Health Effects Of Tobacco Use Research Articles

Oral health status of male adolescent smokeless tobacco users in Saudi Arabia

Few studies have evaluated the oral effects of smokeless tobacco use in adolescents. This study described the oral health status of adolescents who were daily users of local smokeless tobacco (shamma) in Saudi Arabia. A convenience sample of 270 middle-school male students completed a questionnaire and received an oral examination and a saliva cotinine test. Among the students, 96% had plaque deposits (mean plaque index score 1.66); 41% had gingivitis (mean clinical attachment loss 1.1 mm); 56% had dental caries (mean decayed, missing, filled teeth score 2.1) and 86% had at least I mucosal lesion. The levels of plaque, gingivitis, dental caries and periodontitis among smokeless tobacco users were similar to those of most adolescents regardless of tobacco use. Almost 9/10 students had a mucosal lesion that could be related to smokeless tobacco use. Strong measures should be taken to increase students' awareness of the adverse health effects of tobacco use and to control their access to tobacco.

Loss of sensitivity to varenicline in monkeys receiving chronic nicotine treatment.

Given the adverse health consequences of tobacco use, there is a need to understand pharmacologic mechanisms of drug action as a function of nicotine treatment. Here, the effects of nicotine and varenicline (Chantix) were compared under two distinct conditions of nicotine treatment. One group (n=5) of rhesus monkeys discriminated nicotine base (1.78 mg/kg) from saline; the same dose of nicotine was discriminated by a second group of monkeys that received 8.9–10.68 mg/kg/day. Nicotine dose‐dependently increased nicotine‐lever responding in both groups; the ED50 value without daily nicotine treatment (0.47 mg/kg) was not different from that with daily nicotine treatment (0.30 mg/kg). In contrast, varenicline produced 98% nicotine‐lever responding in monkeys not receiving nicotine daily (ED50 value = 0.53 mg/kg), but only produced a maximum of 10% nicotine‐lever responding in monkeys receiving nicotine daily. Although a loss in the discrimination of varenicline in monkeys receiving large doses of nicotine daily is consistent with varenicline having lower agonist efficacy than nicotine, their combined effects did not confirm this possibility inasmuch as varenicline did not shift the nicotine dose‐effect function rightward. A difference in agonist efficacy at a common receptor type is not sufficient to account for the striking loss of sensitivity to varenicline resulting from nicotine treatment.

The Food and Drug Administration's Regulation of Tobacco: The Center for Tobacco Products' Office of Science

The Family Smoking Prevention and Tobacco Control Act (TCA) was signed into law on June 22, 2009, and provided the Food and Drug Administration (FDA) broad regulatory authority with respect to the manufacture, marketing, and distribution of tobacco products. The three public health goals of the Center for Tobacco Products (CTP), FDA, are to prevent youth initiation of tobacco use, decrease harm and/or addictiveness of tobacco products, and encourage tobacco use cessation. The CTP has established an Office of Science to ensure that sound science exists with which to develop regulatory actions. Although there is a vast and sound science base with regard to numerous provisions within the TCA, new research will not only help assess the impact of FDA regulatory authority over tobacco products but will inform future regulatory activities. In order to meet the broad science demands within the TCA, the CTP developed seven research priority areas: 1understanding the diversity of tobacco products; 2reducing addiction to tobacco products; 3reducing toxicity and carcinogenicity of tobacco products and smoke; 4understanding adverse health consequences of tobacco use; 5understanding communications about tobacco products; 6understanding tobacco product marketing; and 7understanding economics and policies on tobacco use and perceptions.

