Showing papers on "Smokeless tobacco published in 2010"

Impact of Smokeless Tobacco Products on Cardiovascular Disease: Implications for Policy, Prevention, and Treatment. A Policy Statement From the American Heart Association

Abstract: Various forms of smokeless tobacco (ST) products (snuff, chewing tobacco) are used by individuals of all ages. Over the past several years, US tobacco companies have expanded marketing and promotion of ST products. A major aim of this statement is to review and summarize the scientific evidence regarding ST product use and the potential cardiovascular risks associated with ST product use that can be used to inform policy related to tobacco control and strategies related to tobacco harm reduction. A specific policy question is whether ST products should be recommended to smokers instead of cigarettes to reduce the morbidity and mortality associated with smoking and/or as an approach to enhance smoking cessation. Although evidence is consistent with the suggestion that the cardiovascular risks are lower with ST products compared with cigarette smoking, ST products are not without harm. As reviewed in this statement, there is evidence that long-term ST product use may be associated with a modest risk of fatal myocardial infarction (MI) and fatal stroke, suggesting that ST product use may complicate or reduce the chance for survival after a MI or stroke. In addition, there is inadequate evidence to support the use of ST products as a smoking cessation strategy. Based on the findings reviewed in this statement, clinicians should continue to discourage use of all tobacco products and emphasize prevention of smoking initiation and smoking cessation as primary goals for tobacco control. In the United States, various forms of ST products (snuff, chewing tobacco) are used by individuals of all ages, including adolescents and young adults.1 Over the past several years, US cigarette companies have been purchasing companies that only previously sold ST products.2 Consequently, there has been a proliferation of ST products such as moist snuff and snus that are sold under cigarette brand …

Smoking, Use of Moist Snuff, and Risk of Chronic Inflammatory Diseases

Abstract: Rationale: Cigarette smoking is emerging as a strong risk factor in the otherwise unknown etiology of chronic inflammatory diseases. Whether the same applies also to smokeless tobacco remains unknown. Nicotine is a powerful modifier of the inflammatory response. By comparing risks associated with tobacco smoking and with smokeless tobacco, the role of nicotine in the development of chronic inflammation may be evaluated.Objectives: To assess and compare the risks of rheumatoid arthritis (RA), ulcerative colitis (UC), Crohn's disease (CD), sarcoidosis, and multiple sclerosis (MS) associated with cigarette smoking and with the use of Swedish moist snuff.Methods: We performed a cohort study of 277,777 males within a cohort of Swedish construction workers who had provided information about tobacco use in 1978–1993. Cross-linkage to the nationwide Swedish Hospital Discharge Register provided information about the occurrence of RA, UC, CD, sarcoidosis, and MS through 2004.Measurements and Main Results: Age-adjus...

Patterns of dual use of cigarettes and smokeless tobacco among US males: findings from national surveys

Abstract: Background In the USA, consumption of moist snuff continues to increase and cigarette manufacturers now control nearly its entire market. Manufacturers have developed new products that represent cigarette brand extension and in test marketing are promoting dual use of cigarettes and snuff. This study examined patterns of concurrent use of smokeless tobacco (ST) and cigarettes among young people and adults in the USA just before cigarette companies9 control of the nation9s ST market. Methods Data were drawn from four US nationally representative surveys. Stratified analyses applied sampling weights and accounted for the complex sample designs. Results Cigarette smoking was substantially more prevalent among young males who used ST than among those who did not. Among adult males, those who smoked daily were less likely than others to have used snuff every day. Men who used moist snuff daily had the lowest prevalence of daily smoking, but the prevalence of daily smoking was relatively high among men who used moist snuff less than daily. Unsuccessful past-year attempts by daily smokers to quit smoking were more prevalent among non-daily snuff users (41.2%) than among those who had never used snuff (29.6%). Conclusions Although dual daily use of ST and cigarettes is relatively uncommon in the USA, concurrent ST use is more common among adolescent and young adult male smokers than among more mature tobacco users. Among adult males, daily smoking predominates and non-daily ST use is very strongly associated with current smoking. Adult male smokers who also use ST daily tend to have relatively high levels of serum cotinine and high prevalence of a major indicator for tobacco dependence.

Tobacco industry consumer research on smokeless tobacco users and product development.

