Showing papers on "Smokeless tobacco published in 2006"
TL;DR: All forms of tobacco use, including different types of smoking and chewing tobacco and inhalation of SHS, should be discouraged to prevent cardiovascular diseases.
890 citations
Patent•
12 Sep 2006TL;DR: In this paper, a smokeless tobacco product configured for insertion into the mouth of a user of the product is provided, the tobacco product including a water-permeable pouch containing a tobacco formulation and a plurality of micro-capsules dispersed within the tobacco material, the plurality consisting of microcapsules including an outer shell encapsulating an internal payload, the internal payload may include an additive such as water, flavorants, binders, colorants, pH adjusters, buffering agents, fillers, disintegration aids, antioxidants, preservatives, additives derived from herbal or
Abstract: A smokeless tobacco product configured for insertion into the mouth of a user of the product is provided, the tobacco product including a water-permeable pouch containing a tobacco formulation, the tobacco formulation including a tobacco material and a plurality of microcapsules dispersed within the tobacco material, the plurality of microcapsules including an outer shell encapsulating an internal payload. The internal payload may include an additive such as water, flavorants, binders, colorants, pH adjusters, buffering agents, fillers, disintegration aids, humectants, antioxidants, oral care ingredients, preservatives, additives derived from herbal or botanical sources, and mixtures thereof. Microencapsulated flavorants include tobacco-containing flavorants, such as tobacco extracts or a particulate tobacco material, sweeteners (e.g., sweeteners containing neotame), and vanillin (optionally in a complexed form).
307 citations
TL;DR: The Fagerström Test for Nicotine Dependence for ST users was modified, referred to this scale as the FTND-ST, and its characteristics in a population of 42 ST users were evaluated.
162 citations
TL;DR: The literature has established that buccal cells are useful not only for characterizing the molecular mechanisms underlying tobacco-associated oral cancers but also as exfoliative cells that express diverse changes that offer promise as candidate biomarkers for the early detection of oral cancer.
Abstract: Reported herein are the results of a structured literature review that was undertaken to (a) determine if human buccal (mouth) cell changes are associated with smoking and smokeless ("chewing") tobacco, (b) tabulate different buccal cell alterations that have been reported, (c) delineate buccal cell assays that have been used successfully, (d) determine whether buccal cell changes correlate with oral cancer as defined in clinicopathologic investigations, and (e) assess the feasibility of developing a high-throughput buccal cell assay for screening smokers for the early detection of oral cancer. The results of the studies reported herein have established that diverse buccal cell changes are associated with smoking and smokeless tobacco. This review documents also that buccal cells have been collected in a noninvasive manner, and repetitively for serial studies, from different sites of the mouth (e.g., cheek, gum, and tongue) and from normal tissue, preneoplastic lesions (leukoplakia), and malignant tumors. Tobacco-associated genetic mutations and nongenetic changes have been reported; a partial listing includes (a) micronuclei, (b) bacterial adherence, (c) genetic mutations, (d) DNA polymorphisms, (d) carcinogen-DNA adducts, and (e) chromosomal abnormalities. Clinical studies have correlated buccal cell changes with malignant tumors, and some oral oncologists have reported that the buccal cell changes are practical biomarkers. Summarily, the literature has established that buccal cells are useful not only for characterizing the molecular mechanisms underlying tobacco-associated oral cancers but also as exfoliative cells that express diverse changes that offer promise as candidate biomarkers for the early detection of oral cancer.
160 citations
TL;DR: TSNA levels in new tobacco products range from relatively low to comparable with those found in some conventional brands, and conventional brands had levels consistent with those reported in the literature.
Abstract: New tobacco products, designed to attract consumers who are concerned about the health effects of tobacco, have been appearing on the market. Objective evaluation of these products requires, as a first step, data on their potentially toxic constituents. Tobacco-specific nitrosamines (TSNAs) are an important class of carcinogens in tobacco products, but virtually no data were available on their levels in these products. In the present study, we analyzed several new products-Ariva, Stonewall, Exalt, Revel, Smokey Mountain, and Quest-for TSNAs and compared their TSNA levels with those in nicotine replacement products and conventional smokeless tobacco and cigarette brands. TSNAs were not detected in Smokey Mountain, which is a tobacco-free snuff product. The lowest levels among the new products containing tobacco were in Ariva and Stonewall (0.26-0.28 microg/g wet weight of product). The highest levels in the new products were found in Exalt (3.3 microg/g tobacco), whereas Revel and Quest had intermediate amounts. Only trace amounts were found in nicotine replacement products, and conventional brands had levels consistent with those reported in the literature. These results demonstrate that TSNA levels in new tobacco products range from relatively low to comparable with those found in some conventional brands.
