Current Smokeless Tobacco Use Research Articles

Substance Use Among People Seeking Health Care Services in Primary Health Care Settings in Coastal Karnataka

Background: Patients with substance use disorders are common in general medical practice and are a major risk factor for several non-communicable diseases. Appropriate screening is a vital step for providing brief interventions which can provide a good opportunity to tackle this crisis and in achieving target 3.5 of the sustainable development goal which includes strengthening the prevention and treatment of substance abuse. Objectives: To study the magnitude of substance use and factors associated with it among people seeking health care services at primary care settings. Methods: The cross-sectional study recruited people seeking services at primary care settings to screen for substance users (SU) and determine the associated factors. The data was collected using a pretested semi-structured questionnaire including socio-demographic characteristics, health status and the Alcohol, Smoking and Substance Involvement Screening Test tool. Results: The study showed that 43.4% of the participants were SU. The current use of smokeless tobacco was higher compared to tobacco smoking (21.3% and 4.7%). The multivariate logistic regression showed that advancing age (AOR: 2.61 and 95% CI of 1.01–6.79), male gender (AOR: 705 and 95% CI of 4.25–11.70), primary and middle school (AOR: 3.24 and 95% CI of 1.52–6.92) literacy status, unemployed (AOR: 0.49 and 95% CI of 0.25–0.95), religion and other backward caste (AOR: 2.42 and 95% CI of 1.37–4.30) were significant correlates of SU. Conclusion: Substance use was reported by two-fifths of the participants seeking services at primary care centres in our study and stresses the need for incorporating brief interventions to prevent higher degrees of dependence and its complications.

The diversity in tobacco use among women of reproductive age (15-49 years) in Pakistan: A secondary analysis of a Multiple Indicator Cluster Survey (MICS) 2016-2018.

Tobacco use in women of reproductive age group(15-49 years) may contribute to poor maternal and child health outcomes. We estimated the prevalence of smokeless tobacco (ST), cigarette, and waterpipe use among these women in Pakistan and explored associations with socio-economic differences and birthweights after recent childbirths (past 2 years). We used the Multiple Indicator Cluster Surveys(MICS) datasets from three provinces in Pakistan. Prevalence was generated for current use of tobacco among women with recent childbirth(WWRC) and without recent childbirth(WWoRC). We further compared socio-economic status and birthweights between tobacco users and non-users. The prevalence of current ST use was 1·4% and 2·5%, and waterpipe smoking was 1·2% and 1·8%, in WWRC and WWoRC, respectively. ST use varied across Pakistan's provinces by 13 percentage points in WWRC and WWoRC while waterpipe smoking by 10 and 15 percentage points, respectively. The odds of using any form of tobacco were significantly lower with higher levels of education or wealth index. Compared to children born to mothers who did not use tobacco, the birthweight of children born to mothers who smoked waterpipe was on average 0.83kg (95%CI -1·6 to -0·1) lower whereas it was 0·33kg (95%CI -0·9 to 0·3) higher for ST users. Tobacco use among women of reproductive age in Pakistan varied significantly based on province and tobacco type. Waterpipe smoking was associated with a reduction in birth weight. Raising awareness of the harms of tobacco use among women of reproductive age and targeting interventions in high-burden regions of Pakistan should be prioritised. The prevalence of current smokeless tobacco use and waterpipe smoking varied significantly in Pakistan (~13 and ~15 percentage points, respectively) among women of reproductive age, and there seems to be little change in tobacco use behaviour around pregnancy and early motherhood. The study highlights a need to better understand the prevalence of tobacco use in Pakistan, and further contextual research is warranted to understand the reasons for such high tobacco use in certain areas. This information highlights the need for improving current tobacco control interventions and policies, including measures that could help reduce its use and prevent its uptake. Furthermore, compared to children born to mothers who did not use any form of tobacco, we found a statistically significant difference (830 grams) in birthweight for babies born to mothers who at the time of the interview smoked waterpipe and a non-statistically significant difference of about 330 grams for children born to mothers who at the time of the interview used smokeless tobacco. In addition to our findings, some literature suggests the association of waterpipe smoking with low birth weight. A possible explanation could be the exposure to smoke that contains toxicants from the tobacco product itself in addition to the burning of charcoal, which is required when using waterpipe. Waterpipe smoking also results in high exposures of carbon monoxide and polycyclic aromatic hydrocarbons, which are known to be carcinogenic and teratogenic. In terms of smokeless tobacco use, further research is warranted to understand its impact on birth outcomes through longitudinal studies accounting for diverse products, its constituents and the amount of consumption.

