Trends in patient tobacco use behaviors as reported by tobacco treatment providers: Findings from a repeated crosssectional survey

Position Statement on Tobacco Exposures in Children and Families

Rise in oral cancer risk factors associated with the COVID-19 pandemic mandates a more diligent approach to oral cancer screening and treatment

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.

To determine risk for oral cancer in Puerto Rico associated with use of alcohol and tobacco. In Puerto Rico, alcohol and tobacco use were compared among nonsalivary gland cancers of the mouth and pharynx (n = 342), cancers of major and minor salivary glands (n = 25) and 521 population-based controls. Alcohol (usual use, Ptrend < 0.0001 for men and Ptrend = 0.02 for women) and tobacco (usual use, Ptrend < 0.0001, for both men and women) were strong independent risk factors for oral cancer in Puerto Rico, with a multiplicative effect from combined exposures. Risks did not vary systematically by use of filter vs. nonfilter cigarettes. Risks with use of other forms of smoked tobacco were about sevenfold among both men and women. Risks decreased only gradually after cessation of tobacco and alcohol use. Tobacco use, but not alcohol, was linked to cancers of the salivary glands. The burden of oral cancer due to alcohol and tobacco use in Puerto Rico (76% for men, 52% for women) agreed closely with earlier estimates for the mainland US population, while about 72% of salivary gland cancer (men and women, combined) was due to tobacco use. Excess risks for oral cancer in Puerto Rico are largely explained by patterns of alcohol and tobacco use. Smoking filter vs. nonfilter cigarettes does not alter risk, while cessation of alcohol and tobacco use appears to reduce risk only gradually.

A scientometric study of tobacco and alcohol use as risk factors for oral cavity health

Fourteen percent of US adults use tobacco products. Because many of those who use tobacco are parents and/or caregivers, children are disproportionately exposed to tobacco smoke. People who use tobacco products often become addicted to nicotine, resulting in tobacco dependence, a chronic, relapsing disease. Tobacco use and exposure are more likely to occur in vulnerable and marginalized groups, including those living in poverty. Although some view tobacco use as a personal choice, evidence suggests that structural forces play an important role in tobacco uptake, subsequent nicotine addiction, and perpetuation of use. Viewing tobacco use and tobacco dependence through a structural competency lens promotes recognition of the larger systemic forces perpetuating tobacco use, including deliberate targeting of groups by the tobacco industry, lack of enforcement of age-for-sale laws, inferior access to health insurance and health care, poor access to cessation resources, and economic stress. Each of these forces perpetuates tobacco initiation and use; in turn, tobacco use perpetuates the user's adverse health and economic conditions. Pediatricians are urged to view family tobacco use as a social determinant of health. In addition to screening adolescents for tobacco use and providing resources and treatment of tobacco dependence, pediatricians are encouraged to systematically screen children for secondhand smoke exposure and support family members who smoke with tobacco cessation. Additionally, pediatricians can address the structural issues perpetuating tobacco use by becoming involved in policy and advocacy initiatives.

Tobacco smoking is associated with adverse health outcomes for both pregnant women and their offspring. Smoking cessation counseling is an effective method to help women quit smoking. Developing a targeted smoking cessation intervention could benefit those who struggle to quit tobacco and potentially reduce the harm due to any co-occurring tobacco use. Assessing the prevalence of tobacco, electronic nicotine delivery systems (ENDS), nicotine replacement therapy (NRT), and cannabinoid use in pregnancy is key to developing such interventions. Thus, we aimed to assess the prevalence and patterns of tobacco, ENDS, NRT, and cannabinoid use in pregnancy. We further aimed to assess the prevalence of smoking cessation counseling intervention. We conducted a cross-sectional survey among pregnant women attending regular clinical visits at Spitalzentrum Biel between February and May 2023 (n = 262). Frequency and proportion along with 95% confidence intervals (CI) were reported for tobacco, ENDS, NRT, and cannabinoid use in pregnancy. Tobacco use was reported among 7.6% (20/262, 95% CI: 4.2%-11.1%) of the included pregnant women. Tobacco cigarettes (conventional or roll-on) were used by 7.3% (19/262, 95% CI: 3.8%-10.7%) of the surveyed pregnant women, with 0.8% (2/262, 95% CI: 0.0%-3.4%) of them reporting use of cigarettes along with ENDS and 0.4% (1/262, 95% CI: 0.0%-3.8%) reporting use of the cigarettes with NRT. Cannabinoid use was reported by 3.8% (10/262, 95% CI: 1.1%-7.0%) of pregnant womenand all of them used products with Cannabidiol (CBD) only. Additionally, only 25% (5/20, 95% CI: 10.0%-48.3%) of tobacco users had received smoking cessation counseling intervention. The estimated prevalence of tobacco, ENDS, NRT, and cannabinoid use among the pregnant women in this survey was 7.6%, 0.8%, 0.4%, and 3.8% respectively. However, among tobacco users, only one-fourth received smoking cessation counseling intervention.