Discussions with adults and youth to inform the development of a community-based tobacco control programme

Project Advancing Cessation of Tobacco in Vulnerable Indian Tobacco Consuming Youth (ACTIVITY) is a community-based group randomized intervention trial focused on disadvantaged youth (aged 10-19 years) residing in 14 low-income communities (slums and resettlement colonies) in Delhi, India. This article discusses the findings of Focus Group Discussions (FGDs) conducted to inform the development and test the appropriateness of Project ACTIVITY's intervention model. The findings of the FGDs facilitated the understanding of factors contributing to increased tobacco uptake and cessation (both smoking and smokeless tobacco) among youth in this setting. Twenty-two FGDs were conducted with youth (10-19 years) and adults in two urban slums in Delhi. Key findings revealed: (i) youth and adults had limited knowledge about long-term health consequences of tobacco use; (ii) socio-environmental determinants and peer pressure were important variables influencing initiation of tobacco use; (iii) lack of motivation, support and sufficient skills hinder tobacco cessation and (iv) active involvement of community, family, religious leaders, local policy makers and health professionals is important in creating and reinforcing tobacco-free norms. The results of these FGDs aided in finalizing the intervention model for Project ACTIVITY and guided its intervention development.

Knowledge of the health impacts of smoking and public attitudes towards tobacco control in the former Soviet Union

AimsTo describe levels of knowledge on the harmful effects of tobacco and public support for tobacco control measures in nine countries of the former Soviet Union and to examine the...

FDA's Tobacco Products Research Program likely to play role in cancer prevention

Editor's note: This is Part 2 of a 2-part series on cancer prevention research. Part 1 was published in the June 1 issue of “CancerScope.” When the Family Smoking Prevention and Tobacco Control Act (TCA) became law in 2009, giving the US Food and Drug Administration (FDA) the power to regulate tobacco products, the FDA created the Center for Tobacco Products. The center's principal mission is to regulate the manufacture, marketing, and distribution of tobacco products. According to David Ashley, PhD, director of the center's Office of Science, scientific research is necessary to inform the FDA's regulations, which involve reducing initiation, promoting cessation, and reducing harms for those who use tobacco products. Understanding the diversity of tobacco products; Reducing addiction to tobacco products; Reducing the toxicity and carcinogenicity of tobacco products and smoke; Understanding the adverse health consequences of tobacco use; Understanding communications about tobacco products; Understanding tobacco product marketing; and Understanding how economics and policies affect tobacco product use. Center representatives add that scientists also can submit basic research proposals if they can inform regulatory issues. Within this framework, the FDA recently announced 56 questions they would like to see answered through research. (For the full list of questions, visit the Center for Tobacco Products' summary of its meeting on research priorities at www.fda.gov/TobaccoProducts and click on “News & Events.”) “They're growing a regulatory and research arm from scratch, in a paradigm that's totally foreign to the FDA,” says Peter Shields, MD, president of the American Society of Preventive Oncology and deputy director at the Lombardi Comprehensive Cancer Center at Georgetown University Medical Center. “If they applied any of the rules they use for drugs or food to tobacco, they would get rid of it, but the law prohibits them from banning it.” Because Congress will never ban tobacco, the FDA is trying to limit as much as possible the harm of tobacco products, he says. “Tobacco research has been underfunded for 20 years, and now the FDA needs data that doesn't exist,” says Dr. Shields. “There are fundamental, basic questions that need to be answered.” National Study Will Assess Regulation Impact The first large-scale FDA/National Institutes of Health (NIH) study to be announced since the FDA gained authority to regulate tobacco products is a national study of tobacco users to monitor and assess the behavioral and health impacts of new government tobacco regulations. The effort is a collaboration between the NIH's National Institute on Drug Abuse and the Center for Tobacco Products. What makes people susceptible to tobacco use; Use patterns and resulting health problems; Patterns of tobacco cessation and relapse in the era of tobacco regulation; The effects of regulatory changes on risk perceptions and other tobacco-related attitudes; and Differences in attitudes, behaviors, and key health outcomes in racial/ethnic, gender, and age subgroups. Tobacco research has been underfunded for 20 years, and now the FDA needs data that doesn't exist. There are fundamental, basic questions that need to be answered.—Peter Shields, MD Knowledge gleaned from this study will help the FDA target the most effective actions to decrease the toll of tobacco use on the nation's health, said Margaret Hamburg, FDA commissioner, when the study was announced last fall. More specifically, the results will help the FDA assess the impact of the TCA and understand how best to use its regulatory authority regarding product marketing and standards and communicating the risks of tobacco use. Additional Efforts Similar to the Department of Defense funding breast cancer research, the FDA is contracting with the NIH to award additional grants. Among the questions to be answered is whether the FDA should regulate levels of nicotine. In addition, researchers need to test the blood and urine of people using the new tobacco products to understand their impact. Tobacco companies claim these products reduce carcinogens, but scientists currently do not have those tests. As a result, the best options now are testing individuals for certain biomarkers and developing and validating specific modeling that will determine how regulators can best impact public health, Dr. Shields says. Researchers also need to understand how people use the new products and what they think of them. Clinical trials are difficult to conduct because the typical tobacco user does not want to participate in a trial, Dr. Shields adds. “Tobacco is a complex problem that's been around a long time, and it won't be solved overnight,” he says.

