Alternative Tobacco Research Articles

Sociodemographic risk indicators of hookah smoking among White Americans: A pilot study

Despite the sustained public health efforts to decrease cigarette smoking, there is an increasing trend in the use of alternative tobacco products that are perceived by some as less harmful. One example is hookah smoking. This study aimed to assess hookah trends among White Americans. Two hundred and forty-five White American adults residing in southeast Michigan answered a self-administered standardized questionnaire that included basic demographics, socioeconomic status, and questions related to hookah smoking behavior. Logistic regression was used to determine risk indicators for hookah smoking. The combined prevalence of hookah smoking in the White American study population was 19%, with 10% of the sample smoking hookah only and 9% smoking both hookah and cigarettes. Approximately 19% of respondents believed that smoking hookah was less harmful than smoking cigarettes. Significant risk indicators for smoking hookah were being younger than 22 years and living with a family member who used tobacco. In addition to reporting the prevalence of use in this important group of potential users, we outline important sociodemographic risk factors for hookah use in a non-Arab American population. More research is needed with a larger population to better understand this new tobacco trend in order to curb a new potential health threat.

Use of Alternative Tobacco Products in Multiethnic Youth from Jujuy, Argentina

This study examines alternative tobacco use among Latin American youth. A self-administered survey in a random sample of 27 schools was administered in 2004 in Jujuy, Argentina (N = 3218). Prevalence of alternative tobacco product use was 24.1%; 15.3% of youth used hand-rolled cigarettes, 7.8% smoked cigars, 2.3% chewed tobacco leaf and 1.6% smoked pipe. Among youth who never smoked manufactured cigarettes, alternative product use was rare (2.9%), except for chewing tobacco (22%). In multivariate logistic regression boys were more likely than girls to smoke pipe (OR = 3.1; 95% CI 1.1–8.7); indigenous language was associated with smoking hand-rolled cigarettes (OR = 1.4; 95% CI-1.1–1.9) and pipe (OR = 2.2; 95% CI 1.5–3.4). Working in tobacco sales was a risk factor for chewing tobacco (OR = 2.9; 95% CI: 1.7–4.9) and smoking hand-rolled cigarettes (OR = 1.4; 95% CI 1.1–1.8). Having friends who smoked was associated with chewing tobacco (OR = 1.8; 95% CI 1.0–3.2) and with smoking cigars (OR = 2.1; 95% CI 1.5–2.9). Current drinking and thrill-seeking orientation were associated with cigars and pipe smoking. Findings highlight the importance of surveillance of alternative tobacco products use and availability among youth and for addressing identified risk factors.

Tobacco decoupling impacts on income, employment and environment in European tobacco regions

This paper presents a multicriteria mathematical programming model that was developed to study the impacts of different tobacco diversification alternatives on income, employment and environment. The model estimates the farmers' utility function taking in account various conflicting criteria that can explain the farmers' behaviour (e.g., maximisation of farm income, risk minimisation, labour, etc.). The model is used to simulate alternative tobacco decoupling scenarios to take alternative farm plans that achieve different levels of income, labour and environmental impacts. Different tobacco alternatives have been used for this purpose resulting from field research in four of the European tobacco regions, two in Greece and two in Spain. The results have shown differences in all case studies in Greece and Spain due to the impacts of tobacco decoupling and in spite of its positive effect on the environment, the loss in farmers' income and mainly the increase of unemployment in the tobacco regions of Greece and Spain will be very important in short and medium terms as it is obvious that these matters will cause significant problems in the local rural economies.

Relative harm of snus and cigarettes: what do Norwegian adolescents say?

Background:The public receives mixed messages about the harmfulness of alternative tobacco products to cigarettes, and little is known about what present and potential users of these products actually think about...

A Latent Class Analysis of Nicotine-Dependence Criteria and Use of Alternate Tobacco

Prior latent class analyses have identified subgroups of smokers that vary by the severity and individual symptoms of nicotine dependence. These analyses have not accounted for the use of alternate tobacco, which is most prevalent among current cigarette smokers. The objective of this study was to determine whether smokers who frequently use other forms of tobacco constitute a latent class characteristic of nicotine-dependence symptoms. Current cigarette smokers (N=4,517), who had a lifetime history of daily smoking, were selected from Wave III of the National Longitudinal Study of Adolescent Health. A latent class model was based on 10 indicators, which included 6 items from the Fagerstrom Test for Nicotine Dependence and 4 measures of the past-month use of tobacco products (cigarettes, cigars, smokeless tobacco, bidis). Covariates included demographic, psychosocial, smoking-related characteristics, and the use of other substances. One of the five estimated latent classes, which ranked second in severity of nicotine dependence only to the class with the heaviest smokers, consisted of light-to-medium smokers who were the most frequent users of alternate tobacco. Alternate tobacco use is correlated with nicotine dependence among smokers, a factor that should be considered in promoting the substitution of one tobacco product for another.

