Smokeless Tobacco Chewing Research Articles

IJCM_161A: Lifestyle related risk behaviour among hypertensive fishermen: Baseline: characteristics of an interventional study

Background: Fishing forms one of the essential livelihood options of inhabitants of the coastal line of the country. It is a stressful and hazardous occupation making fishermen prone to multiple lifestyle diseases. A number of researches have revealed that modifiable risk factors of NCDs are prevalent and are associated with NCDs, including hypertension among fishermen. Risk factors contributing to these include; tobacco and alcohol consumption, unhealthy dietary habits and obesity Objective: To identify the socio-demographic and lifestyle related risk factors among hypertensive fishermen at baseline of an interventional study Methodology: Baseline data for an interventional study was collected among hypertensive fishermen. Participants were recruited from Malpe and Kaup villages of Udupi district for the intervention and routine care arms respectively using a purposive sampling method identified from existing database. Data was collected using a pre-tested questionnaire using standard protocols. A health educational video was then shown to the participants of the intervention arm. The baseline data of both arms was entered and analysed using SPSS Version.26.0. Results: The mean (±SD) age of 112 participating fishermen from both study arms was 58.53 (± 8.72) years. Around 62.5% and 37.5% fishermen had blood pressure in grade 2 and grade 1 range respectively. More than half (61.6%) were ever tobacco users with 50.9% indulging in the habit of smokeless tobacco chewing. Majority (90.2%) were consumers of alcohol with 33% users indulging in hazardous drinking and showing dependence patterns. Nearly three-fourth (70.6%) fishermen were found to be obese and only 1.8% showed a low risk of cardiovascular diseases based on their waist-hip ratio. Conclusion: Risk factors for hypertension and other NCDs like substance use and central obesity were found in more than half of the hypertensive fishermen. Novel interventions facilitating behavioural modification in such occupational groups is essential

Screening of the Combined Risk of Genetics and Epidemiology on Infertility Among Indian Men: Synergistic Effect of AZFc Partial Deletions and Habits of Smokeless Chewing Tobacco.

The AZFc partial deletions of Y chromosome and lifestyle/epidemiological factors such as the use of smokeless chewing tobacco (SCT) exhibit intriguing variations in their association with male infertility across the population, ethnicity, and genetic background. Here, a pioneering attempt has been made to elucidate the interactions of such deletions with the habits of SCT consumption among the participating individuals, using their large epidemiological data. This screening program was conducted among Bengali-speaking men in West Bengal, India. We screened the prevalence and association of distinct partial deletions (gr/gr, b1/b3, and b2/b3) of the AZFc region using locus-specific sequence-tagged site (STS) markers among 728 case subjects and compared them with 264 ethnicity- and age-matched proven-fertile control men. The recorded epidemiological data of the study group and the outcome of partial deletion analysis were compiled to frame the plausible Gene × Epidemiological factor (G × E) interactions. The gr/gr deletion was reported to be significantly associated with azoospermic (p = .0015, odds ratio [OR] = 3.413) and oligozoospermic (p = .0382, OR = 3.012) case subgroups, and b1/b3 deletions were also detected among the infertile persons only. The G × E model revealed that men who carried microdeletions as well as were SCT users had an elevated risk of infertility (p = .002, OR = 6.38). The study highlights the fact that AZFc partial deletions and SCT, when co-occurred, synergistically increase the risk of infertility among men. This work helps to get more insight into the etiology of male infertility in the light of gene-environmental interaction.

Betel quid may stimulate oral submucous fibrosis by inducing increased mitochondrial reactive oxygen species generation via copper overload

Betel quid (BQ), a smokeless chewing tobacco that includes the areca (betel) nut among its ingredients, increases the risk of oral submucous fibrosis (OSMF) and oral cancer, a disease classified as an potentially malignant oral disorder. A wound from the coarse areca nut fibers, as well as the catechin, copper, and alkaloids (e.g., arecoline, arecaidine, guvacoline, and guvacine) in BQ, may stimulate reactive oxygen species (ROS) production, causing myofibroblast differentiation and contraction, fibroblast proliferation, collagen cross-linking, and collagen phagocytosis inhibition, which could result in OSMF and oral cancer. Mitochondria, the primary source of ROS in OSMF, play a crucial role in cellular metabolism. Copper is required for mitochondrial bioenergetics, dynamics, and mitophagy, affecting metabolic reprogramming and cell fate. Given that copper levels are elevated in patients with OSMF, we hypothesize that increased mitochondrial ROS production induced by copper overload and areca nut components may regulate fibrosis-related gene expression and myofibroblast differentiation. Therefore, targeting this fundamental pathomechanism is an appropriate strategy for developing new therapeutic options for OSMF.

