Adult Smokeless Tobacco Users Research Articles

Lipid profile alterations in Young Adults using Smokeless Tobacco: A prospective observational study from an urban center in Pakistan.

Background: Smokeless tobacco (ST) use is a prevalent health concern in South Asia, with increasing consumption among young adults. While the association between smoking and cardiovascular diseases (CVDs) is well-documented, the impact of ST on lipid profiles and related cardiovascular risks remains underexplored. This study aims to assess the lipid parameters in young adult ST users to evaluate potential dyslipidemia and its implications for cardiovascular health. Methodology: This prospective observational study was conducted at Sindh Government Hospital Liaquatabad from November 2021 to April 2022. A total of 100 participants aged 18-30 years, who self-reported regular use of ST for at least 12 months and were non-smokers, were included. Lipid profiles, including total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C), were measured after an overnight fast. Patients on lipid-altering medications or with significant comorbidities were excluded. Statistical analysis was performed using SPSS version 22.0. Results: The cohort predominantly consisted of young men (87%), with a mean age of 21.72 ± 3.66 years. Most participants were students (57%) and from low socioeconomic backgrounds (89%). Overall, lipid levels were generally within normal ranges, with the exception of low levels of HDL-C, which were particularly pronounced in women. In detail, the mean HDL-C for men was 41.55 ± 6.94 mg/dL, whereas women exhibited significantly lower HDL-C levels at 30.09 ± 5.94 mg/dL (p < 0.01). Other lipid parameters, including LDL-C, total cholesterol, and triglycerides, did not show significant elevations. Specifically, the mean LDL-C was 147.16 ± 3.60 mg/dL for men and 136.36 ± 9.96 mg/dL for women (p < 0.01), while total cholesterol levels averaged 125.70 ± 23.81 mg/dL for men and 124.55 ± 27.52 mg/dL for women (p = 0.882). Triglycerides were comparable between genders, with men at 131.21 ± 17.14 mg/dL and women at 131.91 ± 20.70 mg/dL (p = 0.902). Conclusion: This study found that while overall lipid levels were normal, female participants exhibited significantly low levels of HDL-C, indicating potential gender-specific cardiovascular risks.

Behavioural support and nicotine replacement therapy for smokeless tobacco cessation in Bangladesh, India and Pakistan: A pilot randomized controlled trial.

Smokeless tobacco (ST) use in South Asia is high, yet interventions to support its cessation are lacking. We tested the feasibility of delivering interventions for ST cessation in South Asia. We used a 2× 2 factorial design, pilot randomized controlled trial with a duration of 26 weeks, including baseline and follow-up (6, 12 and 26 weeks) assessments. Two primary health-care facilities each in Dhaka (Bangladesh) and Karachi (Pakistan) and a walk-in cancer screening clinic in Noida (India) took part. Adult daily ST users willing to make a quit attempt within 30 days. Of 392 screened, 264 participants [mean age: 35 years, standard deviation = 12.5, 140 (53%) male] were recruited between December 2020 and December 2021; 132 from Bangladesh, 44 from India and 88 from Pakistan. Participants were randomized to one of three treatment options [8-week support through nicotine replacement therapy (NRT, n= 66), a behavioural intervention for smokeless tobacco cessation in adults (BISCA, n= 66) or their combination (n= 66)] or the control condition of very brief advice (VBA) to quit (n= 66). Recruitment and retention, data completeness and feasibility of intervention delivery were evaluated. Biochemically verified abstinence from tobacco, using salivary cotinine, was measured at 26 weeks. Retention rates were 94.7% at 6 weeks, dropping to 89.4% at 26 weeks. Attendance in BISCA pre-quit (100%) and quit sessions (86.3%) was high, but lower in post-quit sessions (65.9%), with variability among countries. Adherence to NRT also varied (45.5% Bangladesh, 90% India). Data completion for key variables exceeded 93% among time-points, except at 26 weeks for questions on nicotine dependence (90%), urges (89%) and saliva samples (62.7%). Among follow-up time-points, self-reported abstinence was generally higher among participants receiving BISCA and/or NRT. At 26 weeks, biochemically verified abstinence was observed among 16 (12.1%) participants receiving BISCA and 13 (9.8%) participants receiving NRT. This multi-country pilot randomized controlled trial of tobacco cessation among adult smokeless tobacco users in South Asia demonstrated the ability to recruit and retain participants and report abstinence, suggesting that a future definitive smokeless tobacco cessation trial is viable.