Cigar and smokeless tobacco use in the lesbian, gay, and bisexual population

Large population-based studies of alternative tobacco use in the lesbian, gay, and bisexual (LGB) population are needed to more fully measure tobacco use outcomes. This descriptive study used standard measures of alternative tobacco use from two separate, statewide household-based studies to compare basic prevalence rates in the LGB population and the general population in California. A total of 1,950 adult lesbians, bisexual women, heterosexual women who have sex with women, gay men, bisexual men, and heterosexual men who have sex with men, all living in California, completed surveys between 2003 and 2004. From a general population-based sample (California Tobacco Survey, 2002), a total of 11,037 adult women and 9,488 men were used as comparisons. The prevalence rates for lifetime and current cigar smoking and smokeless tobacco use were lower for all LGB subpopulations compared with the general population.

Tobacco Control Policy Initiatives and UK Resident Bangladeshi Male Smokers: Community-Based, Qualitative Study

Objective. To reflect on recent proposed tobacco control initiatives in the socio-cultural context of the smoking behaviours of UK resident Bangladeshi men. Design. Cross-sectional study using focus groups and one-to-one interviews conducted in English and Sylheti. Eighty-one men, aged 18–64 years, were recruited from the Bangladeshi community of Tower Hamlets, London, during 2002. Participants were purposively selected to reflect their age, place of birth and tobacco-use status. The discussions were tape-recorded and subsequently transcribed. The transcripts were analysed using ‘framework’ principles. Three of the current themes for tobacco control—smoke-free workplace environments, access to alternative sources of tobacco, and use and availability of nicotine replacement therapy—were used to organise the data. Results. Smoking initiation and use was confirmed as linked to gender, age, religion and tradition. Continued smoking was supported by anxieties about harassment in younger respondents, the migration experience of older respondents, and the unskilled employment opportunities available in the restaurant trade. These employment opportunities, whilst providing social support, did not support smoking regulations, in contrast to the practices observed in the general employment market. Levels of knowledge about the health risks of smoking varied by age. Three cheaper alternative tobacco types were readily accessible for use: contraband, roll-ups and traditional chewing tobacco in paan (chewing tobacco mixed with areca nut rolled in a betel leaf). Despite the latter's associations with use by women, younger respondents described the transition to chewing tobacco in paan as a smoking cessation aid instead of nicotine replacement therapy. There was confusion about the purpose, availability and efficacy of nicotine replacement therapy. Respondents reported isolation and marginalisation from current tobacco control initiatives, including much NHS Stop Smoking Service provision. Conclusion. The socio-cultural context of the smoking behaviours of this group of Bangladeshi men was linked to a reported isolation and exclusion from current tobacco control initiatives. These initiatives should be inclusive and address the reported needs of this community. The findings have implications for service development. Addressing these findings will help to inform the implementation of relevant public health policy initiatives for tobacco control to meet the needs of this community.

Prevalence of alternative forms of tobacco use in a population of young adult military recruits

Recent evidence suggests that the popularity of certain alternative forms of tobacco may be increasing in adolescents. Little is known, however, about the use of these products among young adults. This study examined the use of alternative tobacco products including bidis, cigars, kreteks (clove cigarettes), pipes, and smokeless tobacco in a large sample of young adult military recruits ( N = 31 107). Overall, 18.5% of participants were using some form of alternative tobacco product prior to entry into Basic Military Training. Results revealed a relatively high prevalence of cigar (12.3%) and smokeless tobacco use (6.7%). Use of other products was less common, including 1.1% for pipes, 2.0% for bidis, and 3.0% for kreteks. With the exception of kreteks, which did not differ by gender, the prevalence of use of alternative tobacco products was greater for males than for females ( p < .001). Patterns of use also differed according to other demographic characteristics including race, ethnicity, age, and income. Implications for surveillance and tobacco control efforts are discussed.

Smokeless tobacco use 1992–2002: trends and measurement in the Current Population Survey-Tobacco Use Supplements

Background: As smoking prevalence declines in the United States, it is important to understand if smokeless tobacco (SLT) use is also changing and if so, among what groups. Methods: We...