Tobacco and cannabis use among pregnant women with prenatal opioid use.

Researchers have found that concurrent use of tobacco and cannabis was associated with higher levels of externalizing problems compared to use of only one of the substances for youths aged 14 to 17 years, but that there was no association with higher levels of internalizing problems. Externalizing problems include hyperactivity, impulsivity, aggression, and conduct disorders, while internalizing problems are characterized by anxiety abnd depression, and social withdrawal. The study results suggested that there should be integrated treatment for mental health, tobacco, and cannabis use for youth. For the study, the researchers analyzed wave 6 data within the Population Assessment of Tobacco and Health (PATH) Study, with data collected from March to November, 2021. The cohort is US youths aged 14–17 years. The researchers divided past 30 day use of any tobacco and cannabis products into four categories: concurrent, tobacco only, cannabis only, and non‐use. Mental health problems (internalizing and externalizing) were measured by self‐report using the Global Appraisal of Individual Needs–Short Screener and separately categorized into 3 levels: low (0–1 symptoms), moderate (2–3 symptoms), and high (4 or more symptoms). A total of 5,585 youths were included, half male and half female. The prevalence of concurrent use was 3.4%, and comparable to tobacco‐only use (3.9%) but greater than cannabis‐only use (2.9%). There were high levels of internalizing and externalizing problems for the concurrent use group (47.4% internalizing, 61.6% externalizing), followed by the cannabis‐only group (44.8% internalizing, 48.5% externalizing), the tobacco‐only group (41.4% internalizing, 46.3% externalizing), and the non‐use group (22.4% internalizing, 30.4% externalizing). After controlling for covariates, only concurrent tobacco and cannabis use was associated with higher levels of externalizing problems than cannabis‐only or tobacco‐only use. There were no associations of internalizing problems with concurrent use compared to use of cannabis or tobacco alone. The study, Concurrent Use of Tobacco and Cannabis and Internalizing and Externalizing Problems in US Youths, is published in the July 1 issue of JAMA Network Open.

Trends in cigarette, cigar, and smokeless tobacco use among New York City public high school youth smokers, 2001–2013

BackgroundPsychosocial challenges among human immunodeficiency virus (HIV)-positive patients may promote substance use disorders. This study explored the relationship between conjoint tobacco and alcohol use and depression symptoms among HIV positive patients in Sedibeng District, South Africa.MethodsIn a cross-sectional study of 404 participants, a questionnaire collected information on sociodemography, tobacco and alcohol use and depression symptoms. Outcome measures included the prevalence of conjoint tobacco and alcohol use and its association with positive screen for depression.ResultsThe mean participant age was 43.2 years. Most completed secondary school (62.9%), were black (99.0%), female (65.8%), unemployed (53.6%) and on antiretroviral therapy (ART) for > 1 year (97.8%). Current tobacco use was reported by 23.3% (n = 94) participants with most smoking cigarette (73.7%) and having low nicotine dependence (75.5%). Current alcohol use was reported by 43.6% (n = 176) participants, and 36.9% were categorised as harmful users. Only 7.7% (n = 31) participants screened positive for depression; the prevalence of conjoint tobacco and alcohol use was 19.6% (n = 79) and this was not associated with depression (p = 0.438). Harmful alcohol users were more than five times likely to report conjoint tobacco and alcohol use (p = 0.000), but women were less likely to report it (p = 0.000).ConclusionConjoint tobacco and alcohol use is common among patients with HIV infection. Although not associated with positive screen for depression, its relationship with harmful alcohol use reiterates the need for an integrated tobacco and alcohol use screening and treatment strategy in the HIV treatment programme in primary care.ContributionTo the authors best knowledge, this study is the first published study that explored the relationship between conjoint tobacco and alcohol use, and depression among HIV-positive patients in the South African primary care settings.