Smokeless tobacco and periodontitis: A systematic review with meta-analysis.

The present systematic review with meta-analysis aimed to investigate the global association between smokeless tobacco (SLT) use and periodontitis, considering significant effect size variation based on the income levels of countries. We searched seven databases to identify studies that assessed the prevalence of periodontitis in adult SLT users compared to non-users. The quality of studies was evaluated using the 10-item risk-of-bias tool, and publication bias was addressed through the trim-and-fill method. Sensitivity analysis utilized the leave-one-out approach. Meta-analysis and meta-regression, stratified by country income, SLT type, and smoking status, employed robust variance estimation. From an initial pool of 484 studies, 29 studies met the selection criteria and were subjected to qualitative synthesis. Subsequently, data from 19 studies were included in the meta-analysis. SLT users exhibited a nearly threefold greater likelihood of periodontitis compared to non-users (OR = 2.99; 95% CI: 2.10, 4.27; p < .01). The pooled estimate did not vary significantly based on the type of SLT used or concurrent smoking. However, the odds of periodontitis varied according to the economic level of the country; the pooled estimate was higher in high-income countries (OR = 1.69; 95% CI: 1.20, 2.37; p < .01) and even higher in lower-middle-income and lower-income countries (OR = 3.91; 95% CI: 2.66, 5.77; p < .01). Smokeless tobacco users have a higher likelihood of developing periodontitis. This study underscores global disparities in the SLT-periodontitis relationship, highlighting the need for targeted interventions, particularly in economically challenged areas where SLT use is largely unregulated.

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Background:Pharmacotherapies have been shown to increase tobacco abstinence rates among smokeless tobacco (ST) users. Bupropion SR has demonstrated potential efficacy for ST users in pilot studies. We conducted a randomized, clinical trial to assess the efficacy and safety of bupropion SR for tobacco abstinence among ST users.Methods:Adult ST users were randomized to bupropion SR titrated to 150 mg twice daily (N= 32) for 12 weeks. The primary endpoint was the 7-day point-prevalence tobacco abstinence rate at 6 week. Secondary outcomes included prolonged and continuous tobacco abstinence rates, craving and nicotine withdrawal, at week 8 and week 12.Results:The 7-day point-prevalence tobacco abstinence rates with bupropion SR at week 6 (28.1%), week 8 (28.1%) and week 12 (28.1%); p = 0.0003). The prolonged and continuous tobacco abstinence rates did not differ at weeks 6, 8, and 12. The treatment response was observed over time with FTND-ST scale. At 12 weeks, the mean (±SD) FTND-ST score change from baseline among abstinent subjects was a decrease of 2.66 (±1.52) for the bupropion SR group.Conclusions:Bupropion SR did significantly increase tobacco abstinence rates among ST users, as well as it significantly decreased craving over the treatment period.

Oral Health-Related Quality of Life Among Adult Smokeless Tobacco Users and Nontobacco Users of Ghaziabad District, Uttar Pradesh

Introduction: Smokeless tobacco (ST) being a crucial determinant of oral health and oral health-related quality of life is a part of many religious and cultural rituals which has gained a degree of social acceptance in the Indian subcontinent. Aim: The aim of this study was to assess the oral health-related quality of life (OHRQoL) among adult ST users and nontobacco users of Ghaziabad. Materials and Methods: A hospital-based cross-sectional study was designed to determine the oral health status and OHRQoL of ST users and nontobacco users. A sample of 620 adult individuals was taken. A pretested questionnaire was used to collect the demographic variables. Oral health status was assessed using the World Health Organization 2013 Oral Health Assessment Form, and OHRQoL was measured with the Oral Health Impact Profile-14. Statistical analysis was done by the Statistical Package for the Social Sciences version 20.0. Chi-square test, Spearman's correlation coefficient, Mann–Whitney U-test, and Kruskal–Wallis test were applied. Statistical significance was considered atP&lt; 0.05. Results: In ST users, 90.3% had gingival bleeding, whereas 58.4% of the nontobacco users had gingival bleeding; 53.2% of the ST users had periodontal pocket compared to 47.7% of the nontobacco users. ST users had higher mean scores on the handicap (1.96 ± 1.29), psychological disability (1.89 ± 2.66), psychological discomfort (1.44 ± 1.31), functional limitation (0.92 ± 1.35), physical pain (0.79 ± 0.91), and social disability (0.52 ± 0.70) when compared to the nontobacco users. A ST user has a higher (8.03 ± 4.14) mean score when compared to nontobacco users (4.56 ± 4.01) (P &lt; 0.001) in all subscales of OHRQoL. A statistically significant difference in the oral OHRQoL between ST users and nontobacco users was observed. Conclusion: Hence, the study revealed that ST users definitely had an influence on OHRQoL, with a statistically significant increase in oral health problems in ST users compared to nonusers.