Tobacco Use Among Married Women in Nepal: The Role of Women’s Empowerment

This study documented the prevalence and correlates of tobacco use among women of reproductive age in Nepal using nationally representative data. We utilized the 2006 Nepal Demographic and Health Survey that interviewed 10,793 women and 4,397 men. We analyzed the couple's data or households (N = 2,600) in which both husband and wife were interviewed. We examined the effects of women's empowerment-measured by education, employment, intra-household decisions, and age-on their tobacco use controlling for other individual and household characteristics. Women's empowerment had mixed effects on tobacco use. While women's education was inversely associated with their tobacco use, their age, employment and ability to make intra-household mobility decisions were positively associated with smoking. Women with primary and beyond primary education were 48 and 92 % less likely to smoke compared to women with no education, respectively. Tobacco use among women increased dramatically with age from 8 % in teen years to 42 % in their forties. A 1 year increase in age increased the odds of tobacco use by 6 %. Women whose husbands smoked were twice as likely to smoke. Nepal should not only restrict tobacco use in public places by implementing its Tobacco Control and Regulatory Act of 2010 but also focus on encouraging smoke-free homes by increasing awareness about the health consequences of tobacco use and secondhand smoke among populations most likely to smoke that include nearly all men, employed women, women with low levels of education, women whose spouses smoke and those who are 30 and above in age. Additionally, a long term goal should be to ensure at least 5th grade of education for all girls.

Tobacco expenditure and its implications for household resource allocation in Cambodia

ObjectivesTo assess the determinants of smoking behaviour and to estimate the impact of tobacco consumption on the consumption of other commodities by Cambodian households.MethodsTo assess the determinants of smoking in...

The Epidemiology and Health Effects of Tobacco Use

In the US 20.6% of adults and 19.5% of high school students are current cigarette smokers. Smoking is responsible for 5 million deaths worldwide each year and is known to cause more and a greater variety of human disease than any other known toxin. It causes multiple cancers, significant cardiovascular, respiratory and reproductive disease, and has been linked to health problems in most organ systems of the body. The harmful effects of tobacco begin in young smokers, who experience respiratory symptoms, increased rates of infection, and evidence of cardiovascular effects soon after beginning to smoke, even at low levels of cigarette use. Declines in the rate of cigarette smoking have stalled in the developed world. In the US, the Healthy People 2010 goal of decreasing current smoking in youth to below 16% has not been met. Smoking rates are increasing in the developing world, and there is already a rise in tobacco related problems in those areas least able to cope with the increased burden of disease. Continued efforts on a global scale are needed to combat the persistent and growing problem of tobacco use. Keywords: Tobacco, smoking, health effects, epidemiology, adolescents