142 citations
TL;DR: There is a strong scientific and medical foundation for tobacco harm reduction, and it shows great potential as a public health strategy to help millions of smokers.
Abstract: According to the Centers for Disease Control and Prevention, about 45 million Americans continue to smoke, even after one of the most intense public health campaigns in history, now over 40 years old. Each year some 438,000 smokers die from smoking-related diseases, including lung and other cancers, cardiovascular disorders and pulmonary diseases. Many smokers are unable – or at least unwilling – to achieve cessation through complete nicotine and tobacco abstinence; they continue smoking despite the very real and obvious adverse health consequences. Conventional smoking cessation policies and programs generally present smokers with two unpleasant alternatives: quit, or die. A third approach to smoking cessation, tobacco harm reduction, involves the use of alternative sources of nicotine, including modern smokeless tobacco products. A substantial body of research, much of it produced over the past decade, establishes the scientific and medical foundation for tobacco harm reduction using smokeless tobacco products. This report provides a description of traditional and modern smokeless tobacco products, and of the prevalence of their use in the United States and Sweden. It reviews the epidemiologic evidence for low health risks associated with smokeless use, both in absolute terms and in comparison to the much higher risks of smoking. The report also describes evidence that smokeless tobacco has served as an effective substitute for cigarettes among Swedish men, who consequently have among the lowest smoking-related mortality rates in the developed world. The report documents the fact that extensive misinformation about ST products is widely available from ostensibly reputable sources, including governmental health agencies and major health organizations. The American Council on Science and Health believes that strong support of tobacco harm reduction is fully consistent with its mission to promote sound science in regulation and in public policy, and to assist consumers in distinguishing real health threats from spurious health claims. As this report documents, there is a strong scientific and medical foundation for tobacco harm reduction, and it shows great potential as a public health strategy to help millions of smokers.
128 citations
TL;DR: Smokeless tobacco use during pregnancy increases stillbirth risk, with a risk at least as great as that associated with maternal cigarette smoking.
Abstract: Background:Maternal cigarette smoking has been causally associated with an increased risk for stillbirth. Preliminary reports suggest an increased risk for stillbirth with smokeless tobacco use during pregnancy.Methods:We conducted a population-based prospective cohort study to investigate this asso
126 citations
TL;DR: Overall and demographic-specific data for adolescent boys indicate that smokeless tobacco use increased for 12th-grade students from 1986 until the early 1990s, but has subsequently declined rapidly in all grades since then, especially among adolescent boys.
Abstract: Objectives Smokeless tobacco has many adverse health effects We analyzed long-term national trends in smokeless tobacco useMethods We used 1987 to 2000 National Health Interview Survey data for adults aged 18 years and older, 1986 to 2003 data from Monitoring the Future surveys of adolescents, and 1991 to 2003 data from the Youth Risk Behavior Survey for 9th- to 12th-grade students to examine overall and demographic-specific trendsResults Smokeless tobacco use among adult and adolescent females was low and showed little change Smokeless tobacco use among men declined slowly (relative decline=26%), with the largest declines among those aged 18 to 24 years or 65 years and older, Blacks, residents of the South, and persons in more rural areas Overall and demographic-specific data for adolescent boys indicate that smokeless tobacco use increased for 12th-grade students from 1986 until the early 1990s, but has subsequently declined rapidly in all grades since then (range of relative overall declines=43
123 citations
TL;DR: A research agenda is offered to provide a stronger basis for evaluating the risks and benefits of smokeless tobacco as a means of reducing the adverse health effects of tobacco.
Abstract: Harm reduction strategies involve promoting a product that has adverse health consequences as a substitute for one that has more severe adverse health consequences. Smokeless tobacco low in nitrosamine content offers potential benefits in reducing smoking prevalence rates. Possible harm arises from the potential for such products to serve as a gateway to more harmful tobacco products, public misinterpretation of “less harmful” as “safe,” distraction from the public health goal of tobacco elimination, and ethical issues involved in advising those marketing these harmful products. We offer a research agenda to provide a stronger basis for evaluating the risks and benefits of smokeless tobacco as a means of reducing the adverse health effects of tobacco.
95 citations
Patent•
10 Feb 2006TL;DR: A smokeless tobacco product includes a powder or granular smokeless formulation that is contained within a moisture-permeable packet or pouch as discussed by the authors, which is intended to be placed in the mouth of the user, such that the tobacco formulation within the container may be enjoyed by the user.