Longitudinal pathways of exclusive and polytobacco smokeless use among youth, young adults and adults in the USA: findings from the PATH Study Waves 1–3 (2013–2016)

ObjectiveUse of smokeless tobacco (SLT) with other tobacco products is growing, yet gaps in understanding transitions among SLT and other product use remain. The aim of this study is to...

Biomarkers of Exposure among Adult Smokeless Tobacco Users in the Population Assessment of Tobacco and Health Study (Wave 1, 2013-2014).

Monitoring population-level toxicant exposures from smokeless tobacco (SLT) use is important for assessing population health risks due to product use. In this study, we assessed tobacco biomarkers of exposure (BOE) among SLT users from the Wave 1 (2013-2014) of the Population Assessment of Tobacco and Health (PATH) Study. Urinary biospecimens were collected from adults ages 18 and older. Biomarkers of nicotine, tobacco-specific nitrosamines (TSNA), polycyclic aromatic hydrocarbons (PAH), volatile organic compounds (VOC), metals, and inorganic arsenic were analyzed and reported among exclusive current established SLT users in comparison with exclusive current established cigarette smokers, dual SLT and cigarette users, and never tobacco users. In general, SLT users (n = 448) have significantly higher concentrations of BOE to nicotine, TSNAs, and PAHs compared with never tobacco users; significant dose-response relationships between frequency of SLT use and biomarker concentrations were also reported among exclusive SLT daily users. Exclusive SLT daily users have higher geometric mean concentrations of total nicotine equivalent-2 (TNE2) and TSNAs than exclusive cigarette daily smokers. In contrast, geometric mean concentrations of PAHs and VOCs were substantially lower among exclusive SLT daily users than exclusive cigarette daily smokers. Our study produced a comprehensive assessment of SLT product use and 52 biomarkers of tobacco exposure. Compared with cigarette smokers, SLT users experience greater concentrations of some tobacco toxicants, including nicotine and TSNAs. Our data add information on the risk assessment of exposure to SLT-related toxicants. High levels of harmful constituents in SLT remain a health concern.

The state of smokeless tobacco cessation in a context lacking cessation services: Evidence from Ethiopia.

INTRODUCTIONCessation attempts for smokeless tobacco (SLT) have been studied in the countries that provide comprehensive cessation services, but there is no evidence about SLT cessation in Ethiopia, where there are no comprehensive tobacco cessation services. The objective of this study was to determine cessation attempts and related factors among daily SLT users.METHODSWe analyzed the data obtained from a cross-sectional survey of SLT users in Borena zone, Ethiopia, focusing on a subset of 600 daily SLT users. Participants were adult SLT users aged ≥18 years. The dependent variable was SLT cessation attempt. Multivariable logistic regression was performed to identify association between cessation attempts and explanatory variables. Analyses were performed using SPSS version 20.RESULTSOverall, 18.5% reported having tried to quit SLT in the past 12 months. In multivariable analyses, SLT cessation attempts were significantly associated with being male (AOR=1.96, 95% CI: 1.13–3.40), current dual-product user (AOR=2.11, 95% CI: 1.31–3.38), being advised by α health professional (AOR=1.82, 95% CI: 1.13–2.92), current knowledge (AOR=1.20, 95% CI: 1.00–1.44), and risk perception (AOR=1.06, 95% CI: 1.02–1.10).CONCLUSIONSA low cessation attempt rate among daily SLT users calls for comprehensive cessation intervention. More attention to factors such as knowledge of the health consequences of SLT use, risk perception and health workers advice will be required to encourage cessation attempts.