Abstract: Since 2006, RJ Reynolds (RJR) and Philip Morris have both introduced new smokeless “snus” tobacco products. We analyzed previously secret tobacco industry documents describing the history of RJR and Philip Morris's consumer research, smokeless product development, and marketing strategies. We found that RJR had invested in smokeless research, development, and marketing since 1968. RJR first targeted low-income males through sampling and sponsorship at fishing, rodeo, and baseball events, and through advertising portraying the user as “hard working.” In the early 1990s, Philip Morris and RJR hoped to attract more urban, female smokeless users. The current “snus” campaigns appear to appeal to these targeted consumers and smokers in smoke-free environments. These efforts may expand the tobacco market and undermine smoking cessation.

State-specific prevalence of cigarette smoking and smokeless tobacco use among adults - United States, 2009.

Abstract: The health consequences of cigarette smoking and smokeless tobacco use both have been well documented, including increased risk for lung, throat, oral, and other types of cancers. To assess state-specific current cigarette smoking and smokeless tobacco use among adults, CDC analyzed data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results of that analysis, which indicated wide variation in self-reported cigarette smoking prevalence (range: 6.4% [U.S. Virgin Islands (USVI)] to 25.6% [Kentucky and West Virginia]) and smokeless tobacco use (range: 0.8% [USVI] to 9.1% [Wyoming]). For 15 of the states, Puerto Rico, and Guam, smoking prevalence was significantly higher among men than among women. The prevalence of smokeless tobacco use was higher among men than women in all states and territories. Smokeless tobacco use was highest among persons aged 18--24 years and those with a high school education or less. From 0.9% (Puerto Rico) to 13.7% (Wyoming) of current smokers reported also using smokeless tobacco. Clinicians should identify all tobacco use in their patients and advise those who use any tobacco product to quit. The World Health Organization (WHO) recommends implementing this approach in combination with other measures, including raising excise taxes on tobacco and strengthening smoke-free policies to prevent tobacco-related deaths.

Trends in the epidemiology of oral squamous cell carcinoma in Western UP: An institutional study

Abstract: Objective: The purpose of the study was to identify trends in incidence rates of oral squamous cell carcinoma (OSCC) at specific anatomic sites or within specific age or sex groups in the Western Uttar Pradesh population. Materials and Methods: The study covers the period from January 2004 through April 2009. OSCC cases were retrospectively analysed for site, age, gender and habits and the findings were formulated to chart the trends in Western U.P. Results: The study revealed a male to female ratio of 2.2:1 with the largest number of OSCCs developing in the fourth and fifth decades of life. Overall, the most common site was the buccal mucosa (63.75%), followed by retromolar area (15%), floor of the mouth (11.25%), lateral border of the tongue (3.75%), labial mucosa (3.75%), and palate (2.5%). Smokeless tobacco habit was more prevalent than smoking tobacco in both men as well as women. Karl - Pearson's correlation coefficient was calculated to find the degree of association between the two variables i.e. between gender to buccal mucosa and gender to smokeless and smoking tobacco habits, which were found to be positively correlated with respect to the age. Conclusion: Oral cancer is an important cause of morbidity and mortality worldwide with an incidence rate that varies widely by geographic location. Even within one geographic location, the incidence varies among groups categorized by age, sex, site or habit.

Quantifying the effects of promoting smokeless tobacco as a harm reduction strategy in the USA

Abstract: Background Snus (a form of smokeless tobacco) is less dangerous than cigarettes. Some health professionals argue that snus should be promoted as a component of a harm reduction strategy, while others oppose this approach. Major US tobacco companies (RJ Reynolds and Philip Morris) are marketing snus products as cigarette brand line extensions. The population effects of smokeless tobacco promotion will depend on the combined effects of changes in individual risk with population changes in tobacco use patterns. Objective To quantitatively evaluate the health impact of smokeless tobacco promotion as part of a harm reduction strategy in the US. Methods A Monte Carlo simulation of a decision tree model of tobacco initiation and use was used to estimate the health effects associated with five different patterns of increased smokeless tobacco use. Results With cigarette smoking having a health effect of 100, the base case scenario (based on current US prevalence rates) yields a total health effect of 24.2 (5% to 95% interval 21.7 to 26.5) and the aggressive smokeless promotion (less cigarette use and increased smokeless, health-concerned smokers switching to snus, smokers in smokefree environments switching to snus) was associated with a health effect of 30.4 (5% to 95% interval 25.9 to 35.2). The anticipated health effects for additional scenarios with lower rates of smokeless uptake also overlapped with the base case. Conclusions Promoting smokeless tobacco as a safer alternative to cigarettes is unlikely to result in substantial health benefits at a population level.