Abstract: A smokeless tobacco product includes a powdered or granular smokeless tobacco formulation that is contained within a moisture-permeable packet or pouch. The smokeless tobacco formulation may include finely ground particles of tobacco in powder-like form and other ingredients such as sweeteners, binders, colorants, pH adjusters, fillers, flavoring ingredients, disintegration aids, antioxidants and preservatives. The tobacco formulation may have a dry or moist form. The container has the form of a pouch or bag, such as is the type commonly used for the manufacture of snus products. The container preferably contains at least one capsule, such as a spherical breakable capsule. The container is intended to be placed in the mouth of the tobacco user, such that the tobacco formulation within the container may be enjoyed by the user. After the tobacco user is finished using the smokeless tobacco product, the container is removed from the user's mouth for disposal. Alternatively, the container is dissolvable or dispersible in the mouth of the user.
90 citations
TL;DR: As part of a randomized clinical trial to assess the reach and effectiveness of Web-based programs for delivering an ST cessation intervention, the authors developed and evaluated several methods for overcoming the recruitment challenges associated with Web- based research.
Abstract: An estimated 22% of Americans currently use smokeless tobacco (ST). Most live in small towns and rural areas that offer few ST cessation resources. Approximately 94 million Americans use the Internet for health-related information, and on-line access is growing among lower-income and less-educated groups. As part of a randomized clinical trial to assess the reach and effectiveness of Web-based programs for delivering an ST cessation intervention, the authors developed and evaluated several methods for overcoming the recruitment challenges associated with Web-based research. This report describes and evaluates these methods. Participants were recruited through: (a) Thematic promotional "releases" to print and broadcast media, (b) Google ads, (c) placement of a link on other Web sites, (d) limited purchase of paid advertising, (e) direct mailings to ST users, and (f) targeted mailings to health care and tobacco control professionals. Combined recruitment activities resulted in more than 23,500 hits on our recruitment website from distinct IP addresses over 15 months, which yielded 2,523 eligible ST users who completed the registration process and enrolled in the study. Self-reports revealed that at least 1,276 (50.6%) of these participants were recruited via mailings, 874 (34.6%) from Google ads or via search engines or links on another Web site, and 373 (14.8%) from all other methods combined. The use of thematic mailings is novel in research settings. Recruitment of study participants went quickly and smoothly. Google ads and mailings to media outlets were the methods that recruited the highest number of participants.
TL;DR: Current cigarette smoking is more prevalent among Swedish women than men, while snus use is more popular among men, and among men who reported using both cigarettes and snus during their life-time, it was more common to quit cigarettes and currently use snus than to quit snus and Currently use cigarettes.
Abstract: Aims To investigate the prevalence and patterns of transitions between cigarette and snus use.
Design Cross-sectional study within the population-based Swedish Twin Registry.
Setting and participants A total of 31 213 male and female twins 42–64 years old.
Measurements Age-adjusted prevalence odds ratios (POR) and 95% confidence intervals (CIs) described the association between gender and tobacco use, while Kaplan–Meier survival methods produced cumulative incidence curves of age at onset of tobacco use. Life-time tobacco use histories were constructed using ages at onset of tobacco use and current tobacco use status.
Findings Although more males reported ever smoking (64.4%) than females (61.7%), more males were former smokers (POR: 1.33, 95% CI: 1.27–1.39). Males were far more likely to use snus than females (POR: 18.0, 95% CI: 16.17–20.04). Age at onset of cigarette smoking occurred almost entirely before age 25, while the age at onset of snus use among males occurred over a longer time period. Most men began using cigarettes first, nearly one-third of whom switched to using cigarettes and snus in combination. While 30.6% of these combined users quit tobacco completely, only 7.4% quit snus and currently use cigarettes, while 47.7% quit cigarettes and currently use snus.
Conclusions Current cigarette smoking is more prevalent among Swedish women than men, while snus use is more prevalent among men. Among men who reported using both cigarettes and snus during their life-time, it was more common to quit cigarettes and currently use snus than to quit snus and currently use cigarettes. Once snus use was initiated, more men continued using snus rather than quit tobacco completely.
01 Jun 2006
TL;DR: The evidence base has notable gaps and numerous study deficiencies, and there is little information to address some of the issues that previous authoritative reviews had not covered, but some information to substantiate earlier conclusions and recommendations from those reviews are found.