Tobacco chewing and associated factors among a vulnerable youth population in Sri Lanka

BackgroundTobacco in any form kills millions of people every year. Tobacco addiction among youth shows an increasing trend while smokeless type is becoming more common. This study aimed to describe the lifestyle of chewing smokeless tobacco among a group of high-risk youth population in Sri Lanka.MethodsA descriptive cross-sectional study was conducted among a sample of 1431 youths aged between 15 to 24 years residing in urban slums in Colombo Sri Lanka, using a cluster sampling technique combined with probability proportionate to size technique. Data were collected using an interviewer-administered questionnaire. Chewing smokeless tobacco was assessed using betel quid chewing and commercially prepared tobacco and areca nut packet chewing. Current chewer was defined as who had the practice of chewing during past 30 days.ResultsThe mean age of the study sample was 17.53 (95% CI: 17.40–17.65). Of the 1431 respondents, 57% were males and 43% were females. The prevalence of current smokeless tobacco chewers was 44.9% and among them 90.8% were males and 9.8% were females. Around 31.3% did not have smokeless tobacco chewing practice (Male-5.9%, Female-64.9%). Among the current smokeless tobacco chewers 21.5% chew both types of smokeless tobacco products and all of them were males. Male gender (OR 17.9; 11.4 -27.9) and ever smoking lifestyle (OR 4.4; 2.9–6.6) were significant determinants of current smokeless tobacco chewing lifestyle.Conclusion and recommendationsThe study shows a high prevalence of smokeless tobacco use by youth aged between 15 to 24 years who were residing in urban slum areas in the district of Colombo, in Sri Lanka, highlighting this target group for early intervention to reduce the uptake and promote the quitting of this practice.

Understanding etiology of chromosome 21 nondisjunction from gene\u2009\xd7\u2009environment models

Maternal risk factors and their interactions with each other that associate chromosome 21 nondisjunction are intriguing and need incisive study to be resolved. We determined recombination profile of nondisjoined chromosome 21 and maternal genotypes for four selected polymorphic variants from the folate regulators genes stratifying the women according to the origin of segregation error and age at conception. We conducted association study for genotype and maternal addiction to smokeless chewing tobacco, usually chopped tobacco leaves or paste of tobacco leaves with the incidence of Down syndrome birth. Additionally, we designed various logistic regression models to explore the effects of maternal genotype, maternal habit of smokeless chewing tobacco, maternal age at conception and all possible interactions among them on chromosome 21 nondisjunction. We found folate regulator gene mutations are associated with maternal meiosis II error. Regression models revealed smokeless chewing tobacco and folate polymorphic/mutant risk genotype interact with each other to increase the risk of reduced and single peri-centromeric recombination events on chromosome 21 that nondisjoined at meiosis II in the oocytes and the effect is maternal age independent. We inferred maternal folate polymorphic/mutant risk genotypes and habit of smokeless chewing tobacco interact with each other and increase the risk of meiosis II error in oocytes in maternal age-independent manner.

Effect of vitamin C supplementation on autonomic function tests in smokeless tobacco chewers

According to World Health Organization (WHO) report, tobacco is the single greatest cause of preventable death all over the world. Use of Smokeless Tobacco (ST) increases level of nicotine and autonomic effects throughout the day that are similar to smoking. Aim of the present study was to evaluate the effect of ST on ratio, Sustained Handgrip test (SHG), serum (CTN) level and serum Vitamin C (VC) in ST chewers. Total 338 participants aged years were divided in two groups, ST chewers and ST non chewers (controls). ST chewers were further classified with respect to Smokeless Tobacco Chewing (STC) duration (years), frequency (times/day) and quantity (/ day). Participants were asked to consume 1000 mg of vitamin C for 45 days. ratio, SHG, serum CTN and serum VC levels were measured at the baseline study and after supplementation of VC. ratio (p= 0.006), DBP rise in SHG (p=0.002) and serum VC (p<0.001) levels were significantly decreased however, serum CTN (p<0.001) level was significantly increased in ST chewers as compared to controls. VC supplementation did not show any significant change in ratio and SHG however, serum CTN (p<0.001) level was significantly decreased and serum VC (p<0.001) level was significantly increased in ST chewers as compared to baseline values. Increased STC duration, frequency and quantity did not show any significant change in ratio and DBP rise in SHG in ST chewers. The use of ST is associated with decreased sympathetic activity and serum VC level as well as increased serum CTN level in tobacco chewers as compared to controls.