Method and device for flavoring smokeless tobacco

Abstract: An encapsulated flavorant or artificial sweetener for use with smokeless tobacco and related products The encapsulated flavorant or artificial sweetener comprises a core encapsulated with a lipid-based coating that provides stability when in contact with tobacco, yet releases flavor over time when the product is used The core comprises a carrier, such as silica, tobacco, beet fiber, citrus fiber, artificial sweetener, or the like, coated or loaded with a flavorant Flavor loading may be in the range of approximately 10% to 60%, by weight Flavorants include, but are not limited to, methyl salicylate (oil of wintergreen), cinnamon (eg, cinnamon oil), peppermint (eg, peppermint oil), and spearmint (oil of spearmint)

Adult tobacco survey - 19 States, 2003-2007.

Abstract: Problem/condition Tobacco use is the leading cause of preventable death in the United States. Reporting period This report includes data collected during February 2003-November 2007. Description of the system The Adult Tobacco Survey (ATS) is a state-administered, random-digit--dialed telephone survey of the noninstitutionalized U.S. population aged >or=18 years. ATS collects data on tobacco use, smoking cessation, secondhand smoke exposure, risk perception and social influences, health influences, and tobacco-related policy issues in the United States. ATS was developed primarily for evaluation of state tobacco control programs rather than for surveillance and offers states a great deal of flexibility in terms of when and how often the surveys can be conducted. During 2003-2007, a total of 33 state ATSs were conducted by 19 states, with sample sizes ranging from 1,301 to 12,734 completed and partially completed interviews. Results ATS data indicate that during 2003-2007, 13.3%-25.4% of adults smoked cigarettes (median: 19.2%); fewer adults smoked cigars (median: 6.4%) or used smokeless tobacco (median: 3.5%). The majority of tobacco users used one tobacco product (median: 82.5%). In most states, approximately half of cigarette smokers reported that they would try to quit in the next 6 months (median: 58.4%), and approximately half made an attempt to quit in the preceding year (median: 46.8%). The majority of adults (i.e., smokers and nonsmokers combined) reported that smoking should not be allowed at all in workplaces (median: 77.6%), restaurants (median: 65.5%), public buildings (median: 72.5%), or indoor sporting events/concerts (median: 72.1%). One third of adults reported smoking should not be allowed at all in cocktail lounges or bars (median: 33.1%). The percentage of adults who reported having smoke-free policies at work or home ranged from 51.2% to 75.2% (median: 61.7%). Interpretation These data indicate that respondents support certain state tobacco control measures; for example, the majority of adults in participating states were supportive of smoke-free policies as well as of an increase in tobacco excise tax. However, one of every five tobacco users in the participating states used multiple tobacco products, a behavior that was more common among young adults. Therefore, these data also underscore a continued need for monitoring and evaluating evidence-based, comprehensive U.S. tobacco control programs and policies. Public health actions State ATSs can be used by states to monitor and evaluate comprehensive statewide tobacco control programs. Continued surveillance of tobacco use and tobacco control outcome indicators are needed to monitor, evaluate, and improve state programs that address tobacco use, cessation, and secondhand smoke exposure.

Analysis of 23 Polycyclic Aromatic Hydrocarbons in Smokeless Tobacco by Gas Chromatography−Mass Spectrometry

Abstract: Smokeless tobacco contains 28 known carcinogens and causes precancerous oral lesions and oral and pancreatic cancer. A recent study conducted by our research team identified eight different polycyclic aromatic hydrocarbons (PAHs) in U.S. moist snuff, encouraging further investigations of this group of toxicants and carcinogens in smokeless tobacco products. In this study, we developed a gas chromatography−mass spectrometry method that allows simultaneous analysis of 23 various PAHs in smokeless tobacco after a simple two-step extraction and purification procedure. The method produced coefficients of variation under 10% for most PAHs. The limits of quantitation for different PAHs varied between 0.3 and 11 ng/g tobacco, starting with a 300 mg sample. The recovery of the stable isotope-labeled internal standards averaged 87%. The method was applied to analysis of 23 moist snuff samples that included various flavors of the most popular U.S. moist snuff brands, as well as 17 samples representing the currently ...