Abstract: Practice Center (RTI-UNC EPC) systematically reviewed the evidence on (a) the effectiveness of community- and population-based interventions to prevent tobacco use and to increase consumer demand for and implementation of effective cessation interventions; (b) the impacts of smokeless tobacco marketing on smoking, use of those products, and population harm; and (c) the directions for future research. Data Sources: We searched MEDLINE®, Cumulative Index to Nursing and Applied Health (CINAHL), Cochrane libraries, Cochrane Clinical Trials Register, Psychological Abstracts, and Sociological Abstracts from January 1980 through June 10, 2005. We included English-language randomized controlled trials, other trials, and observational studies, with sample size and followup restrictions. We used 15 Cochrane Collaboration systematic reviews, 5 prior systematic reviews, and 2 meta-analyses as the foundation for this report. Review Methods: Trained reviewers abstracted detailed data from included articles into evidence tables and completed quality assessments; other senior reviewers confirmed accuracy and resolved disagreements. Results: We identified 1,288 unique abstracts; 642 did not meet inclusion criteria, 156 overlapped with prior reviews, and 2 were not published articles. Of 488 full-text articles retrieved and reviewed, we excluded 298 for several reasons, marked 88 as background, and retained 102. Evidence (consistent with previous reviews) showed that (a) school-based prevention interventions have short-term (but not long-term) effects on adolescents; (b) multicomponent approaches, including telephone counseling, increase the number of users who attempt to quit; (c) self-help strategies alone are ineffective, but counseling and pharmacotherapy used either alone or in combination can improve success rates of quit attempts; and (d) provide training and academic detailing improve provider delivery of cessation treatments, but evidence is insufficient to show that these approaches yield higher quit rates. Recent evidence on the following topics was insufficient to change prior review findings: (a) effectiveness of population-based prevention interventions; (b) effectiveness of providerbased interventions to reduce tobacco initiation; (c) effectiveness of community- and providerbased interventions to increase use of proven cessation strategies; (d) effectiveness of marketing campaigns to switch tobacco users from smoking to smokeless tobacco products; and (e) effectiveness of interventions in populations with comorbidities and risk behaviors (e.g., depression, substance and alcohol abuse). No evidence was available on the way in which smokeless tobacco product marketing affects population harm. Conclusions: The evidence base has notable gaps and numerous study deficiencies. We found little information to address some of the issues that previous authoritative reviews had not covered, some information to substantiate earlier conclusions and recommendations from those reviews, and no evidence that would overturn any previous recommendations.
TL;DR: Tobacco use appears to be an independent risk factor for low BMI in this population of adults in India, and tobacco control research and interventions will need to be conducted in concert with nutritionResearch and interventions in order to improve the overall health status of the population.
Abstract: Body mass index [BMI, weight (kg)/height (m2)], a measure of relative weight, is a good overall indicator of nutritional status and predictor of overall health. As in many developing countries, the high prevalence of very low BMIs in India represents an important public health risk. Tobacco, smoked in the form of cigarettes or bidis (handmade by rolling a dried rectangular piece of temburni leaf with 0.15–0.25 g of tobacco) or chewed, is another important determinant of health. Tobacco use also may exert a strong influence on BMI. The relationship between very low BMI (< 18.5 kg/m2) and tobacco use was examined using data from a representative cross-sectional survey of 99,598 adults (40,071 men and 59,527 women) carried out in the city of Mumbai (formerly known as Bombay) in western India. Participants were men and women aged ≥ 35 years who were residents of the main city of Mumbai. All forms of tobacco use were associated with low BMI. The prevalence of low BMI was highest in bidi-smokers (32% compared to 13% in non-users). For smokers, the adjusted odds ratio (OR) and 95% confidence interval (CI) were OR = 1.80(1.65 to 1.96) for men and OR = 1.59(1.09 to 2.32) for women, respectively, relative to non-users. For smokeless tobacco and mixed habits (smoking and smokeless tobacco), OR = 1.28(1.19 to 1.38) and OR = 1.83(1.67 to 2.00) for men and OR = 1.50(1.43 to 1.59) and OR = 2.19(1.90 to 3.41) for women, respectively. Tobacco use appears to be an independent risk factor for low BMI in this population. We conclude that in such populations tobacco control research and interventions will need to be conducted in concert with nutrition research and interventions in order to improve the overall health status of the population.
TL;DR: There is ample evidence for the efficacy of dental office-based tobacco cessation programmes, but adoption of these tobacco cessation activities into practice has been slow and researchers and clinicians must continue to work together towards universal adoption of effective tobacco cessation interventions at each clinical encounter.