Association of smokeless tobacco and cerebrovascular accident: a systematic review and meta-analysis of global data.

The association of smokeless tobacco (SLT) with stroke has been dealt with in only a few reviews. The present meta-analysis aims to present the updated comprehensive summary risk of stroke in adult SLT users along with sub group analysis. A systematic literature search for articles evaluating risk of stroke in SLT users was conducted. The study characteristics and risk estimates were extracted independently by two authors (RG and SG). Random-effect model was used to estimate the summary relative risks. The overall risk of stroke in SLT users was found to be significantly higher (1.17, 95% CI 1.04–1.30) compared to non-users, especially for users in Southeast Asian region. The results remained unchanged even after strict adjustment for smoking (1.18, 95% CI 1.04–1.32). SLT users had 1.34 times or 13.4% higher risk of fatal stroke, though risk of nonfatal stroke was not enhanced. Significantly higher risk of stroke was seen in users of chewing tobacco (1.35, 95% CI 1.20–1.50) in comparison to non-chewers. Gender-based analysis showed enhanced risk of fatal stroke in both male and female users. SLT-attributable fraction of fatal stroke was highest for India at 14.8%. The significant higher risk of stroke with SLT use, even after adjustment for smoking, emphasizes the imperative need to include SLT cessation advice for control and prevention of stroke.

The Poorest of Poor Suffer the Greatest Burden From Smokeless Tobacco Use: A Study From 140 Countries.

The full extent of global smokeless tobacco (SLT) use and its association with key demographic factors such as gender, place of residence, and household or country income status is not yet known. The global burden of SLT use among adults was estimated using nationally representative data of 140 countries by gender and country income group. Countries were grouped in Group 1 (low and low-middle income countries combined) and Group 2 (upper middle and high income countries combined). The number of male and female SLT users was calculated using prevalence and population estimates of corresponding age groups. Nearly one in 10 males and one in 20 females used SLT in some form. SLT use prevalence was significantly higher among males (p < .001) and females (p < .001) in Group 1 countries compared with their counterparts in Group 2 countries. However, for both Group 1 (p < .01) and Group 2 (p < .01), males were more likely to use SLT than females. Nearly 91% of a total 356 million adult SLT users resided in Group 1 countries, with 81.6% in countries of WHO South-East Asia region (SEAR). In SEAR and African region, SLT use was higher in rural areas and poorest communities. The majority of the burden of SLT use is on lower and lower middle income countries with the greatest burden on the poorest segments of the population in these countries. This study brings the comprehensive information on epidemiology of SLT use among adults at global level. Ninety percent of SLT burden is in low and low-middle income group of countries and more specifically among the poorest group in such countries. These countries need to have strategies to implement different provisions of the WHO Framework Convention on Tobacco Control. The program in such countries should be targeted towards the poorest communities for effective SLT control.

Prevalence and factors that influence smokeless tobacco use among adults in pastoralist communities of Borena Zone, Ethiopia: mixed method study

BackgroundDeaths due to tobacco consumption are on the rise, from 5.4 million in 2005 to 6.4 million in 2015 and 8.3 million in 2030 of which more than 80% will be in developing countries. Smokeless tobacco use is a significant health risk and cause of disease. Over 300 million people use smokeless tobacco worldwide. More than 250 million adult smokeless tobacco users are in low- and middle-income countries, the total burden of smokeless tobacco use is likely to be substantial. In Ethiopia, nationally representative data on the smokeless tobacco use is not available. Most studies conducted in the country focused on cigarette smoking.MethodA community based cross-sectional study using quantitative and qualitative approaches was conducted from September 14–29, 2015. The study was conducted among adults in pastoralist communities in Borena zone, Ethiopia. A total of 634 households were selected randomly for interview. An interviewer-administered questionnaire and in-depth interview guide was used to assess adults’ practice, attitude, knowledge, and perception on Smokeless Tobacco use. Logistic regression was used to assess association between dependent and independent variables.ResultOut of 634 participants, 287 (45.3%) of them were current users of smokeless tobacco. Being Muslim (AOR = .21, 95% CI: .13, .33), being Christian (AOR = .38, 95% CI: .22, .67), and having good health risk perception toward smokeless tobacco use (AOR = .49, 95% CI: .34, .70) were protective factors for smokeless tobacco use, whereas favorable attitude (AOR = 2.12, 95% CI: 1.48, 3.04) and high social pressure towards smokeless tobacco use (AOR = 1.73, 95% CI: 1.21, 2.47) were factors independently associated with smokeless tobacco use.ConclusionThis study concludes that smokeless tobacco use is very common in the selected districts of the Borena zone. The practice is strong linked to the lifestyle of the community.