Smokeless tobacco products

Abstract: A smokeless tobacco product is provided. A tobacco product configured for insertion into the mouth of a user of that product comprises a water-permeable pouch containing a tobacco formulation that includes a granular tobacco composition, wherein the pouch comprises a fleece material configured to provide enhanced flavor.

How Does Smoking Reduce the Risk of Preeclampsia

Abstract: Although smoking during pregnancy may lead to many adverse effects, such as fetal growth restriction, placental abruption, stillbirth, and preterm labor, smoking is the only environmental exposure known to consistently reduce the risk of preeclampsia and gestational hypertension.1 The article by Wikstrom et al2 is a major step forward in understanding this protective effect. Using data from the Swedish Medical Birth Register in a large epidemiological study of >600 000 Nordic women, the authors conclude that use of Swedish snuff, a smokeless tobacco, did not reduce the risk of preeclampsia and gestational hypertension but that tobacco, when smoked, did. They infer that combustion products of tobacco, such as carbon monoxide (CO), protect against preeclampsia but that constituents of tobacco, such as nicotine, do not. The data strengthen and extend results of a previous smaller study using the Swedish Medical Birth Register, which had reported a similar association.3 Although snuff use did not reduce the risk of mild or severe preeclampsia, preeclampsia that began before or after 37 weeks of gestation, or preeclampsia with or without delivery of a small for gestational age (SGA) infant or stillbirth, smoking reduced the risk of all categories of preeclampsia except for preeclampsia with an SGA infant or stillbirth. Of considerable interest, using data from women who changed their tobacco habits at gestational weeks 30 to 32 from those reported at the first antenatal visit (usually before 15 weeks of gestation), Wikstrom et al2 found that women who had reported smoking at the first antenatal visit but no use of tobacco at 30 to …

Symptoms of nicotine dependence in a cohort of Swedish youths: a comparison between smokers, smokeless tobacco users and dual tobacco users.

Abstract: Aims To determine whether symptoms of nicotine dependence, addiction and withdrawal symptoms differ between exclusive smokers, exclusive snus (moist snuff) users and dual users. Design A cross-sectional survey of a cohort subsample. Setting County of Stockholm, Sweden. Participants Current exclusive smokers (n = 466), exclusive snus users (n = 209) and dual users (n = 144), mean age 17.6 years. Measurements Self-reported life-time experienceof nicotinedependenceandwithdrawalsymptomsinperiodsof discontinuedtobaccouse.Selecteditemsfromthe modified FagerstomTolerance Questionnaire (mFTQ), the Hooked on Nicotine Checklist (HONC) and theDiagnostic and StatisticalManualof MentalDisorders(DSM-IV).Findings Theoddsratioof endorsingeachof fourmFTQitemsaswell astheHONCiteminvestigatingtheriskof feelingaddictedtotobaccowastwotofive-foldhigherforexclusivesnususers and for dual users compared to exclusive smokers. One DSM-IV item (difficult to refrain from use) was elevated among dual users compared to smokers. Dual users reported the highest prevalence of any withdrawal symptom in contrast to exclusive snus users, who reported a lower risk of withdrawal symptoms compared to exclusive smokers. Conclusions Smokeless tobacco users show symptoms of nicotine dependence at least as frequently as cigarette smokers. Symptoms of nicotine dependence and of withdrawal during quit attempts are particularly frequent in the subgroup of users who combine smokeless tobacco with smoking.

Risk of Incident Cardiovascular Disease Among Users of Smokeless Tobacco in the Atherosclerosis Risk in Communities (ARIC) Study

Abstract: Use of smokeless tobacco in the United States has been relatively constant in recent years, as tobacco companies continue aggressive marketing campaigns. The health effects of smokeless tobacco use need further documentation. Thus, the authors examined whether current use of smokeless tobacco was associated with increased incidence of cardiovascular disease (CVD) in 14,498 men and women aged 45–64 years at baseline (1987–1989) in the Atherosclerosis Risk in Communities (ARIC) Study. There were 2,572 incident CVD events (myocardial infarction, coronary revascularization, coronary death, or stroke) during a median of 16.7 years of follow-up (maximum = 19.1 years). Current use of smokeless tobacco at baseline was associated with 1.27-fold greater CVD incidence (95% confidence interval: 1.06, 1.52) than was nonuse, independently of demographic, socioeconomic, and lifestyle and other tobacco-related variables. Past use of smokeless tobacco was not associated with CVD incidence. In conclusion, current use of smokeless tobacco was associated with increased risk of CVD incidence in ARIC cigarette nonsmokers. Current users of smokeless tobacco should be informed of its harm and advised to quit the practice. Current cigarette smokers should also be given sufficient information on safe, therapeutic methods of quitting which do not include switching to smokeless tobacco.