Abstract: The hazards associated with cigarette smoking and smokeless tobacco use have been well documented. In addition to its association with many cancers and coronary conditions, tobacco plays a role in the aetiology of a number of oral morbidities. Dental care practitioners are a largely untapped resource for providing advice and brief counselling to tobacco-using patients, and there are good reasons to believe that they can be effective. Data from seven randomised trials indicate there is ample evidence for the efficacy of dental office-based interventions, but adoption of these tobacco cessation activities into practice has been slow. The limited research on dissemination of tobacco interventions is promising, but there is a need to develop and evaluate new methods for encouraging adoption, implementation and maintenance of tobacco interventions into routine dental care. Several studies currently under way may help to increase the effectiveness and dissemination of office-based tobacco cessation programmes into routine dental care. If dental practitioners provided cessation assistance routinely to their patients and achieved even modest success rates, the public health impact would be enormous. Researchers and clinicians must continue to work together towards universal adoption of effective tobacco cessation interventions at each clinical encounter.
TL;DR: Investigation of associations between several lifestyle factors and MetSy found that MetSy is independently associated with high consumption of snus, even when controlling for smoking status, of public health interest in societies with widespread use ofsnus.
Abstract: AIM: Combined effects of genetic and environmental factors underlie the clustering of cardiovascular risk factors in the metabolic syndrome (MetSy). The aim was to investigate associations between ...
TL;DR: Prevalence of use of chewable products is high in Pakistan with particularly high use of certain substances related with socio-demographic profiles, especially Industrially prepared products, chaalia and gutka, are gaining popularity among youth.
Abstract: Head and neck cancers are a major cancer burden in Pakistan. They share a common risk factor profile including regular consumption of products of betel, areca and tobacco. Use of paan, chaalia, gutka, niswar and tumbaku is acceptable in Pakistan and is considered a normal cultural practice. This cross-sectional study was carried out to understand the relation of socio-demographic factors for the consumption of paan, chaalia, gutka, niswar and tumbaku in Pakistani population. Through systematic sampling, 425 subjects from a squatter settlement in Karachi were interviewed using a structured questionnaire. High risk behavior was defined as Daily use of any of the above products. Daily use of all the substances except chaalia was higher among males compared to females. Chaalia use was higher among adolescents than adults while non-married consumed both chaalia and gutka more than married. Mohajir ethnicity had higher prevalence of paan, gutka and tumbaku use while Pathans had higher prevalence of niswar use. Prevalence of use of chewable products is high in Pakistan with particularly high use of certain substances related with socio-demographic profiles. Industrially prepared products, chaalia and gutka, are gaining popularity among youth. Policies and focused interventions can be developed taking into consideration the preferred use of products among different socio-demographic groups.
TL;DR: All the tobacco products tested are likely to be hazardous to users’ health, but the data indicate that it should be possible to reduce key toxins to non-detectable levels.
Abstract: Objective: This study examined the constituents of smokeless tobacco products available in the UK and compared them with products available in India, Sweden, and the USA Methods: Seven UK brands of smokeless tobacco, including a tooth cleaning powder, and four international brands of smokeless tobacco were tested for a range of toxins and known carcinogens, such as tobacco specific N-nitrosamines (TSNA), as well as nicotine availability. Results: Ten of the 11 brands tested had detectable levels of tobacco specific nitrosamines, which are proven carcinogens, and levels varied 130-fold. All had detectable levels of benzo(a)pyrene, another proven carcinogen (with around 175-fold variation) and several toxic metals (with nearly 150-fold variation). Nicotine availability varied in the UK products from 0.1 mg/g to 63.2 mg/g. All the tobacco products tested are likely to be hazardous to users' health, but the data indicate that it should be possible to reduce key toxins to non-detectable levels. Conclusions: Smokeless tobacco products should be regulated and standards set for maximum levels of toxins and carcinogens.
TL;DR: Smoking was not found to be significantly associated with cataract formation; however, smokeless tobacco use was more strongly associated withCataract.
Abstract: Aim: To study the influence of tobacco use on cataract formation in a rural South Indian population. Methods: 3924 subjects from the Chennai Glaucoma Study conducted in rural south India underwent a comprehensive eye examination, including Lens Opacities Classification System II grading. Information on tobacco use, type of tobacco (smoking and smokeless), duration and quantity of use was collected. Results: 1705 (male:female (M:F) 1106:599) people used tobacco and were significantly older (mean (standard deviation (SD)) age 55.80 (10.64) years) than non-users (52.23 (10.51); p Conclusion: Tobacco use was significantly associated with cataract. Smoking was not found to be significantly associated with cataract formation; however, smokeless tobacco use was more strongly associated with cataract.
TL;DR: The authors evaluated the effect of a brief tailored smoking control intervention delivered during basic military training on tobacco use in a population of military personnel, suggesting potential for large-scale tobacco control efforts.