A content analysis of tobacco control policy in the US Department of Defense

We conducted a content analysis of the US military tobacco policies at the Department of Defense, each respective military service (Army, Air Force, Navy, and Marine Corps), and their Major Commands (MAJCOM). Ninety-seven policies were evaluated using the Military Tobacco Policy Rating Form (MTPRF). More than three quarters addressed the following domains: (1) deleterious health effects of tobacco use; (2) environmental tobacco smoke; (3) designation of smoking areas; (4) tobacco prevention/cessation programs; and (5) smokeless tobacco. Few policies (2.1 per cent) mentioned relevant Department of Defense and respective service tobacco use prevalence statistics. Smoking as non-normative or incompatible with military service, the impact of tobacco use on military readiness, and the tobacco industry were addressed infrequently (6.2 per cent, 33.0 per cent, and 8.2 per cent, respectively). Future military tobacco policies should address important omissions of critical information such as the current service tobacco use prevalence, effects on readiness, and smoking as non-normative.

Assessing the Current Status of Tobacco Dependence Education Curricula in US Physician Assistant Programs

Tobacco use continues to be the single most preventable cause of death and disease in the United States. A paradigm shift is needed in physician assistant (PA) education to address tobacco dependence as a chronic, relapsing disease requiring patient education, counseling, treatment, and follow-up. A national study was conducted to assess the existing tobacco dependence education currently offered in U.S. PA programs. An established tobacco dependence curriculum survey was revised and mailed to the 141 accredited PA programs in the United States during the 2008-2009 academic year. The survey asked respondents to report the following with regard to tobacco dependence education content in their PA program; (1) Perceived self-efficacy and barriers; (2) Medical topics covered and minutes spent; (3) Evaluation of students' competency level; (4) Tobacco courses, topics, and resources used; and (5) Level of tobacco-cessation competency expected upon graduation. A total of 79 surveys were returned (56% response rate). Though, on average, over 827 minutes (14 hours) were devoted to tobacco dependence education curriculum, most minutes (223 minutes) were spent on the health effects of tobacco use, with only 42 minutes spent on cessation counseling, 55 minutes on medications, and 13 minutes on integrating tobacco-cessation into clinical practice. PA educators have the unique opportunity to affect tobacco-related morbidity and mortality. The present study demonstrates that PA instructors are more than adequately teaching students about tobacco use. However, it is not clear if students are being adequately taught how to assist patients to quit using tobacco.

Pharmacologic agents for smoking cessation: a clinical review.

Tobacco use has been clearly demonstrated to have negative health consequences. Smoking cigarettes is the predominant method of tobacco use. The tar contained within cigarettes and other similar products is also harmful. Other tarless tobacco containing products do exist but carry no significantly decreased risk. While nicotine is considered to be principally responsible for tobacco addiction, other chemicals in the cigarette smoke including acetaldehyde may contribute to the addictive properties of tobacco products. The adverse health consequences of tobacco use have been well documented. Studies have shown that a combined behavioral and pharmacological approach is more effective in smoking cessation than either approach alone. Pharmacotherapy can achieve 50% reduction in smoking. With pharmacotherapy the estimated 6-month abstinence rate is about 20%, whereas it is about 10% without pharmacotherapy. The first-line of drugs for smoking cessation are varenicline, bupropion sustained release, and nicotine replacement drugs, which are approved for use in adults. Data are insufficient to recommend their use in adolescents. This article reviews the use of pharmacological agents used for smoking cessation. A brief overview of epidemiology, chemistry, and adverse health effects of smoking is provided.