Stopping smokeless tobacco with varenicline: randomised double blind placebo controlled trial

Abstract: Objective To assess the efficacy and safety of varenicline (a licensed cigarette smoking cessation aid) in helping users of smokeless tobacco to quit. Design Double blind, placebo controlled, parallel group, multicentre, randomised controlled trial. Setting Medical clinics (mostly primary care) in Norway and Sweden. Participants Men and women aged ≥18 who used smokeless tobacco at least eight times a day, with no abstinence period over three months within one year before screening, who wanted to quit all tobacco use. Participants were excluded if they used any other form of tobacco (except smokeless tobacco) or medication to stop smoking within three months of screening or had any pre-existing medical or psychiatric condition. Interventions Varenicline 1 mg twice daily (titrated during the first week) or placebo for 12 weeks, with 14 weeks’ follow-up after treatment. Main outcome measures The primary end point was the four week continuous abstinence rate at the end of treatment (weeks 9-12) confirmed with cotinine concentration. A secondary end point was continuous abstinence rate for weeks 9-26. Safety and tolerability were also evaluated. Results 431 participants (213 varenicline; 218 placebo) were randomised and received at least one dose of study drug. Participants’ demographics and baseline use of smokeless tobacco were similar (89% (189) and 90% (196), respectively, were men; mean age in both groups was 43.9; participants used smokeless tobacco products about 15 times a day, and about 80% first used smokeless tobacco within 30 minutes after awakening). Continuous abstinence rate at week 9-12 was higher in the varenicline group than the placebo group (59% (125) v 39% (85); relative risk 1.60, 95% confidence interval 1.32 to 1.87, P Conclusion Varenicline can help people to give up smokeless tobacco and has an acceptable safety profile. The response rate in the placebo group in this study was high, suggesting a population less resistant to treatment than smokers. Trial RegistrationNCT00717093.

Areca nut dependence among chewers in a South Indian community who do not also use tobacco

Abstract: Aims Previously reported research suggests a dependence syndrome for areca nut use, though well-designed studies are virtually non-existent. The goal of this study was to examine evidence of areca dependence in a sample of areca-only (i.e. no tobacco) chewers using modified measurement scales. Design A purposive sample of chewers, identified via local informants and advertisements, was surveyed from January to March of 2005. Setting Six villages in Dakshina Kannada District, Karnataka State, India. Participants Fifty-nine daily areca chewers who do not also currently use any form of tobacco. Measurements Questionnaires included modified versions of the Fagerstrom Tolerance Questionnaire, Cigarette Dependence Scale (CDS-5) and the Smokeless Tobacco Dependence Scale (STDS). Additional questions assessed demographic characteristics and patterns of use. Findings Approximately half of respondents reported 1–3 chews/day (mean = 1.9; SD = 0.98). The average number of chewing episodes/day was 4.4 (SD = 3.4) and the average number of nuts/day was 1.2 (SD = 1.1). Users’ typical chew lasts up to 20 minutes and includes spitting out the juices and rinsing the mouth with water. Overall, the levels of reported dependence symptoms were quite low, but approximately 44% of chewers endorsed at least one of the following items: continued use despite illness or mouth wounds, difficulty refraining from chewing in forbidden places, or craving during periods of abstinence. Approximately 15.4% of chewers reported at least one intentional quit attempt and a subset had summary scores indicative of dependence (13.6% had scores >16 on the CDS-5 and 5.3% had scores >11 on the STDS). Dependence scores were positively correlated with frequency of chews/day. Conclusions The symptoms of dependence observed in a subset of areca-only chewers warrant further investigation. Next steps should include well-controlled laboratory evaluation of dependence features.

Feasibility of a tobacco cessation intervention for pregnant Alaska Native women.