Abstract: The authors evaluated the effect of a brief tailored smoking control intervention delivered during basic military training on tobacco use in a population of military personnel (N = 33,215). Participants were randomized to either a tobacco use intervention (smoking cessation, smokeless tobacco use cessation, or prevention depending on tobacco use history) or a health education control condition. Results indicated that smokers who received intervention were 1.16 (95% confidence interval [CI] = 1.04, 1.30) times (7-day point prevalence) and 1.23 (95% CI = 1.07, 1.41) times (continuous abstinence) more likely to be abstinent than controls from smoking cigarettes at the 1-year follow-up (p <.01); the cessation rate difference was 1.60% (31.09% vs. 29.49%) and 1.73% (15.47% vs. 13.74%) for point prevalence and continuous abstinence, respectively. Additionally, smokeless tobacco users were 1.33 (95% CI = 1.08, 1.63) times more likely than controls (p <.01) to be continuously abstinent at follow-up, an overall cessation rate difference of 5.44% (33.72% vs. 28.28%). The smoking prevention program had no impact on smoking initiation. These results suggest potential for large-scale tobacco control efforts.
TL;DR: In the present population sample of adolescents, the use of smokeless tobacco (moist snuff) was not associated with the presence of periodontal disease except for a significantly high prevalence of gingival recessions.
Abstract: Aim: The aim of this study was to evaluate the potential association of the use of smokeless tobacco (moist snuff) on the periodontal conditions of adolescents. Material and methods: A subject sample of one hundred and three 19-year-old male individuals (33 snuff users, 70 controls) living in Goteborg, Sweden, were clinically examined with regard to oral hygiene, gingivitis, probing pocket depth (PPD), clinical attachment loss (CAL) and gingival recession. Bitewing radiographs were obtained for assessments of alveolar bone level. Information about tobacco and oral hygiene habits was obtained by a structured questionnaire. Student 's t-test, Χ 2 -test and logistic regression analysis were used for statistical analysis. Results: The mean plaque and gingivitis scores in snuff-users were 59% (SD 21.0) and 47% (18.6), respectively, and in controls 64% (22.4) and 50% (18.3), respectively. The average PPD and CAL in snuff-users amounted to 2.3 mm (0.3) and 0.2 mm (0.1), respectively, and in controls 2.4 mm (0.3) and 0.1 mm (0.1) (p>0.05), respectively. The mean bone level was 1.3 mm (0.2) in both groups. The prevalence of subjects showing recession was 42% among snuff-users and 17% among controls (p = 0.006). In snuff users, an average of 4% (0.9) of the teeth showed recession, compared with 1% (0.3) in controls (p<0.001). Limiting the analysis to the maxillary anterior tooth region, 33% of the snuff-users and 10% of the controls presented recessions (p = 0.002). The use of snuff entailed an OR - 5.1 to have gingival recessions. Conclusion: In the present population sample of adolescents, the use of smokeless tobacco (moist snuff) was not associated with the presence of periodontal disease except for a significantly high prevalence of gingival recessions.
TL;DR: This Commentary aims to synthesize recent epidemiological data on tobacco and health inequalities for New Zealand and present it in new ways, and describes both existing and potential tobacco control responses for addressing these inequalities.
Abstract: In this Commentary, we aim to synthesize recent epidemiological data on tobacco and health inequalities for New Zealand and present it in new ways. We also aim to describe both existing and potential tobacco control responses for addressing these inequalities. In New Zealand smoking prevalence is higher amongst Māori and Pacific peoples (compared to those of "New Zealand European" ethnicity) and amongst those with low socioeconomic position (SEP). Consequently the smoking-related mortality burden is higher among these populations. Regarding the gap in mortality between low and high socioeconomic groups, 21% and 11% of this gap for men and women was estimated to be due to smoking in 1996–99. Regarding the gap in mortality between Māori and non-Māori/non-Pacific, 5% and 8% of this gap for men and women was estimated to be due to smoking. The estimates from both these studies are probably moderate underestimates due to misclassification bias of smoking status. Despite the modest relative contribution of smoking to these gaps, the absolute number of smoking-attributable deaths is sizable and amenable to policy and health sector responses. There is some evidence, from New Zealand and elsewhere, for interventions that reduce smoking by low-income populations and indigenous peoples. These include tobacco taxation, thematically appropriate mass media campaigns, and appropriate smoking cessation support services. But there are as yet untried interventions with major potential. A key one is for a tighter regulatory framework that could rapidly shift the nicotine market towards pharmaceutical-grade nicotine (or smokeless tobacco products) and away from smoked tobacco.