Teaching about tobacco in medical schools: A worldwide study

As medical practitioners of the future, medical students should be taught about tobacco control strategies and smoking cessation interventions. By including education about tobacco in the medical curricula, they can be informed about the health effects of tobacco use and learn to assist smokers to quit. Our study aimed to estimate the extent of teaching about tobacco and smoking cessation techniques in medical schools worldwide and compare with results we reported 10 years ago, to determine the content of curricula and range of teaching formats and to identify barriers to teaching about tobacco in medical schools and solutions. A cross-sectional survey of all existing medical schools (n = 2090) in 171 countries was conducted. A questionnaire was designed, translated and sent to all medical schools. Main outcome measures included whether and how tobacco is taught; comparisons with the survey conducted 10 years ago; tobacco content in the curriculum; format of teaching; and barriers to teaching and solutions. 665 medical schools from 109 countries completed the full questionnaire, with a response rate of 31.8% from medical schools and 64% of countries and consisting of 39% of medical schools in developed and 28% in less developed countries. A further 67 medical schools responded to a single question on whether they taught about tobacco. The total response rate was 35%. Of 561 medical schools responding to questions on teaching options, 27% of medical schools taught a specific module on tobacco compared with only 11% in our survey of medical schools conducted a decade ago; 77% integrated teaching on tobacco with other topics compared with 40% 10 years ago; 31% taught about tobacco informally as the topic arose (vs. 58%) and 4% did not teach about tobacco (vs. 12%). Most common topics taught were: health effects of smoking (94%), health effects of passive smoking (84.5%), epidemiology of tobacco use (81%), nicotine dependence (78%) and taking a smoking history (75%). Most popular method of teaching was by lectures (78%), case study discussions and problem-based learning exercises (51%), class readings 46%, in the clinical setting with real patients (45%), special projects and assignments (45%) and patient-centred teaching approaches, such as role plays (31%). Significantly, more barriers to teaching were identified by less developed countries (>60%) including: lack of available teaching time in the medical program, limited organisational ability to include new subjects, lack of staff resources to teach, lack of current plans to introduce a tobacco curriculum, lack of a key person to champion and organise teaching, lack of financial resources and lack of incentives or advantages to teach. A majority described solutions to these problems. A case study of education on tobacco throughout the medical curriculum is presented. We found an encouraging increase in the extent of teaching on tobacco in medical schools over 10 years. We report that although progress has been made to address the teaching of tobacco in medical schools worldwide, there is a great deal more effort required so that education on tobacco is an ongoing part of medical curricula. The teaching content is generally based on evidence-based smoking cessation guidelines

Gruesome photos on cigarette packages reduce tobacco use

Gruesome photos on cigarette packages reduce tobacco use

Review: the need for smoking cessation among HIV-positive smokers.

Most HIV-positive persons in the U.S. smoke cigarettes. Despite substantial clinical advances in HIV care in the era of highly active antiretroviral therapy (HAART), HIV-positive persons are at high risk of tobacco-related disease and death. HIV-positive persons have complex social, economic, psychiatric, and medical needs that may impact smoking behavior and response to smoking cessation interventions, but there is a dearth of research on smoking cessation interventions tailored to HIV-positive persons. HIV care providers should treat tobacco use with the array of evidence-based smoking cessation treatments available, updating their clinical practice as new data emerge. This article reviews the literature on the health consequences of tobacco use in HIV-positive persons, the treatment of tobacco dependence, and the research to date on smoking cessation interventions in HIV-positive persons, and it presents recommendations for future research and intervention.

Knowledge, attitudes and prevalence of tobacco use among physicians and dentists in Oman.

Tobacco use among Omani physicians and dentists has not been studied, so we conducted a crossectional survey using a WHO questionnaire to measure prevalence and to learn about smoking practices among this population and about their knowledge and attitudes of the health effects of tobacco use and tobacco control. The 1191 subjects who participated (787 men and 404 women) ranged in age from 24 to 65 years with a mean (SD) of 41.7 (6.8) years for men and 38.1 (6.9) years for women. The prevalence of tobacco use was 16.4% among males and less than 1% among females. Manufactured cigarettes were the most common form of tobacco used (14.7%), followed by smokeless tobacco (2.2%) and waterpipes (1.7%). Tobacco users were significantly less favorable to strict control and policy measures than never tobacco users and had less knowledge of some of the health effects of tobacco use. Tobacco use among physicians and dentists in Oman is lower than in other countries in the region, but remains a cause of concern. Programs and policies should strive to maintain the low level of tobacco use or reduce it further.