Prevalence of Smokeless Tobacco Use and Number of Users in 121 Countries

Background: In 2010, a study estimated the number of smokeless tobacco (SLT) users in 70 countries at 302.4 million. These countries represented 70% of the global population. We aimed to update this information and widen the scope to estimate the global prevalence of SLT use by including a larger number of countries. Methods: Data on the prevalence of current SLT use in 121 countries were obtained from various sources. Country-wise and gender-wise breakdown of the adult population in these countries was derived from the UN World Population for 2015. To translate prevalence rates into an estimate of the number of adult SLT users, we multiplied the adult male and female SLT prevalence rates by the corresponding male and female adult population in the respective countries. We then added the Short Research Article Sinha et al.; BJMMR, 9(6): 1-20, 2015; Article no.BJMMR.16285 2 estimated number of male and female SLT users to get an overall estimate of SLT use. Results: There were 352 million SLT users (351.9 million) in 121 countries. Of these, 67% were men (232.7 million) and 33% were women (119.2 million). Nearly 95% (333.1 million) of global SLT users lived in developing countries and only 5% (918.8 million) lived in developed countries; 82.7% of global SLT users lived in the World Health Organization (WHO) South-East Asia Region. Globally, 90.4% of SLT users live in 11 countries of the world: India (237.4 million, 67.5%), Bangladesh (30.9 million), Myanmar (12.6 million), Pakistan (10.1 million), USA (9.6 million), China (4.1 million), Indonesia (3.2 million), Nepal (2.7 million), Madagascar (2.6 million), Germany and Uzbekistan (2.4 million each). Conclusion: Smokeless tobacco use is a global epidemic affecting 121 countries. All 180 countries that have ratified the WHO Framework Convention on Tobacco Control (WHO FCTC) are obliged to monitor SLT use. Parties to the Convention should collect information periodically using standard protocols for national and international comparability. To prevent health and economic losses attributable to SLT use, countries, especially developing countries, should formulate strategies specific to SLT control.

Determinants of Salivary Cotinine Concentrations Among Smokeless Tobacco Users

Factors associated with cotinine concentrations have been studied in smokers. Based on these studies, cotinine is recommended as a biomarker to assess severity of tobacco dependence. Evidence of association between cotinine concentrations and various factors among smokeless tobacco (ST) users is limited and mostly comes from tobacco cessation studies. The present study describes the relationship of salivary cotinine concentrations to sociodemographic factors, tobacco use characteristics, and ST products among ST users. Data are from a community-based sample of 95 current adult ST users. Study participants provided a saliva sample for cotinine analysis and completed a mail survey that included questionnaires regarding sociodemographic information, tobacco use characteristics, and tobacco dependence measures. Crude and adjusted associations between cotinine and other variables were calculated. Age, years of ST use, cans per week, and swallowing of tobacco juices were significantly associated with salivary cotinine concentrations in the multiple regression model. Fine-cut ST products resulted in higher cotinine concentrations as compared with long-cut ST products when adjusted for age and tobacco use characteristics (p = .029). The Fagerström Test for Nicotine Dependence for ST users (r = .58, p < .0001) and the modified Tobacco Dependence Screener (r = .24, p < .0001) were both correlated with cotinine concentration. The findings suggest some similarities in the determinants of cotinine concentrations in ST users and smokers. Swallowing of tobacco juices and type of ST product are unique to ST users and are associated with higher cotinine concentrations.