Would alternate tobacco products use be better than smoking?

Tobacco use is dominated by cigarette smoking. Most toxicity due to cigarette smoking is related to the burning process. Several observations suggest that unburned or oral tobacco is less harmful than cigarette smoking. Up to now, physicians have advised a policy based on two ideas: (i) young people should not start smoking and (ii) the only choice for smokers is to quit. However, numerous smokers cannot or do not want to give up; eventually, one out of two lifelong smokers will die from smoke-related diseases. Thus, it is legitimate to ask if alternate nicotine containing product use would be better than cigarette smoking and limit the tobacco death toll. However, the logic leading to the concept of tobacco harm reduction (THR) turns out to be much more complex than it looks at a first glance.

Safety assessment of high fructose corn syrup (HFCS) as an ingredient added to cigarette tobacco

A tiered testing strategy has been developed to evaluate the potential for new ingredients, tobacco processes, and technological developments to alter the biological activity that results from burning tobacco. A series of studies was initially conducted with cigarettes containing 3% high fructose corn syrup (HFCS) as an alternate tobacco casing material to corn syrup/invert sugar, including determination of selected mainstream cigarette smoke (MS) constituent yields, Ames assay, sister chromatid exchange (SCE) assay in Chinese hamster ovary (CHO) cells, a 30-week dermal tumor-promotion evaluation of cigarette smoke condensate (CSC) in SENCAR mice, and a 13-week subchronic inhalation study of MS in Sprague-Dawley rats. A second series of studies was conducted with cigarettes containing 3%, 4% and 5% HFCS including MS chemistry, Ames assay, SCE assay in CHO cells, and a neutral red cytotoxicity assays. Collectively, mainstream smoke chemistry, genotoxicity, dermal tumor-promotion, and inhalation toxicity studies demonstrated no differences between cigarettes with 3% HFCS and cigarettes with 3% corn syrup/invert sugar. Also, mainstream smoke chemistry and genotoxicity of cigarettes with 4% and 5% HFCS were not different from cigarettes with 3% HFCS. In conclusion, the addition of up to 5% HFCS to cigarette does not alter the mainstream smoke chemistry or biological activity of mainstream smoke or mainstream smoke condensate as compared to cigarettes with 3% corn syrup/invert sugar with regard to the parameters investigated and presented.

Youth Attitudes and Beliefs Toward Alternative Tobacco Products: Cigars, Bidis, and Kreteks

Youth use of cigars, bidis, and kreteks has spread as youth cigarette use has declined. This study investigates young people's attitudes toward and beliefs about these alternative tobacco products. The study used data from a convenience sample survey of 5,016 7th-through 12th-grade students in Massachusetts. The cigar attitudes receiving the highest endorsement levels were that cigars smell good and are something different to try, whereas the item receiving the lowest endorsement was that cigars give you a goodbuzz. The most endorsed bidi attitudes were that bid is look like joints and are something different to try. For kreteks, the most endorsed items were that kreteks smell good and are something different to try. Multivariate analyses found that reporting that these products tasted, smelled good, or were something different to try predicted use. Because the study was conducted with a convenience sample in one state, results do not necessarily generalize.

BALUJA ET AL. RESPOND

McCarthy and his colleagues raise interesting questions about smoking behavior in other countries. Our research, however, is restricted to the smoking behavior of foreign-born men and women in the United States. We apologize for any confusion about the meaning of “country of origin.” We follow the convention of most immigration research by using country of birth. That should resolve the doubts expressed by the letter writers regarding the treatment of migrants who stop over in, for example, Canada before settling in the United States. We regret that the tobacco use supplement data from the Current Population Survey prevent us from exploring the use of alternative tobacco products such as bidis or paan. The data in question pertain primarily to cigarette smoking. There may well be cultural differences in what is considered “smoking.” This is always a challenge when making cross-cultural comparisons.

Characteristics of users of cigars, bidis, and kreteks and the relationship to cigarette use

Background In the 1990s, youth use of alternative tobacco products including cigars, bidis, and kreteks increased. This article discusses the prevalence of youth use of cigars, bidis, and kreteks, and characteristics of users. Methods The Cigar Use Reasons Evaluation (CURE)—a questionnaire assessing alternative tobacco use and associated attitudes and behaviors—was administered to middle and high school students from 12 school districts across Massachusetts. Results Males were more likely to use all forms of alternative tobacco and females more likely to smoke cigarettes. Hispanics were less likely to smoke kreteks or use smokeless tobacco. Urban students were more likely to smoke bidis or use smokeless tobacco than suburban or rural youth. Most smokeless and alternative tobacco users were lifetime cigarette smokers. There was, however, a significant group of cigar smokers, associated with higher parental education, who were not current cigarette smokers. Conclusions Use of alternative tobacco poses a risk to the success of tobacco control efforts. While many alternative tobacco users smoke cigarettes, some alternative tobacco users are current cigarette smokers. Cigar use thus constitutes a potential serious risk for youth who otherwise might not be exposed to tobacco.