Integrative system dynamics: analysis of policy options for tobacco control in New Zealand

AbstractTobacco use is a global problem and the health consequences are far reaching. Systemic approaches are needed to help investigate policies to reduce the adverse health effects of tobacco use. This paper provides an overview of the system dynamics model that has been developed to assist the Ministry of Health to evaluate the dynamic consequences of tobacco control policies in New Zealand. The model consists of six sectors: population; smoking prevalences; tobacco consumption; second hand smoke; relative risks and tobacco attributable deaths. The model is simulated for 20–30 years into the future. The simulation package used is'iThink', and a user interface is presented for policy analysis. A range of illustrative scenarios are provided, including: business as usual; fiscal strategies involving less affordable cigarettes; harm minimization strategies involving either less addictive cigarettes or less toxic cigarettes and combinations of the above policies. The main output variables (performance measures) include current smoking prevalence, tobacco consumption and tobacco attributable mortality. Finally some areas for future model enhancement are identified. Copyright © 2009 John Wiley & Sons, Ltd.

Tobacco smoking cessation management: integrating varenicline in current practice

Tobacco smoking is widespread and is one of the world's most prevalent modifiable risk factors for morbidity and mortality. It is important to facilitate smoking cessation better in order to reduce the health consequences of tobacco use. The most effective approach assisting smokers in their quit attempts combines both pharmacotherapy and nonpharmacological interventions. This review summarizes the latest international epidemiological data available on tobacco use, considers the associated effects on health, and reviews existing policies against tobacco use. Among the interventions for smoking cessation, the three major pharmacotherapies (which have demonstrated efficacy when combined with behavioral support) are discussed: nicotine replacement therapy (NRT), bupropion, and varenicline. As the newest pharmacotherapy made available in this area, particular consideration is given to varenicline, and a review of our clinical experience is offered.

Smoking and smoking cessation in Latin America: a review of the current situation and available treatments

Tobacco smoking is a growing problem throughout Latin American countries, especially in underdeveloped countries where poverty and lack of education about the dangers of smoking may make people more susceptible to becoming smokers. Moreover, the economies of many Latin American countries have become dependent on the production of tobacco. Furthermore, because of the associated promotion of tobacco, smoking has integrated into many Latin American cultures. Nevertheless, the harmful health effects of tobacco use are well documented, including greatly increased risks of developing chronic obstructive pulmonary disease, cardiovascular disease, and many forms of cancer. The medical costs associated with treating these diseases far outweigh the economic benefits of producing and selling this deadly crop. To control the tobacco pandemic in Latin American countries, nicotine addiction must be recognized and treated as a disease. Governments, both national and local, need to be more involved in enacting anti-smoking policies such as higher tobacco taxation, control of illegal tobacco smuggling, and reimbursement of medical smoking cessation interventions. The training of health professions in the area of nicotine addiction must also be improved, so that they may better assist smokers in their quit attempts and advise patients on, and prescribe, effective smoking cessation pharmacotherapies.

A formative examination of messages that discourage tobacco use among junior enlisted members of the United States military

Smoking prevalence among junior enlisted members of the United States armed forces significantly exceeds that of civilians. Furthermore, nearly 40% of junior enlisted who smoke reported they initiated smoking after joining the military. Although the tobacco industry has attempted to develop messages that encourage military members to use tobacco, no research has examined messages that would counteract industry messages and effectively discourage military members from using tobacco. This study conducted 24 focus groups on four Air Force and two Army installations (N = 189 personnel) to discover effective messages that discourage tobacco use among junior enlisted personnel. Four message themes were identified that hold promise for tobacco control efforts in the military: (a) smoking harms one's ability to positively influence others, (b) smoking increases the chance a military member will be discharged from the military prematurely, (c) smoking lowers readiness to fight and win wars, and (d) smokers are not as productive as other military personnel. In contrast, messages focusing on manipulation by the tobacco industry and the health effects of tobacco use were not strongly supported by military personnel.