Abstract: Background Among Alaska Native women residing in the Yukon-Kuskokwim (Y-K) Delta region of Western Alaska, about 79% smoke cigarettes or use smokeless tobacco during pregnancy. Treatment methods developed and evaluated among Alaska Native pregnant tobacco users do not exist. This pilot study used a randomized two-group design to assess the feasibility and acceptability of a targeted cessation intervention for Alaska Native pregnant women. Methods Recruitment occurred over an 8-month period. Enrolled participants were randomly assigned to the control group (n = 18; brief face-to-face counseling at the first visit and written materials) or to the intervention group (n = 17) consisting of face-to-face counseling at the first visit, four telephone calls, a video highlighting personal stories, and a cessation guide. Interview-based assessments were conducted at baseline and follow-up during pregnancy (>or=60 days postrandomization). Feasibility was determined by the recruitment and retention rates. Results The participation rate was very low with only 12% of eligible women (35/293) enrolled. Among enrolled participants, the study retention rates were high in both the intervention (71%) and control (94%) groups. The biochemically confirmed abstinence rates at follow-up were 0% and 6% for the intervention and control groups, respectively. Discussion The low enrollment rate suggests that the program was not feasible or acceptable. Alternative approaches are needed to improve the reach and efficacy of cessation interventions for Alaska Native women.

Tobacco use and secondhand smoke exposure during pregnancy in low- and middle-income countries: the need for social and cultural research

Abstract: Tobacco use is a leading cause of death and of poor pregnancy outcome in many countries. While tobacco use is decreasing in many high-income countries, it is increasing in many low- and middle-income countries (LMICs), where by the year 2030, 80% of deaths caused by tobacco use are expected to occur. In many LMICs, few women smoke tobacco, but strong evidence indicates this is changing; increased tobacco smoking by pregnant women will worsen pregnancy outcomes, especially in resource-poor settings, and threatens to undermine or reverse hard-won gains in maternal and child health. To date, little research has focused on preventing pregnant women's tobacco use and secondhand smoke (SHS) exposure in LMICs. Research on social and cultural influences on pregnant women's tobacco use will greatly facilitate the design and implementation of effective prevention programs and policies, including the adaptation of successful strategies used in high-income countries. This paper describes pregnant women's tobacco use and SHS exposure and the social and cultural influences on pregnant women's tobacco exposure; it also presents a research agenda put forward by an international workgroup convened to make recommendations in this area.

Unintentional Child Poisonings Through Ingestion of Conventional and Novel Tobacco Products

Abstract: This study examines child poisonings resulting from in- gestion of tobacco products throughout the nation and assesses the potential toxicity of novel smokeless tobacco products, which are of concern with their discreet form, candy-like appearance, and added flavorings that may be attractive to young children. METHODS: Data representing all single-substance, accidental poison- ings resulting from ingestion of tobacco products by children6 years of age, reported to poison control centers, were examined. Age asso- ciation with ingestion of smokeless tobacco versus other tobacco products was tested through logistic regression. Total nicotine con- tent, pH, and un-ionized nicotine level were determined, and the latter was compared with values for moist snuff and cigarettes. RESULTS: A total of 13 705 tobacco product ingestion cases were re- ported, 70% of which involved infants 1 year of age. Smokeless tobacco products were the second most common tobacco products ingested by children, after cigarettes, and represented an increasing proportion of tobacco ingestions with each year of age from 0 to 5 years (odds ratio: 1.94 (95% confidence interval: 1.86 -2.03)). A novel, dissolvable, smokeless tobacco product with discreet form, candy-like appearance, and added flavorings was found to contain an average of 0.83 mg of nicotine per pellet, with an average pH of 7.9, which resulted in an average of 42% of the nicotine in the un-ionized form. CONCLUSION: In light of the novelty and potential harm of dissolvable nicotine products, public health authorities are advised to study these products to determine the appropriate regulatory approach. Pediatrics 2010;125:896-899

The pituri story: a review of the historical literature surrounding traditional Australian Aboriginal use of nicotine in Central Australia.

Abstract: The harmful outcomes of nicotine self administration have been the focus of sustained global health education campaigns that have targeted tobacco smoking and to a lesser extent, smokeless tobacco use. 'Smokeless tobacco' infers that the nicotine is not burnt, and administration can be through a range of methods including chewing. The chewing of wild tobacco plants (Nicotiana spp.) is practiced across a broad inland area of Central Australia by traditional Aboriginal groups. Collectively these plants are known by a variety of names - one common name being 'pituri'. This is the first paper to examine the historical literature and consider the linkage between pituri use and health outcomes. Using a narrative approach, this paper reviews the literature generated since 1770 surrounding the term pituri and the behaviours associated with its use. The review examines the scientific literature, as well as the diaries and journals of nineteenth century explorers, expedition notes, and early Australian novels to expound the scientific evidence and broaden the sense of understanding related to pituri, particularly the behavioural elements. The evaluation considers the complexities of ethnobotany pertaining to language and distance and the ethnopharmacology of indigenous plant usage. The review compares the use of burnt and smokeless tobacco to pituri and establishes the foundation for research into the clinical significance and health outcomes of pituri use. Additionally, this review provides contemporary information for clinicians providing care for patients who chew pituri.