Gender differences in use of cigarette and non-cigarette tobacco products among adolescents aged 13-15 years in 20 African countries.

Examining gender differences in youth tobacco use is important as it aligns tobacco control within the context of broader human development goals seeking to eliminate gender inequalities. In this study, we examined gender differences in adolescent use of cigarettes, smokeless tobacco, shisha, and e-cigarettes in Africa. This was a cross-sectional study using data from the Global Youth Tobacco Survey. Our analytical sample comprised 56442 adolescents aged 13-15 years from 20 African countries. Weighted, country-specific prevalence estimates were computed overall and by gender. Adjusted prevalence ratios (APRs) were calculated in a multivariable Poisson regression model to examine whether correlates of tobacco use differed between boys and girls. Ever cigarette smoking prevalence was significantly higher among boys than girls in 16 of the 20 countries, but a significantly higher percentage of girls reported earlier age of cigarette smoking initiation than boys within pooled analysis. Some of the largest gender differences in current cigarette smoking were seen in Algeria (12.2% vs 0.8%, boys and girls, respectively), Mauritius (21.2% vs 6.6%), and Madagascar (15.0% vs 4.1%). Current use of e-cigarettes, shisha, and smokeless tobacco was generally comparable between boys and girls where data existed. Among girls, higher levels of reported exposure to tobacco advertisement were positively associated with shisha smoking whereas perceived tobacco harm was inversely associated with current cigarette and shisha smoking. Among boys, perceived social acceptability of smoking at parties was associated with an increased likelihood of cigarette smoking (APR=2.27; 95% Cl: 1.20-4.30). The prevalence of cigarette smoking among boys was higher than that of girls in many countries. However, girls who smoke tend to start at an earlier age than boys. Differential gender patterns of cigarette and non-cigarette tobacco product use among youth may have implications for future disease burden. As the tobacco control landscape evolves, tobacco prevention efforts should focus on all tobacco products, not just cigarettes.

Prevalence and associated factors of shisha smoking among students in Senegal: Global Youth Tobacco Survey 2020.

Although shisha smoking is banned in Senegal, it has become increasingly popular, especially among youth. Despite the health risks associated with shisha smoking, there are few studies on shisha smoking in West Africa and none in Senegal. Our study assessed the prevalence and factors associated with shisha smoking among students aged 13-15 years in Senegal. We used the 2020 Global Youth Tobacco Survey (GYTS) Senegal data from 2524 students aged 13-15 years. We calculated the weighted prevalence of ever and current (past 30 days) shisha smoking. Multivariable logistic regression analyses identified factors associated with ever and current shisha smoking among students. The prevalences of ever and current shisha smoking were 9.8% (95% CI: 7.7-12.3) and 2.2% (95% CI: 1.5-3.1), respectively. Ever shisha smoking was significantly associated with being male (AOR=1.97; 95% CI: 1.33-2.92), current cigarette smoking (AOR=7.54; 95% CI: 2.95-19.29), higher class grade (AOR=2.27; 95% CI:1.10-4.67), more weekly pocket money (AOR=3.29; 95% CI:1.36-7.95), current use of smokeless tobacco (AOR=11.53; 95% CI: 4.98- 26.72), and exposure to secondhand cigarette smoke in public (AOR=1.55; 95% CI: 1.00-2.41). Current shisha smoking was significantly associated with current cigarette smoking (AOR=21.75; 95% CI: 6.08-77.78), more weekly pocket money (AOR=8.91; 95% CI: 1.75-45.40), current use of smokeless tobacco (AOR=8.26; 95% CI: 2.07-33.04), and fathers' smoking (AOR=3.34; 95% CI: 1.24-8.96). One in 10 students aged 13-15 years have ever smoked shisha and 2.2% were currently smoking it, suggesting that shisha smoking is a public health concern in Senegal. Senegal might consider offering students more education on the harms of shisha, both in schools and through comprehensive media campaigns that address all tobacco products.