TL;DR: The findings suggest that the stricter cigarette policies of recent years may not only reduce cigarette use, but also the use of alternative tobacco products.
Abstract: Background: As smoking prevalence declines in the United States, it is important to understand if smokeless tobacco (SLT) use is also changing and if so, among what groups. Methods: We examine the prevalence of SLT use and smoking, 1992–2002, using the Current Population Survey-Tobacco Use Supplements (CPS-TUS), which used US nationally representative samples based on stratified clusters of households. Results: Consistent with declines in smoking, the prevalence of current SLT use declined over the period 1992–2002 for males and females ages 18 and older. The overall separate declines in SLT use and in smoking are mirrored by a decline in concurrent use of SLT and cigarettes. SLT use is becoming more associated with white males, but use is declining faster among the youngest males. Conclusions: The findings indicate that relative reductions in smoking prevalence are exceeded by relative reductions in SLT use, with sizeable reductions in concurrent use. These results suggest that the stricter cigarette policies of recent years may not only reduce cigarette use, but also the use of alternative tobacco products. In light of potential policy implications of SLT use as a potential reduced exposure product (PREP), current survey methods require more careful measurement of SLT use in terms of initiation, duration, quantity, and cessation.
TL;DR: It is concluded that tobacco smoking and high BMI do not entail an increased risk of NHL and HD, and the findings of a relation between the duration of snuff dipping and HD need further investigation.
Abstract: In the search for risk factors involved in the etiology of lymphoproliferative malignancies there is still inconsistent evidence regarding effects of smoking tobacco, and the role of smokeless tobacco is poorly investigated. New evidence indicates that excess body weight increases the risk of NHL and HD. To determine if tobacco use of various forms and high Body Mass Index (BMI) affect the occurrence of these neoplasms, we conducted a prospective cohort study on over 330,000 Swedish construction workers included in the Construction Industry Working Environment and Health program. Information on smoking, snuff dipping, height and weight was gathered by self administered questionnaires together with personal interviews. Cancer incidence was ascertained through the year 2000 by record linkage to the nationwide Swedish Cancer Registry, Migration Registry and Cause of Death Registry. At the end of follow up, 1,309 subjects had been diagnosed with NHL (including chronic lymphocytic leukemia) and 205 with HD respectively. Age adjusted incidence rate ratios were computed using Cox proportional Hazard regression modeling. Smoking cigarette, pipe or cigar was not associated with NHL or HD. There was no evidence indicating a relation between quantity and duration of smoking and NHL or HD risk. No link was found between NHL and usage of smokeless tobacco. Having a BMI of 30 or higher did not convey excess risk of developing NHL or HD compared to normal weight (BMI 18.6-24.9). We conclude that tobacco smoking and high BMI do not entail an increased risk of NHL and HD. Our findings of a relation between the duration of snuff dipping and HD need further investigation.
TL;DR: The introduction of a new LN-SLT product under strict regulations would increase SLT use, but reduce overall smoking prevalence, but uncertainties surround the role of marketing and other tobacco control policies.
TL;DR: The nationwide smoking cessation quitline appears to have had a positive effect on GPs' engagement in smoking cessation, and a paradigm shift regarding awareness of the complexity of smoking cessation support may be ongoing amongst Swedish GPs.
Abstract: This cross-sectional study assessed changes between 1999 and 2003 in attitudes among Swedish general practitioners (GPs) toward smoking cessation activities and also assessed the effect of a nationwide quitline on GPs' smoking cessation activities. A random sample of 621 Swedish GPs answered a questionnaire mailed to their home addresses in spring 2003. When possible, the results of the present study were compared with results from a similar study conducted in 1999. Main outcome measures were GPs' self-reported activities, perceived barriers to engaging in smoking cessation, and referrals to the quitline. Between 1999 and 2003, GPs increased their overall smoking cessation activities and were more aware of the complexity of smoking cessation support. Significantly more GPs experienced smoking cessation support as "too time consuming" and preferred to refer smokers to counselors specializing in smoking cessation. GPs referring patients to the quitline were more likely to be active in other smoking cessation activities. One out of five GPs had advised their patients to use oral smokeless tobacco as a means to stop smoking. A paradigm shift regarding awareness of the complexity of smoking cessation support may be ongoing amongst Swedish GPs. The nationwide smoking cessation quitline appears to have had a positive effect on GPs' engagement in smoking cessation.
Patent•
18 Jan 2006
TL;DR: In this paper, a chewing tobacco substitute made from natural leaves and additives which simulate the taste and consistency of chewing tobacco to which a nicotine compound is added is presented, which allows those addicted to chewing tobacco, to chew and receive nicotine without incurring the other harmful side effects of tobacco.