Evaluating the Acute Effects of Oral, Non-combustible Potential Reduced Exposure Products Marketed to Smokers

Abstract: Background: Non-combustible potential reduced exposure products (PREPs; e.g., Star Scientific’s Ariva; a variety of other smokeless tobacco products) are marketed to reduce the harm associated with smoking. This marketing occurs despite an absence of objective data concerning the toxicant exposure and effects of these PREPs. This study adapted methods used to examine combustible PREPs to assess the acute effects of non-combustible PREPs for smokers. Methods: Twenty-eight overnight abstinent cigarette smokers (17 men; 14 non-white) each completed seven, Latin-squared ordered, approximately 2.5-hour laboratory sessions that differed by product administered: Ariva, Marlboro snus (Philip Morris USA), Camel snus (RJ Reynolds), Commit nicotine lozenge (GlaxoSmithKline; 2 mg), own brand cigarettes, Quest cigarettes (Vector Tobacco; delivers very low levels of nicotine), and sham smoking (i.e., puffing on an unlit cigarette). In each session the product was administered twice (separated by 60 minutes), and plasma nicotine levels, expired air CO, and subjective effects were assessed regularly. Results: Results indicated that the non-combustible products delivered less nicotine than own brand cigarettes, did not expose smokers to CO, and failed to suppress tobacco abstinence symptoms as effectively as combustible products. Conclusions: While decreased toxicant exposure is a potential indicator of harm reduction potential, a failure to suppress abstinence symptoms suggests that currently marketed non-combustible PREPs may not be a viable harm reduction strategy for U.S. smokers. This study demonstrates how clinical laboratory methods can be used to evaluate the short-term effects of non-combustible PREPs for smokers.

Effect of menthol on the penetration of tobacco carcinogens and nicotine across porcine oral mucosa ex vivo.

Abstract: Introduction: Menthol is a flavored tobacco additive claimed to mask the bitter taste and reduce the harshness of cigarette smoke. (Azzi, C., Zhang, J., Purdon, C. H., Chapman, J. M., Nitcheva, D., Hebert, J. R., et al., 2006, Permeation and reservoir function of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) and benzo(a)pyrene (B(a)P) across porcine esophageal tissue in the presence of ethanol and menthol. Carcinogenesis, 27, 137-145). have shown that menthol increased the flux of tobacco carcinogens (TC) across porcine esophagus. As oral mucosa is exposed to both smoke and smokeless tobacco in tobacco users, the objective of this study was to determine whether menthol influenced the penetration of the TC nitroso - nornicotine (NNN) across porcine buccal (BM) and floor of mouth (FM) mucosa. Methods: Porcine BM and FM were collected at slaughter, mounted in perfusion chambers (n = 7/group), and exposed to tritiated NNN ( 3

Evaluation Of Micronuclei Using Papanicolaou And May Grunwald Giemsa Stain In Individuals With Different Tobacco Habits - A Comparative Study

Abstract: Aims: To compare the Papanicolaou's (Pap) and May Grunwald's Giemsa (MGG) staining techniques which are done to detect micronuclei (MN) in exfoliated buccal mucosal cells in individuals with different tobacco habits. To determine the severity of human buccal cell changes which are associated with smoking and smokeless (''chewing'') tobacco (SLT). Methods and Material: A total of 45 male subjects (15 smokers, 15 smokeless tobacco users and 15 non users/ non smokers) were examined. Two cytological smears were taken from the apparently normal buccal mucosa from each individual. 45 smears (1 per individual) were wet fixed and stained with Pap and the remaining 45 smears were air dried and stained with the MGG stain. All the smears were assessed for cellularity and were scored for MN. Statistical analysis used: The ANOVA (one way analysis of variance) was used to analyse the frequency of cells with micronuclei. Bonferroni multiple comparisons were done to determine the significance (p<0.05) of the mean difference. Results: MNs were easily seen in the clear cytoplasm in the Pap smears. Regarding the MGG smears, bacteria and cell debris masked the effect of the MNs as compared to the Pap smears, where the fixative destroyed the bacteria and clearly demarcated the cell boundaries. The score of the MN frequency decreased as we moved from the smokeless tobacco chewers to the smokers and then to the non users and the non smokers. Conclusions: Pap is a better stain as compared to MGG for counting micronuclei. Smokeless tobacco chewers showed an increased number of MNs as compared to the smokers, thus laying emphasis on the greater carcinogenic potential of tobacco which was used in the chewable form.