Rural-urban health differences among aging adults in India

BackgroundThe aim of this study was to determine the rural-urban health differences among aging adults in India. MethodsThe national cross-sectional data of 67,489 individuals (≥45 years) in 2017–2018 from 35 states and union territories of India (excluding Sikkim) in 2017–2018 were analysed. Various sociodemographic data, well-being indicators, lifestyle factors and physical conditions were assessed by face-to-face interviews and physical measurement. Univariable and multivariable logistic regression was utilized to assess the predictors between residence status (rural dweller, urban migrant, and urban dweller) and various health indicator outcomes. ResultsMajority (70.4 %) of the participants lived in rural areas, 10.3 % were urban migrants and 19.3 % urban dwellers. In the multivariable logistic regression analysis, urban migrants and urban dwellers had a higher self-rated health status, cognitive functioning, physical inactivity, overweight or obesity and abdominal obesity than rural dwellers, while urban migrants and/or urban dwellers had lower functional disability, insomnia symptoms, current smokeless tobacco use, current smoking, heavy episodic drinking and underweight than rural dwellers. Furthermore, urban migrants and/or urban dwellers had higher odds of diabetes, hypertension, heart disease, cancer, high cholesterol than rural dwellers, while urban migrants and/or urban dwellers had lower odds of persistent headaches, major injury, recurrent fall, physical pain, periodontal disease, vision impairment, and gastrointestinal problems than rural dwellers. ConclusionAmong 30 health indicators assessed, 16 had an urban migrant and/or urban dweller advantage, 8 had urban migrant and/or urban dweller penalty, and 6 did not differ between rural-urban groups. Public health promotion and health care should address differing health care needs of rural and urban middle-aged and older adults.

Electronic cigarette use and cigarette smoking associated with inadequate sleep duration among U.S. young adults

ObjectiveNicotine use can influence inadequate sleep, but less is known about the associations of exclusive and dual use of electronic cigarettes (e-cigarettes) with combustible cigarettes in U.S. young adults. This study assessed the associations between current exclusive e-cigarette use, exclusive cigarette smoking, and dual e-cigarette and combustible cigarette use and inadequate sleep duration among U.S. young adults. MethodsWe performed a secondary analysis of 2020 Behavioral Risk Factor Surveillance System (BRFSS) data including 13,978 U.S. young adults ages 18–24 years. Inadequate sleep duration was assessed categorically using the National Sleep Foundation's age-specific recommendations that define <7 h as inadequate sleep. Weighted logistic regression models were performed while adjusting for participants' sex, race/ethnicity, education level, annual household income level, body mass index, current physical activity, mental health status, disability status, current alcohol use, and current smokeless tobacco use. ResultsConcerning use patterns, 11.8% of young adults were exclusive e-cigarette users, 4.7% were exclusive cigarette smokers, and 3.8% were dual e-cigarette and combustible cigarette users. Exclusive e-cigarette users (adjusted odds ratio [AOR] = 1.41, 95% confidence interval [CI] = 1.16–1.72), exclusive cigarette smokers (AOR = 1.63, 95%CI = 1.22–2.18), and dual product users (AOR = 2.03, 95%CI = 1.44–2.86) were at increased odds of having inadequate sleep duration compared to non-users, while adjusting for the covariates. Additionally, dual product users were at increased odds (AOR = 1.52, 95%CI = 1.06–2.19) of reporting inadequate sleep duration compared to exclusive e-cigarette users, while adjusting for the covariates. ConclusionsCurrent e-cigarette and cigarette use may influence inadequate sleep among U.S. young adults. Tobacco cessation efforts may encourage increased sleep health.

Socio-economic distribution of modifiable risk factors for cardiovascular diseases: An analysis of the national longitudinal ageing study in India

The association of socioeconomic status (SES) with modifiable risk factors for cardiovascular diseases (CVDs) is unclear in developing nations. We studied SES variations in major risk factors and their percentage distribution for adults aged 45 years or above in India. Using individual records of 59,672 individuals aged 45 years or above from the Longitudinal Ageing Study in India Wave 1 (cross-sectional study design), 2017–18, we chart age-and-sex-adjusted prevalence of clinical risk factors such as measured high blood pressure, hypertension, overweight, obesity, central adiposity and self-reported high blood glucose; and lifestyle risk factors such as excessive use of alcohol, current use of smoking and smokeless tobacco and physical inactivity across SES variables of education, quintiles of mean per capita expenditure and social caste. Multivariable analysis was used to explore the SES gradient of risk factors. The sample used in the study is predominantly rural (69.9%), illiterate (50.7%), has more females (54.2%), and belongs to other backward classes (45.6%). Prevalence of high blood pressure, overweight, obesity, central adiposity, high blood glucose, and physical inactivity increased; and excessive alcohol consumption and current use of smoking/smokeless tobacco decreased with income, education, and social caste. However, no significant income gradient was noted for lifestyle risk factors except the use of smokeless tobacco. The income gradient was largest for central adiposity (waist-circumference) with a difference of 23.4 percentage points as it increased from 38.7% among the poorest to 62.1% among the richest. The major burden of CVDs risk factors among older adults aged 45+ years falls among high SES.

