Abstract
BackgroundSmokeless tobacco use is becoming an increasingly important public health issue in the US and may influence cigarette smoking behavior. Systematic information on transitions between smokeless tobacco and cigarette use in the US is limited.MethodsWe conducted a systematic review of published literature on transitions between smokeless tobacco and cigarette use in the US. We searched PubMed, Web of Science and EbscoHost databases for all published articles from January 2000 to March 2014 that presented estimates of transitions in US youth and adult study populations over time between at least one of the following tobacco use states: exclusive cigarette smoking, exclusive smokeless tobacco use, dual use of both products, and use of neither product. We excluded non-English language studies, studies published before 2000, clinical trials, controlled cessation programs, and clinical studies or evaluations of smokeless tobacco cessation programs.ResultsThe review identified six studies on US populations published since 2000 with longitudinal data on some or all of the transitions that users can undergo between smokeless tobacco and cigarette use. There was considerable heterogeneity across studies in design and tobacco use definitions. Despite these differences, the existing data indicate that switching behaviors from exclusive smoking to exclusive smokeless tobacco use are limited (adults: 0%-1.4%, adolescents: 0.8%-3.8%) but may be more common from exclusive smokeless tobacco use to exclusive smoking (adults: 0.9%-26.6%, adolescents: 16.6%-25.5%). Among adults, exclusive cigarette smoking was generally stable and consistent (79.7% to 87.6%) over follow-up across studies but less stable in adolescents (46.8%-78.7%). Exclusive smokeless tobacco use was less stable than exclusive cigarette smoking over time (adults: 59.4%-76.6%, adolescents: 26.2%-44.8%).ConclusionThis review provides published estimates of the proportions of adults and adolescents transitioning between tobacco use categories from the most recently available studies on longitudinal transitions between smokeless tobacco and cigarettes in the US. These data can be used to track tobacco use behaviors and evaluate their effect on public health; however, the data for these studies were generally collected more than a decade ago. Additional research including nationally representative longitudinal estimates using consistent definitions and designs, would improve understanding of current tobacco transition behaviors.
Highlights
Smokeless tobacco use is becoming an increasingly important public health issue in the US and may influence cigarette smoking behavior
During review of the abstracts, 23 articles were excluded as non-human studies, 158 articles were excluded for evaluating smokeless tobacco cessation interventions without additional follow-up beyond the originally planned timeframe of the intervention or using smokeless tobacco as a smoking cessation aid, 213 articles were excluded as non-empirical studies such as reviews, reports, or commentaries, 313 articles were excluded for describing studies not conducted in the US, 14 articles were excluded for focusing on e-cigarettes, and 316 articles were excluded because they had no data on the tobacco transition states of interest
Of the 16 articles assessed for full text review, nine articles were from crosssectional studies and only reported prevalence estimates and one article was from a study that did not distinguish between dual use and exclusive use of smokeless tobacco
Summary
Smokeless tobacco use is becoming an increasingly important public health issue in the US and may influence cigarette smoking behavior. Systematic information on transitions between smokeless tobacco and cigarette use in the US is limited. Smokeless tobacco is a commonly used tobacco product in the US. According to the US National Adult Tobacco Survey (NATS), 6.5% of US adult males were current users of chewing tobacco, snuff, or dip and 2.5% were current users of snus in 2009–2010, making smokeless tobacco one of the most commonly used tobacco product among US adults after cigarettes and cigars [1]. The Act stipulates that the FDA should, when making certain regulatory decisions concerning tobacco products, consider the impacts of decisions on the population as a whole, including impacts on the likelihood of initiation of tobacco use among non-users and cessation among users [4]. An understanding of tobacco use behavior, including the extent to which individuals transition between products, provides useful information in this context
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