Does Dual Use Jeopardize the Potential Role of Smokeless Tobacco in Harm Reduction

Abstract: Introduction The use of smokeless tobacco as part of a strategy to reduce the harm from cigarette smoking is a topic of debate within the tobacco control and public health communities. One concern voiced regarding endorsement of such a tactic is the possibility of actually increasing harm should current smokers adopt dual cigarette/smokeless tobacco use (dual use), which could lead to unintended consequences by perpetuating cigarette smoking, diminishing tobacco cessation, or increasing tobacco-related harm. Methods Here, we review the available literature on health effects and trajectories of use among dual users from a variety of U.S. and European epidemiological studies. Results These data suggest that there are not any unique health risks associated with dual use of smokeless tobacco products and cigarettes, which are not anticipated or observed from cigarette smoking alone. Furthermore, studies show that dual users smoke fewer cigarettes than exclusive smokers, and studies of tobacco use patterns over time (tobacco use trajectory data) indicate that dual users are more likely than exclusive cigarette smokers to cease smoking. Conclusions Overall, the concern about dual use appears to be contradicted by the evidence in the literature that dual use of smokeless tobacco and cigarettes may result in reduction in smoking-related harm as smoking intensity is decreased and smoking cessation increases.

Smokeless tobacco product

Abstract: A nonaqueous, extrudable composition includes at least one thermoplastic polymer in an amount of more than 20 wt% of the whole composition and tobacco A smokeless tobacco product in the form of a sheet can be made by extruding or hot melt shaping a nonaqueous composition comprising at least one thermoplastic polymer and tobacco, the sheet being soluble in a user's mouth and resulting in sustained release of nicotine to the user The sheet can be in a form that may be placed in the buccal cavity of, on the palate of or sublingually in the user, and have an average dissolution time of 5 to 50 minutes for delivering super bioavailable nicotine to the user

A Survey of 24,000 Students Aged 13–15 Years in India: Global Youth Tobacco Survey 2006 and 2009

Abstract: Background: Students aged 13–15 years in Grades 8–10 have been surveyed in the year 2006 and in 2009 to monitor the prevalences of smoking and smokeless tobacco use and to assess their attitudes, knowledge and behaviors towards tobacco use and its health impact. Methods: The Global Youth Tobacco Survey is a cross sectional survey that uses a two-stage cluster sample design to get a representative sample of schools and students for the study. In India, a total of 12 086 students in the year 2006 and 11 768 in 2009 were surveyed. Results: About 14% (13.7% in 2006 and 14.6% in 2009) of students use tobacco (smoking/smokeless tobacco). The prevalence of smoking among boys is about three times that of girls in both the surveys. The prevalence of smokeless tobacco among girls is twice that of smoking tobacco in both the surveys. In the 2009 survey comparing with the 2006, the percentage of students who initiated bidi smoking before 10 years of age is significantly higher in boys (2006: 26.0% and 2009:45.4%); the percentage of never smokers likely to initiate smoking in the following year is significantly lower in girls (2006: 16.0% and 2009: 10.8%); the percentage of students exposed to smoke from parents is significantly lower (2006: Boys-38.3%, Girls-30.7% and 2009: Boys-29.3%, Girls-22.4%); the percentage of students who reported that they were taught about the dangers of smoking during the school year is higher; and, ever smokers received help or advice to help stop smoking is significantly higher (2009: 19.5% and 2006: 4.4%). The percentage of students who saw any advertisements for tobacco, the percentage of students offered free cigarettes by a cigarette company representative or their access/availability to smoking tobacco and the changes observed in the prevalences of tobacco use among students in 2009 is not significantly different from 2006. Conclusions: No significant difference is seen in the prevalence of tobacco use among students between the 2006 and 2009 surveys. The percentage of boys who initiated bidi smoking before age 10 is statistically higher in 2009 compared to 2006. There is a need to strengthen enforcement of policies already in place as well as focus on expansion into additional program efforts.