Suicidal behaviour among adults in Cabo Verde in 2020.

The aim of the investigation was to evaluate past 12-month suicidal behaviour (PSB) among adults in Cabo Verde. Data from 4,563 adults (mean age 41.4 years) that participated in the 2020 Cabo Verde STEPS survey were analysed. Results indicate that the proportion of PSB (attempt 0.6%, plan 1.5% and ideation 3.3%) was 3.7% (2.4% men/5.0% women). In adjusted logistic regression analysis, younger age, female sex, unemployed, widowed or divorced, alcohol family problem, heart attack, angina or stroke, current smokeless tobacco use and low fruit/vegetable intake were associated with PSB. Almost 4% of participants had PSB and several associated factors were identified that can guide public health interventions.

Smokeless Tobacco Use and Cessation Attempts during COVID-19 Lockdown: A Qualitative Study.

Smokeless tobacco (SLT) use among women is widely prevalent in Manipur state accounting for 45% users as per Global Adult Tobacco Survey (GATS)-2 India. Studies from India and elsewhere indicate changes in the way people used SLT during COVID-19 lockdown. This study explores individual and economic influences on SLT consumption and cessation attempts by tribal women in Manipur during the first COVID-19 lockdown (March-June, 2020) in India. Twenty in-depth interviews, both in-person and telephonically, were conducted among tribal women from Imphal west, Manipur, India, who used any SLT, from April to September 2020. Objective of the study was to understand the use, factors associated with consumption, purchasing behaviors, and cessation attempts of SLT during the lockdown. Thematic content analysis was used to identify core themes and codes. Study participants reported of changes in current SLT use during restrictions imposed to contain COVID-19 pandemic in India. Majority reported of reduction or quit attempts in SLT use. Reasons included inaccessibility due to travel restrictions, limited availability and price rise of SLT products, fear of COVID-19, and disposable income for purchase of SLT products. However, a few women reported of increased consumption due to bulk purchasing, or switching to other SLT products as a result of unavailability or price rise of preferred products or to cope up with social isolation caused by the lockdown. Study findings on factors influencing quit attempts and strategies used for reducing SLT use by tribal women in Imphal, Manipur provide valuable insights for development of appropriate intervention for prevention of SLT use among women.

Association of Smokeless Tobacco Use With Incident Peripheral Artery Disease: Results From the Atherosclerotic Risk in Communities Study

Cigarette smoking is associated with an increased risk for peripheral artery disease. It is unknown whether smokeless tobacco, a noncombustible form of tobacco exposure, is also associated with increased peripheral artery disease risk. Using data from the Atherosclerosis Risk in Communities study, we tested the hypothesis that the use of smokeless tobacco is associated with a higher risk of developing peripheral artery disease. Participants with peripheral artery disease at baseline were excluded. Smokeless tobacco use was assessed 3 times from 1987 to 1995, and peripheral artery disease events accrued from 1987 to 2018. Smokeless tobacco was modeled as a time-dependent exposure in Cox regression models. Analyses were completed in 2021. This study included 14,344 participants with a baseline mean (SD) age of 54.1 (5.7) years; 54.8% were female, and 26.4% were Black. There were 635 incident peripheral artery disease events over a median follow-up of 27.6 years (maximum of 32.1 years). The peripheral artery disease incidence rate was 4.44 per 1,000 person-years among those who used smokeless tobacco compared with 1.74 per 1,000 person-years for those who did not. The hazard ratio for current versus never smokeless tobacco use was 1.94 (95% CI=1.31, 2.88) after adjustment for sociodemographic characteristics and cigarette smoking. Peripheral artery disease incidence rate among those currently using smokeless tobacco was similar to that of those who currently smoke cigarette (3.39 per 1,000 person-years). Current smokeless tobacco use was associated with high rates of peripheral artery disease, similar to cigarette smoking. Future research should evaluate the effect of cessation of noncombustible tobacco on incident peripheral artery disease.

