. CONCLUSION—Other states and countries can use lessons learned from Massachusetts about the organisational development of a comprehensive tobacco control programme as they embark upon similar efforts. Keywords: Massachusetts; infrastructure; system development; tobacco control programme

Correlates of youth smokeless tobacco use

Abstract: The objectives of this study are to identify knowledge and attitude variables that correlate with smokeless tobacco use and how youth users and non-users differ in their attitudes and knowledge about smokeless tobacco. A randomized cluster sample of 1834 total fifth, eighth, and 11th grade students in West Virginia public schools during the 1996-1997 school year were surveyed on smokeless tobacco knowledge, attitudes and practices. Data from 648 male non-users and 160 male monthly and daily users of smokeless tobacco were compared using chi 2 and two-tailed t-tests. Logistic regression analysis of survey variables revealed the following correlates of smokeless tobacco use: having a family member not living in the home who uses, having a friend who uses, playing football, having tried cigarettes, and having parents who would permit use at home. Important differences exist in knowledge and attitudes regarding smokeless tobacco between users and non-users in fifth, eighth, and 11th grade West Virginia public schools. Correlates of smokeless tobacco use are identified which can be used to target prevention programs.

Smokeless Tobacco Use Among Adults in the Southeast

Abstract: Tobacco use is associated with numerous illnesses and contributes to as many as 400,000 deaths in the United States each year. Most tobacco use in the United States is in the form of cigarette smoking, but smokeless tobacco use is particularly high in certain areas and within certain subpopulations. Among US adults, smokeless tobacco use is associated with low socioeconomic status, male sex, Native American race, and southern or rural residence. We review six studies among adults (> or = 18 years) describing the epidemiology of smokeless tobacco use in the southeastern United States. These studies indicate that the Southeast, with its strong ties to tobacco production, is an area that requires intensive tobacco cessation strategies targeting the use of smokeless tobacco as well as cigarettes.

Pulmonary effects of smoking.

Abstract: The problems of tobacco addiction have evolved over centuries. The possible relationship between smoking and oral cancer was recognized as early as the 19th century. The use of tobacco results in an estimated 4 million deaths each year worldwide. Approximately 3,000 adolescents start smoking every day; 4.5 million children and adolescents smoke cigarettes; 1 million use smokeless tobacco. This article reviews the effects of environmental tobacco smoke and primary smoking on lung health and maturation and the pathophysiology of smoking-related pulmonary disease. Smoking prevention and timely smoking cessation will significantly reduce the risk of not only lung diseases (chronic obstructive pulmonary disease, cancer, chronic bronchitis, asthma, etc.) but also suboptimal lung growth during preadolescent and adolescent years.

Placebo control study of acute smokeless tobacco abstinence in young adult men.

Abstract: Tobacco use can lead to dependence, as indicated by withdrawal symptomatology during abstinence In smokers, nicotine-free cigarettes suppress tobacco withdrawal, suggesting that non-nicotine stimuli may be relevant to tobacco dependence This study examined non-nicotine factors in smokeless tobacco (SLT) withdrawal SLT users used their own brand of SLT, nicotine-free SLT, or no SLT hourly in 3 approximately 45-hr sessions Participant-rated measures of craving and desire to use SLT were elevated in the abstinence condition relative to the own-brand and nicotine-free conditions Heart rate was significantly elevated in sessions in which participants' own brand was administered relative to the nicotine-free and abstinence conditions These results support the notion that stimuli associated with tobacco use may have some withdrawal suppressing qualities, at least in the short term

Coaches' Attitudes Toward Smokeless Tobacco and Intentions to Intervene with Athletes

Abstract: Smokeless tobacco use among athletes is alarming. Most of these athletes report beginning smokeless tobacco use in middle or high school. West Virginia has significantly higher rates of smokeless tobacco use among adolescent and adult males than the general population. Since West Virginia athletes may be particularly vulnerable to smokeless tobacco use. West Virginia coaches can be critical agents in smokeless tobacco prevention and intervention. This study surveyed West Virginia middle and high school coaches' 1) attitudes toward smokeless tobacco, 2) actions toward athletes who use smokeless tobacco, 3) intentions to provide intervention for users, and 4) tobacco use history. Results indicated coaches had unfavorable attitudes toward smokeless tobacco, perceived it as a problem, and were willing to help athletes quit. These findings provide support for development of training programs for middle and high school coaches to act as smokeless tobacco intervention agents.