Abstract: The invention is a chewing tobacco substitute made from natural leaves and additives which simulate the taste and consistency of chewing tobacco to which a nicotine compound is added. The invention allows those addicted to chewing tobacco to chew and receive nicotine without incurring the other harmful side effects of tobacco. In one embodiment of the invention the product is provided with varying levels of nicotine.
TL;DR: A tobacco-related questionnaire with face and content validity was constructed for Urdu, Punjabi, Cantonese and Sylheti speakers, paving the way for practitioners to collect more valid data to underpin services, for sounder research and ultimately better tobacco control.
Abstract: Objective: To develop cross-culturally valid and comparable questionnaires for use in clinical practice, tobacco cessation services and multiethnic surveys on tobacco use. Methods: Key questions in Urdu, Cantonese, Punjabi and Sylheti on tobacco use were compiled from the best existing surveys. Additional items were translated by bilingual coworkers. In one-to-one and group consultations, lay members of the Pakistani, Chinese, Indian Sikh and Bangladeshi communities assessed the appropriateness of questions. Questionnaires were developed and field tested. Cross-cultural comparability was judged in a discussion between the researchers and coworkers, and questionnaires were finalised. Questionnaires in Cantonese (written and verbal forms differ) and Sylheti (no script in contemporary use) were written as spoken to avoid spot translations by interviewers. Results: The Chinese did not use bidis, hookahs or smokeless tobacco, so these topics were excluded for them. It was unacceptable for Punjabi Sikhs to use tobacco. For the Urdu speakers and Sylheti speakers there was no outright taboo, particularly for men, but it was not encouraged. Use of paan was common among women and men. Many changes to existing questions were necessary to enhance cultural and linguistic appropriateness—for example, using less formal language, or rephrasing to clarify meaning. Questions were modified to ensure comparability across languages, including English. Conclusion: Using theoretically recommended approaches, a tobacco-related questionnaire with face and content validity was constructed for Urdu, Punjabi, Cantonese and Sylheti speakers, paving the way for practitioners to collect more valid data to underpin services, for sounder research and ultimately better tobacco control. The methods and lessons are applicable internationally.
Journal Article•
TL;DR: Use of the argument that smoking is not a proven cause of lung cancer declined in frequency during and after the period when tobacco companies began to publicly admit that smoking causes disease.
Abstract: Background: In the late 1990s and the early part of this decade, the major US cigarette manufacturers admitted, to varying degrees, that smoking causes cancer and other diseases. Objective: To examine how tobacco manufacturers have defended themselves against charges that their products caused cancer in plaintiffs in 34 personal injury lawsuits, all but one of which were litigated between the years 1986 and 2003. Methods: Defence opening and closing statements, trial testimony, and depositions for these cases were obtained from the Tobacco Deposition and Trial Testimony Archive (http://tobaccodocuments.org/datta/). All available defence-related transcripts from these cases were reviewed and a content analysis was conducted to identify common themes in the defendants’ arguments. Results: After review of the transcripts, defendants’ arguments were grouped into seven categories: (1) there is no scientific proof that cigarette smoking causes lung cancer; (2) the plaintiff did not have lung cancer as claimed; (3) the plaintiff had a type of lung cancer not associated with cigarette smoking; (4) the plaintiff had cancer that may have been associated with cigarette smoking or smokeless tobacco use, but tobacco products were not to blame in this particular case; (5) the plaintiff had cancer that may have been associated with cigarette smoking, but the defendant’s cigarette brands were not to blame; (6) the defendant’s cigarettes (or smokeless tobacco) may have played a role in the plaintiff’s illness/death, but other risk factors were present that negate or mitigate the defendant’s responsibility; and (7) the defendant’s cigarettes may have been a factor in the plaintiff’s illness/death, but the plaintiff knew of the health risks and exercised free will in choosing to smoke and declining to quit. Use of the argument that smoking is not a proven cause of lung cancer declined in frequency during and after the period when tobacco companies began to publicly admit that smoking causes disease. Corresponding increases occurred over time in the use of other arguments (namely, presence of other risk factors and “free will”). Conclusions: Despite the vast body of literature showing that cigarette smoking causes cancer, and despite tobacco companies’ recent admissions that smoking causes cancer, defendants used numerous arguments in these cases to deny that their products had caused cancer in plaintiffs. The cigarette companies, through their public admissions and courtroom arguments, seem to be saying, “Yes, smoking causes lung cancer, but not in people who sue us”.