Tobacco use and incident sleep parameters among a rural ageing population in South Africa.

Tobacco use may be associated with incident insomnia. The aim of the study was to investigate the association between tobacco use and incident sleep parameters in a longitudinal study in South Africa. Longitudinal data from two consecutive waves of middle-aged and older adults in 2014-2015 (n=5059) and 2018-2019 (n=4176) in rural South Africa were analyzed. Tobacco use and sleep parameters were assessed by self-report. The associations between tobacco use and incident sleep parameters were estimated with multivariable logistic regression. The prevalence of baseline sleep parameters was poor sleep quality 6.5%, sleep disturbance 13.6%, restless sleep 32.9%, and breathing stops 7.0%. In the fully adjusted model for people without poor sleep quality at baseline, daily tobacco smoking, smoking ≥10 units of tobacco products, current tobacco use and current smokeless tobacco use did not increase the odds of incident poor sleep quality. Smoking ≥10 units of tobacco products in a day (AOR=3.83; 95% CI: 1.77-8.28), current tobacco use (AOR=1.65; 95% CI: 1.09-2.51), and daily tobacco smoking (AOR=2.16; 95% CI: 1.15-4.07), were significantly positively associated with incident sleep disturbance. Furthermore, incident restless sleep was significantly positively associated with smoking ≥10 units of tobacco products in a day (AOR=3.97; 95% CI: 1.18-13.37), current smokeless tobacco use (AOR=2.78; 95% CI: 1.17-6.62) and current tobacco use (AOR=2.00; 95% CI: 1.00-4.00). Incident breathing stops were significantly positively associated with daily smoking tobacco (AOR=2.08; 95% CI: 1.11-3.34), smoking 1-9 units of tobacco products in a day (AOR=2.17; 95% CI: 1.20-3.94), and current tobacco use (AOR=1.77; 95% CI: 1.16-2.72). Higher tobacco use was independently associated with incident sleep disturbance, incident restless sleep, and incident breathing stops, but not with incident poor sleep quality.

Prevalence and correlates of tobacco use in Botswana: evidence from the 2014 Botswana STEPwise survey

BackgroundTobacco use is one of the notable risk factors for non-communicable diseases globally. The objective of this study was to assess the prevalence of tobacco use and identify its correlates in the general population of Botswana aged 15 to 69 years.MethodsThis study used a nationally representative WHO STEPwise Approach to Non-Communicable Disease Risk Factor Surveillance (STEPS) risk factors conducted in 2014 to explore the prevalence of tobacco use and its correlates in Botswana. Using IBM SPSS version 27, data on 4062 people aged 15 to 69 years who had been selected using multistage cluster sampling and had successfully completed the individual questionnaire were analysed. The prevalence of current tobacco smoking and smokeless tobacco use was determined using descriptive statistics while multivariable logistic regression was employed to assess correlates of current tobacco smoking and smokeless tobacco use. All comparisons were statistically significant at 5% significance level.ResultsFrom a total sample of 4062 participants the prevalence of current tobacco smoking was estimated to be 12.9% while smokeless tobacco use was 3.2%. Adjusted results indicate that the odds of current tobacco smoking were eight times (AOR = 8.57, C.I = 6.28-11.7) higher among males compared to their female counterparts; six(AOR = 6.52, C.I 3.64-11.6) and three (AOR = 3.27, C.I. =2.07-5.15) times higher among respondents with no education and primary level education respectively, compared to their counterparts with tertiary or higher education; while for alcohol users the odds of current tobacco smoking were four times (AOR = 4.28, C.I = 2.93-6.24) higher than among non-alcohol users. The odds of smokeless tobacco use were significantly higher among women compared to men (AOR = 7.34, C.I = 4.01-13.4); individuals aged 50-59 (AOR = 1.15, C.I = 1.06-3.37) and 60-69 years (AOR = 1.23, C.I. =1.08-3.63) compared to 15-29 years; individuals with no education (AOR = 2.07, C.I = 1.03-4.02) and primary education (AOR = 1.05, C.I = 1.01-2.23) compared to individuals with tertiary education. However, the odds of smokeless tobacco use were significantly lower among individuals who consume alcohol (AOR = 0.48, C.I. = 0.29-0.80) compared to non-alcohol consumers.ConclusionFindings of this study indicate the need to strengthen existing national policies to reduce harmful use of tobacco among men, women, older adults, no or primary education level individuals and alcohol users.