A randomized controlled trial of Telephone Counseling with smokeless tobacco users: The ChewFree Minnesota study

Although a considerable body of evidence supports telephone quit lines for smoking cessation, much less is known about the effectiveness of proactive Telephone Counseling with smokeless tobacco (ST) users. We conducted a randomized controlled trial comparing Telephone Counseling with the distribution of a self-help manual for ST cessation. We recruited 406 adult ST users throughout the state of Minnesota and randomized them to receive either: (a) a self-help manual (Manual only) or (b) a self-help manual plus proactive telephone-based cessation counseling (Telephone Counseling). The telephone-based treatment included up to four calls in support of quitting, and personalized various cognitive and behavioral strategies that are generally considered effective in tobacco cessation (such as setting a quit date, examining patterns of use, developing stress reduction skills, avoiding known triggers to use). Participants were surveyed by phone at 3 and 6 months to assess both point prevalence and continued abstinence. Prolonged abstinence from all tobacco was 6.8% and 30.9% (p < .001) at 3 months and 9.8% and 30.9% (p < .001) at 6 months in Manual only and Telephone Counseling, respectively. We found older age, lower dependency, and increased readiness predicted quitting success. Proactive telephone-based counseling is an effective strategy for improving cessation rates among ST users. Future research should determine the components contributing to the intervention success.

ChewFree.com: Evaluation of a Web-based cessation program for smokeless tobacco users

The sizeable percentage of adults who use smokeless tobacco (ST) represents an important public health target since the majority of ST users have a strong desire to quit, but many lack resources. We tested the impact of an interactive, tailored Web-based intervention (Enhanced Condition) versus a more linear, text-based website (Basic Condition) in a randomized trial with 2523 adult ST users. As is common in Internet-based research, there was considerable attrition: follow-up rates at 3 months, 6 months, and for both 3 and 6 months were 48%, 45% and 34%, respectively. Results using repeated point prevalence of all tobacco use at 3 and 6 months showed that participants in the Enhanced Condition quit at significantly higher rates than those in the Basic Condition. Using a Complete Case analysis, abstinence was 40.6% in the Enhanced Condition vs. 21.2% in the Basic Condition (p< .001). Using intent-to-treat analysis, quit rates were 12.6% vs. 7.9%, respectively (p< .001). Similar results were obtained for only ST use. Unobtrusive measures of program exposure indicated that program use was significantly related to outcome as well as to attrition. We conclude that a tailored, interactive Web-assisted cessation program can be an efficacious method for assisting adult ST users to quit.

Bupropion SR for the treatment of smokeless tobacco use

Background No pharmacotherapies have been shown to increase long-term (≥6 months) tobacco abstinence rates among smokeless tobacco (ST) users. Bupropion SR has demonstrated potential efficacy for ST users in pilot studies. We conducted a multicenter, randomized, double-blind, placebo-controlled, clinical trial to assess the efficacy and safety of bupropion SR for tobacco abstinence among ST users. Methods Adult ST users were randomized to bupropion SR titrated to 150 mg twice daily ( N = 113) or placebo ( N = 112) for 12 weeks plus behavioral intervention. The primary endpoint was the 7-day point-prevalence tobacco abstinence rate at week 12. Secondary outcomes included prolonged and continuous tobacco abstinence rates, craving and nicotine withdrawal, and weight gain. Results The 7-day point-prevalence tobacco abstinence rates did not differ between bupropion SR and placebo at the end treatment (53.1% versus 46.4%; odds ratio (OR) 1.3; p = 0.301). The 7-day point-prevalence abstinence did not differ at weeks 24 and 52. The prolonged and continuous tobacco abstinence rates did not differ at weeks 12, 24, and 52. A time-by-treatment interaction was observed in craving over time with greater decreases in the bupropion SR group. At 12 weeks, the mean (±S.D.) weight change from baseline among abstinent subjects was an increase of 1.7 (±2.9) kg for the bupropion SR group compared to 3.2 (±2.7) kg for placebo ( p = 0.005). Conclusions Bupropion SR did not significantly increase tobacco abstinence rates among ST users, but it significantly decreased craving and weight gain over the treatment period.

Adult smokeless tobacco use and age of onset

To determine if an earlier age of onset is associated with greater levels of adult smokeless tobacco (SLT) use and to evaluate if this relationship differs by SLT type, 345 current adult SLT users were interviewed to obtain the age at first onset and current frequency of SLT use. The results indicated that more than twice as many SLT users began during adulthood than during preadolescence. Although preadolescent onset was associated with greater chewing tobacco use than adolescent onset, the greatest levels of both chewing tobacco and snuff use were associated with adult onset, suggesting an increased need for SLT prevention programs for young adults.