The articles in this special issue were inspired by the Second East–West Conference on Tobacco and Alcohol Use, which was held April 5–6, 2005 in Pasadena, California. The conference was hosted by the University of Southern California’s Institute for Health Promotion & Disease Prevention Research (IPR), its Pacific Rim Transdisciplinary Tobacco & Alcohol Use Research Center (PR TTURC), and its Transdisciplinary Drug Prevention Research Center (TPRC). With its theme of Culture, Environment, and Genes, the overarching goal was to provide a forum for basic, clinical, and community-based scientists and public health leaders in the United States and Pacific Rim nations to present trends and emerging issues in tobacco and alcohol use in the Pacific Rim; share recent findings in tobacco and alcohol control and prevention research and practice; inform public health applications in prevention and treatment; and facilitate new transdisciplinary collaborations among tobacco and alcohol researchers and public health leaders. Research findings and public health experience have made it abundantly clear that no single level of science can adequately address the puzzle of dependence and addictive behavior, nor can either scientists or public health officials alone address society’s needs regarding tobacco and alcohol prevention and control. The purpose of this conference was to bring together leading scientists and public health workers for collaborative discussions of issues related to tobacco and alcohol that affect the health of people throughout the world. Pacific Rim nations offer a unique laboratory for studying tobacco and alcohol use and dependence. They are home to a large proportion of the world’s tobacco and alcohol users, yet substance use prevention and cessation programs are still in their infancy in many countries. Social norms around substance use in many Pacific Rim cultures are very different from those in many Western cultures, so it is possible to examine the roles of more proximal risk and protective factors, and the effects of interventions across cultural contexts. The population prevalence of genetic variants associated with substance use differs across populations, so it is possible to identify individuals with especially high or low risk for tobacco or alcohol dependence. In addition to fulfilling an important public health need worldwide, research in the Pacific Rim can inform prevention, cessation, and policy efforts in the United States and other Western countries, where large numbers of immigrants from the Pacific Rim settle every year. Although the conference focused on tobacco and alcohol use in Pacific Rim nations, comparisons also were made with North American and European countries. The conference addressed tobacco use from multiple levels—from the molecular to the cultural— and addressed tobacco use etiology, prevention, treatment, and policy at all levels. Speakers and participants came from 10 countries on four continents, including the Pacific Rim areas of East and Southeast Asia, Australia, the Pacific Islands, North America, and Europe. Some of the world’s leading