Prevalence and trend of smokeless tobacco use and its associated factors among adolescents aged 12–16 years in 138 countries/territories, 1999–2019

BackgroundSmokeless tobacco use is popular in some regions worldwide, but it receives less attention compared to cigarette smoking. We aimed to estimate the recent prevalence of, and trends in, smokeless tobacco use and to examine its associated factors among adolescents aged 12–16 years in 138 countries/territories (hereafter “countries”) from 1999 to 2019.MethodsData from the Global Youth Tobacco Survey conducted in 138 countries in 2010–2019 and the National Youth Tobacco Survey conducted in the United States in 2019 were used to calculate the prevalence of current smokeless tobacco use and investigate its associated factors among adolescents aged 12–16 years. We also assessed the trend in the prevalence of smokeless tobacco use in 100 countries that had conducted more than one survey from 1999 to 2019.ResultsThe overall prevalence of current smokeless tobacco use was 4.4% (95% confidence interval [CI] 4.0–4.9), with 5.7% (5.1–6.3) for boys, 3.1% (2.6–3.5) for girls, 3.9% (3.5–4.4) for adolescents aged 12–14 years and 5.4% (4.8–5.9) for those aged 15–16 years. The prevalence was highest in the South-East Asian region (6.1%, 4.4–7.7) and lowest in the Western Pacific region (2.0%, 1.7–2.4). The prevalence of smokeless tobacco use decreased in 57 of 100 countries, increased in 32 countries, and remained unchanged in 11 countries. Current cigarette smoking (odds ratio [OR]=2.00, 95% CI=1.68–2.39), other tobacco product use (OR=6.03, 95% CI=4.92–7.40), tobacco advertisement exposure (OR=1.44, 95% CI=1.19–1.74), being offered free tobacco products (OR=2.01, 95% CI=1.66–2.42), and not being taught about dangers of smoking (OR=1.28, 95% CI=1.09–1.50) were all positively associated with current smokeless tobacco use.ConclusionsSmokeless tobacco use among adolescents remains a public health concern worldwide. Although the prevalence among adolescents decreased in most countries, it remains high especially in the South-East Asian region. More strict and effective strategies and measures are needed to further curb the smokeless tobacco use among adolescents.

Use of Traditional Smokeless, Snus, and Dissolvable Tobacco Among U.S. Youth

Snus, dissolvable, and traditional smokeless tobacco product use is often amalgamated in youth epidemiologic research despite differences across these products. Prevalence, trends, and correlates of U.S. youth use across different classes of oral tobacco products are unknown. Using 2011-2020 National Youth Tobacco Survey (N=193,933) data, the authors tested for cross-year linear and quadratic trends in the weighted prevalence of ever and current use of traditional smokeless tobacco, snus, and dissolvable tobacco. Multivariable logistic regressions estimated the demographic and tobacco use factors associated with the use of different oral tobacco products in 2020. Analyses were conducted in 2022. During 2011-2020, there were declines in the prevalence of ever use of traditional smokeless tobacco (11.0% to 5.6%; linear trend, p<0.0001) and snus (5.2% to 2.4%; p<0.0001) but no change in ever dissolvable tobacco use (0.8%-1.2%). In 2020, an estimated 1,546,000 U.S. youth ever used traditional smokeless tobacco (7.7% high school, 3.0% middle school), 662,000 ever used snus (high school: 3.5%, middle school: 1.0%), and 326,000 ever used dissolvables (high school: 1.5%, middle school: 0.8%). In 2020, females and non-Hispanic Blacks and Hispanics had lower smokeless or snus ever use odds than males and non-Hispanic Whites, respectively, whereas sexual minorities (than heterosexuals) or those speaking a language other than English at home were more likely to report ever use of dissolvable tobacco. Flavored tobacco use was common, particularly for dissolvable current users (72.8% used any flavor). Differences in the epidemiology of oral tobacco use across product types among U.S. youth suggest that oral tobacco products should be disaggregated in future research and policy strategies.

Prevalence of tobacco consumption and the associated factors among the adults in an urban slum: Findings from the WHO STEPwise survey.