Youth preferences for cigar brands: rates of use and characteristics of users

Objective: Youth use of cigars has increased in the USA. Understanding brand preference among youth could help explain the attraction to cigars, and develop prevention strategies. This study reports on...

Clove cigarette smoking: biochemical, physiological, and subjective effects

Alternative tobacco products such as clove (kreteks) and bidi cigarettes have become increasingly popular among US smokers. The nicotine content of a popular clove cigarette (Djarum Special) filler averaged 7.4 mg; conventional cigarettes contained 13.0 mg. However, smoke yields from standardized machine-smoking analysis indicated it delivered more nicotine, carbon monoxide (CO), and tar than conventional cigarettes. In a clinical study, nicotine delivery, physiologic, and subjective effects of the clove cigarette were compared to their own brand of cigarette in 10 adult smokers (7 males). Average time to smoke the clove cigarette (549 s) and number of puffs (15.1) were significantly greater than own brand (314 s and 9.4 puffs). Increases in venous plasma nicotine and exhaled CO after smoking the clove cigarette (17.4 ng/ml; 6 ppm) were similar to those after own brand (17.6 ng/ml; 4.5 ppm). Maximal changes in heart rate (HR), systolic, and diastolic blood pressures (BP) did not differ significantly between the clove and own brand of cigarette. Compared to their own brand of cigarette, the clove cigarette was rated as better tasting and being distinctly different. Our findings indicate that clove cigarettes deliver significant quantities of nicotine, CO, and presumably other toxic components of tobacco smoke. Taste satisfaction, aromatic odor, and novelty may contribute to their appeal to young smokers.

Psychosocial Correlates of Alternate Tobacco Product Use during Early Adolescence

Background. The objective was to assess psychosocial correlates of alternate tobacco product (chew/snuff, cigar, pipe, bidi, kretek) use. Methods. Measures of alternate tobacco product use, cigarette smoking, environmental smoking exposure, and depression were included in a school-based self-report survey completed by 1,107 ninth graders. Results. The current (past 30 days) use rate for one or more alternate tobacco products was 8.3% and the current use rate for cigarettes was 11%; 45% of current cigarette smokers also used alternate tobacco products. After controlling for demographic factors and current cigarette smoking, adolescents exposed to peers who smoke and those with greater depressive symptoms were two to three times more likely to currently use an alternate tobacco product than adolescents without exposure to peer smoking and those with lesser depressive symptoms. Conclusions. Social and psychological associations with alternate tobacco product use should be further evaluated as this information could be helpful in developing anti-tobacco messages targeted to high-risk youth.

Short report. Students and smoking. Targeted tobacco promotion in the North East of England

Background: The aim of this study was to Investigate the extent to which students in the North East of England are exposed to two alternative tobacco marketing tactics: direct mailing (‘junk mail’) and the sponsorship of musicoriented events particularly attractive to young people (e.g. discos, ‘raves’ or concerts). Method: Self-completion questionnaires were administered to convenience samples of predominantly first-year students aged 16–24 years attending further education colleges in Gateshead and South Tyneside. The questionnaire assessed the receipt of smoking-related ‘junk mail’ and attendance at music-oriented events sponsored by tobacco companies. Results: Almost one in nine students, one in seven smokers and one in 13 non-smokers had been exposed to one or both types of tobacco promotion. One in 12 of the under-18s (including over one in eight smokers and almost one in 17 non-smokers) had been exposed to one or both types of tobacco promotion. Conclusions: The findings provide evidence that the tobacco industry is violating the UK Voluntary Agreement on Tobacco Products' Advertising and Promotion, with companies sponsoring events particularly appealing to young people and the continued inclusion of young people on mailing lists. This study provides further evidence of the ineffectiveness of voluntary agreements in regulating the promotional activities of the tobacco Industry. It is recommended that, in the wake of the European Union directive on tobacco advertising, a more active and formal mechanism for monitoring tobacco promotion and verifying the claims of the tobacco industry be introduced.