Background: Tobacco use is among the most important factors in cancer patient survival. In order to appropriately prioritize resource allocation, we studied the frequency of tobacco use among cancer patients and racial/ethnic minorities in a widely dispersed academic-led cancer care network. Methods: City of Hope (COH) has an academic center in Duarte CA and has 36 community cancer treatment sites across Los Angeles, Riverside, San Bernardino, Orange and Ventura counties. A tobacco use control program was established across multiple departments. A tobacco use screen was developed for every cancer patient and followed by a more detailed tobacco use survey. Self reported racial/ethnic identity and socioeconomic data were collected. A survey of clinicians was performed to determine their attitudes and knowledge about tobacco use, and tobacco cessation treatments. Results: Completion of the tobacco use screen was 96.05%. Data indicated geographically different tobacco use rates at the academic medical center and community sites ranging from 2.75% to 10.81% with an average of 5.87%. The average use was 6.66% in community sites versus only 3.84% in the academic tertiary care center. Highest use was in Antelope Valley (AV), a site with high levels of poverty, chronic disease burden and concentration of dedicated tobacco retail shops. The AV tobacco use rate was 10.81%. Of smokers in AV, 17.30% were African-American, 14.60% were Hispanic, 1.8% were Asian-Pacific Islander, and 40.44% were non-Hispanic white. Tobacco use was highest among communities with the greatest social determinants of health (SDOH) burden and Black population density. 85.96% of clinicians agreed that tobacco cessation should be a standard part of cancer treatment, and 94.74% of clinicians agreed that current smoking and/or tobacco use negatively impact patient outcomes. Patient resistance to cessation advice and treatment as well as lack of proper support were described as the greatest barriers to smoking cessation. There was an association between physician attitude and tobacco use rate which was greater in community sites compared to the academic center. In the highest tobacco use center AV, compared to the academic center, there was perceived greater need for resource allocation to control tobacco use, and this was associated with a higher proportion of minority patients. Conclusions: There are racial, ethnic, SDOH and geographic variations in tobacco use. Allocation of cancer center resources must be based on metrics of patient tobacco use and community factors. Therefore, strategies to reduce tobacco use and cessation must include cultural, linguistic, and community-responsive approaches. Therefore, clinicians, cessation specialists, community advocates and policy makers must coordinate to reduce tobacco exposure and tobacco use disparities. A network-wide tobacco control program coordinated among multiple specialties is needed and elements of such a program at COH will be described as a model for implementation in other institutions. Citation Format: Kimlin Tam Ashing, Cary A. Presant, Sophia Yeung, Jonjon Macalintal, Brian Tiep, Sandoval Argelia, Dan Raz, Ravi Salgia, Loretta Erhunmwunsee, Arya Amini, Amar Merla, Heather Graves, Steven Rosen. Assessment of geographic and racial/ethnic variables in tobacco use among cancer patients in a widely dispersed academic-led cancer care network [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-009.

The aim of this study was to examine socio-demographic and psychosocial correlates of concurrent tobacco use and risky drinking. We analysed data from the cross-sectional South African National Health and Nutrition Examination Survey (SANHANES-1) 2011–2012. The sample included 14 764 adolescents and adults aged 15 years and older. They responded to questions on tobacco and alcohol use, psychosocial, and socio-demographic indicators. Results indicate that 9.6% (16.8% among men and 3.5% among women) of South Africans were involved in concurrent tobacco use and risky drinking, 18.2% in current tobacco use only, and 20.3% in risky drinking only. In covariate adjusted analysis, being 25 to 64 years, being male, belonging to the coloured population group, residing in urban areas, having experienced three or more traumatic events, and poor self-rated health were associated with concurrent tobacco use and risky drinking. Findings suggest socio-demographic and health factors are important for public health interventions in addressing concurrent tobacco and alcohol use in South Africa.

Background: Understanding which subgroups of vocational education students are more likely to use tobacco and/or alcohol is critical for designing interventions. Previous research has not explored important student subgroups. Objectives: This exploratory study examined tobacco use, risky alcohol consumption not meeting Australian guidelines, and concurrent use by type of vocational training and whether previously unexplored factors were associated with these health behaviors among vocational education students. Methods: A cross-sectional online survey was conducted among 1057 students (66% male) attending 14 Technical and Further Education campuses in New South Wales, Australia. Results: Type of vocational training was not associated with tobacco use, risky alcohol consumption, or concurrent use. Participants who were married/living with a partner (adjusted odds ratio (AOR): 0.69; 95% Confidence Interval (CI) 0.48, 0.99), or unemployed (AOR: 0.60; 95% CI 0.36, 0.99) had significantly lower odds of tobacco use. Indigenous students (AOR: 1.82; 95% CI 1.19, 2.80) or those who experienced symptoms of depression (AOR: 1.69; 95% CI 1.12, 2.55) had significantly higher odds of tobacco use. Participants aged ≥25 years (AOR: 0.59; 95% CI 0.40, 0.88), female (AOR: 0.42; 95% CI 0.29, 0.62), or unemployed (AOR: 0.57; 95% CI 0.37, 0.88) had significantly lower odds of risky alcohol consumption. Unemployed participants (AOR: 0.53; 95% CI 0.30, 0.95) had significantly lower odds of concurrent use. Those who experienced symptoms of anxiety (AOR: 1.55; 95% CI 1.02, 2.37) had significantly higher odds of concurrent use. Conclusion: Vocational education institutes could provide tailored and culturally appropriate interventions targeting students at increased risk of tobacco and/or alcohol use to prevent diseases.