Despite Pakistan's stringent tobacco control policy, its effective implementation has always been a challenge, leading to rising tobacco consumption. The aim of the study is to determine the prevalence of tobacco consumption and associated risk factors in the adult population of deprived urban areas. A community-based, cross-sectional survey was conducted from February to July 2019, comprising 607 adults residing in the urban squatter settlement of Lahore using a standardized questionnaire, the WHO STEPwise approach. The outcome was current use of tobacco and/or smokeless tobacco daily. Multivariable logistic regression was applied to determine factors associated with smoking and smokeless tobacco consumption. Among 607 participants, about 64% were females, 49.3% were illiterate, 64.9% were currently unemployed, and 47.1% belonged to the low-income group. The prevalence of tobacco smoke was 10.5% (95% CI: 8.07-12.93), and smokeless tobacco consumption was 8.6% (95% CI: 6.38-10.82). Multivariable logistic regression found that smokeless tobacco was more likely among the aged 50-59 years (AOR=4.1; 95% CI: 1.1-13.8) and unemployed (AOR=3.6; 95% CI: 1.1-12.2). Whereas tobacco smoking was more likely among the aged 30-39 years (AOR=5.5; 95% CI: 1.8-16.7), Urdu ethnicity (AOR=2.9; 95% CI: 1.2-7.3), unemployed (AOR=6.6; 95% CI: 2.9-14.9), and never exposed to any media (AOR=3.2; 95% CI: 1.8-17.4). Participants exposed to health warnings were less likely to smoke (AOR=0.02; 95% CI: 0.01-0.05). This study reports a high prevalence of tobacco consumption among adults and calls for effective policy implementation using a multi-pronged approach, including health professionals and media, to spread awareness about the harmful effects of tobacco and endorsement of health warnings on tobacco packaging.

A Comparison of Mental Health and Substance Use Risk Factors between Veteran and Non-Veteran Connected Families in Nebraska, 2016 and 2019

Background: Many studies have found that Veterans and their family members have experienced more mental health disorders and substance use. The purpose of this study compared mental health and substance use risk indicators between U.S. military Veteran and non-Veteran- connected families, so earlier and more targeted interventions can be developed. Methods: The data for this study were based on the 2016 and 2019 Behavioral Risk Factor Surveillance System (BRFSS) survey in Nebraska. The comparisons between Veterans and non-Veteran connected families were made on a set of 9 indicators, including general health status (fair/poor), poor mental health defined as not good on 14 or more of the past 30 days (yes/no), ever told they had depression (yes/no), current cigarette smoker (yes/no), current smokeless tobacco use (yes/no), current e-cigarette use (yes/ no), any tobacco use (yes/no), any alcohol consumption in the past 30 days (yes/no), and binge drank in the past 30 days (yes/no). A Chi-Square test was used to determine significant differences between the indicators. Results: When comparisons were made between Veterans and non-Veterans, some significant differences were found in both 2016 and 2019. For example, in 2016, non-Veterans were more likely to have poor mental health, ever told they had depression, be a current smoker, and engage in binge alcohol drinking. Significant differences were also found between non-Veterans and the spouses and significant others of Veterans for selective risk factors in 2016 and 2019. For example, in both years, spouses and significant others of Veterans were considerably more likely to have greater mental health distress and depression. However, they were less likely to use alcohol or engage in binge drinking. Conclusion: These results indicate that spouses and significant others of Veterans are more likely to suffer from depression and other mental health conditions than Veterans themselves and the non-Veteran population. Organizations serving military families should develop a greater knowledge and understanding of the culture of military families to implement strategies that effectively support Veteran spouses and partners.

Estimating the quantity of smokeless tobacco consumption among older adults in India

Problem consideredGlobally, smokeless tobacco (SLT) users are highest in India. Whilst, studies examined prevalence and determinants of SLT use, no evidence exists which examined the quantity of SLT consumed. MethodsStudy utilized national representative data from the Longitudinal Aging Study in India (LASI) which adopted a multistage stratified area probability cluster sampling design. First, we computed the average SLT consumption per day (in grams) from the LASI data. Consecutively, we further utilized the projected population approximations from the 26th round of the official United Nations population estimates and prevalence rate of current SLT use from the Global Adult Tobacco Survey (GATS-2) and LASI Survey, separately to estimate SLT use pattern for the entire Indian population aged 45 or above. ResultsThe prevalence of current SLT use among older adults was 17.2% wherein the SLT use is higher among men (20.8%). On average, an older adult consumes 1.01 g of SLT on a daily basis. The range of SLT quantity consumed by users’ according to the LASI and GATS-2 prevalence, varies from 65,000 kg to 85,000 kg per day whereas, annual consumption ranges from 23 million kilograms to 32 million kilograms, respectively. ConclusionThe development of SLT cessation services examining the quantitative aspects of SLT use would be beneficial in tackling the high SLT burden in India and improving the rates of intention to quit.

Patterns of tobacco use in low and middle income countries by tobacco product and sociodemographic characteristics: nationally representative survey data from 82 countries

ObjectivesTo determine the prevalence and frequency of using any tobacco product and each of a detailed set of tobacco products, how tobacco use and use frequency vary across countries, world...

Smokeless tobacco use and oral potentially malignant disorders among people living with HIV (PLHIV) in Pune, India: Implications for oral cancer screening in PLHIV.

In India, smokeless tobacco (SLT) is a predominant form of tobacco used among people living with HIV (PLHIV). Despite SLT being a risk factor for oral potentially malignant disorders (OPMDs), no prior studies have quantified the association of OPMDs with SLT use among PLHIV. This limits the planning of preventive and control strategies for oral cancer among PLHIV, who are at higher risk for the disease. We enrolled 601 PLHIV and 633 HIV-uninfected individuals in an oral cancer screening study at BJ Government Medical College, Pune, India. Oral cavity images were collected using an m-Health application and reviewed by three clinicians. Participants with two clinician positive diagnoses were deemed to have suspected OPMDs. Prevalence ratios (PRs) were used to quantify the association between suspected OPMDs and SLT use among PLHIV. PRs for current SLT users, across HIV status and use duration were also estimated. Corrected PRs were obtained by modifying the maximum likelihood estimation. Models were adjusted for age, smoking, alcohol use and CD4 counts. Of those enrolled, 61% were men, median age was 36 years (IQR: 28-44), and 33% currently use SLT. Proportion of current SLT users was similar across PLHIV and HIV-uninfected groups but use duration for current SLT use was higher among PLHIV(p<0.05). Among PLHIV, current SLT users had a 5-times (95% CI:3.1-7.0) higher prevalence of suspected OPMDs, compared to non-users. Relative to HIV uninfected individuals with the same SLT use duration, significant associations with suspected OPMDs were seen for PLHIV with<10 use years (PR: 3.5, 95% CI: 1.5-8.1) but not for PLHIV with≥10 use years (PR: 1.3, 95% CI: 0.9-1.8). PLHIV that are current SLT users are at high risk of OPMDs and potentially oral cancer. The development of strategies for screening, early detection, and management of OPMDs must be considered for this group.

Disparities in Tobacco Use by Disability and Type: Findings From the 2019 National Health Interview Survey

People with disabilities report a higher prevalence of cigarette use than people without disabilities. However, evidence is limited on the relationships between disability type, degree of functional difficulty, and other tobacco product use. Data from the 2019 U.S. National Health Interview Survey were used to estimate the prevalence and odds of tobacco product use for 6 disability types and degree of functional difficulty. Bivariate and multivariable analyses conducted in 2021 examined the associations between tobacco product use and disability type. Compared to adults who reported no difficulty, current cigarette use prevalence was higher for adults who reported a lot of difficulty/cannot do at all to vision (21.5% vs 13.1%), hearing (19.6% vs 13.6%), mobility (20.0% vs 12.9%), and cognitive (25.4% vs 12.9%) disability questions. The odds of current cigarette (AOR=1.32), pipe (AOR=1.85), and smokeless tobacco (AOR=1.57) use were significantly higher for adults who reported a lot of difficulty/cannot do at all to any disability question and significantly higher for current cigarette (AOR=1.24), e-cigarette (AOR=1.33), pipe (AOR=1.45), and smokeless tobacco (AOR=1.29) use for adults who reported some difficulty to any disability question than those who reported no difficulty. Pipe use was correlated with mobility difficulty (AOR=1.68), and smokeless tobacco use was correlated with hearing difficulty (AOR=1.95). People who reported difficulty with vision, hearing, mobility, or cognition had a higher cigarette use prevalence than people without disabilities. Other tobacco use differed by disability type. Future research should tailor tobacco interventions to reduce these disparities.