A comparative and cross-sectional study on the prevalence of risk factors for mouth ulcer and oral cancers in migrants and native population of a tourist city of Rajasthan

Background: Oral cancer is a major non communicable disease which is considered as one of the major public health problems in India. It can easily be prevented through early detection and stopping the associated risk factors like smokeless tobacco. The objective of the study was to assess the prevalence of risk factors for mouth ulcer and oral cancer among migrants of Udaipur city and comparing them to its native population.Methods: A cross sectional study was conducted to know the prevalence of smokeless tobacco and other associated risk factors and recommend the preventive strategies based on study findings which consisted of 384 migrants and 384 native population of Udaipur, Rajasthan during May 2016 to April 2017.Results: Majority of migrants 36.46% and native 34.11% were in age group of 28-37 years. Out of 384, 89 (23.18%) and 117 (30.47%) migrants and native were having habit of smokeless tobacco chewing respectively (statistically significant p<0.05). The prevalence of smoking among migrants and native were 34.38% and 24.48% respectively (statistically significant p<0.05). A major risk factor of mouth ulcer was same smokeless tobacco chewing in both migrants (57.14%) and in native (66.66%). Migrants with the habit of smokeless chewing were unable to open mouth was recorded (69.04%) whereas native population was recorded (36.66%) (statistically significant p<0.05)..Conclusions: Smokeless tobacco chewing habit in both migrants and native population is a significant risk factor for mouth ulcer and oral cancer.

P-163 - Smokeless tobacco chewing mediates plethora of physiological hazard and neuronal health

Smokeless tobacco (SLT) or chewing tobacco is very common addiction practice in India across the ages making a somber threat and huge disease burden. Oral use of SLT is often assorted with many ingredients and is capable to induce extreme toxicological challenges and carcinogenic developments. The current study investigated the systemic stress in human subjects using blood parameters of SLT chewers. Perturbations in parameters of metabolism, inflammation, RBC morphology and enhanced apoptosis of PBMC in SLT-chewers compared to non-chewer human subjects were found. The study further delved whether SLT mediated any neurodegeration. In vitro studies using SLT showed the neuronal cell death in a dose dependent manner compromising the mitochondrial health. Apoptosis was induced with the consequence of generation of reactive species, induction of DNA damage, alteration of membrane potential, mitochondrial morphology, activation of caspase-cascade, apoptotic proteins and disruption of the neuronal cytoskeleton network. To correlate the neurobiological insult of SLT, mouse behavioral studies with open-field test and plus maze and molecular analyses were investigated. This unique mechanistic study with molecular mechanism validated fatal effects of SLT and SLT-mediated neuronal cell death.

Salivary Sialic Acid Levels in Smokeless Tobacco Users.

BackgroundSmokeless tobacco chewing is one of the known risk factors for oral cancer. It is consumed widely by residents of southeastern Iran.ObjectivesIn this study, salivary free and total sialic acid, and total protein were compared in paan consumers and non-consumers.Patients and MethodsIn this cross-sectional study, unstimulated saliva of 94 subjects (44 paan consumers and 50 non-consumers) who were referred to the oral medicine department of the dentistry school of Zahedan were collected. Salivary free and total sialic acid, and total protein concentration were measured by standard biochemical methods, and the obtained data were analyzed using SPSS 20 through the non-parametric Mann-Whitney test.ResultsThe concentration of salivary free sialic acid (23.21 ± 18.98 mg/L) was significantly increased in paan consumers. The concentration of salivary Total sialic acid (TSA) (39.57 ± 26.58 mg/L) and total protein (0.77 ± 0.81 mg/mL) showed increases in paan consumers, however, the results were not statistically significant.ConclusionsSalivary free and total sialic acid, and total protein were higher in the paan consumers compared to non-consumers. Due to the carcinogenic effect of smokeless tobacco, measurement of these parameters in saliva may be useful in early detection of oral cancer.

Maternal Telomere Length and Risk of Down Syndrome: Epidemiological Impact of Smokeless Chewing Tobacco and Oral Contraceptive on Segregation of Chromosome 21

Background: We have previously demonstrated a relationship between children born with Down syndrome and maternal telomere length. Similarly, exposure to tobacco and oral contraceptives has been explored in one of our earlier studies as a risk factor for Down syndrome. Objective: In the present study, we consider the interactions among these risk factors associated with Down syndrome in a population from Kolkata, India, using analyses stratified by maternal age. Methods: We estimated the telomere length of women with children with Down syndrome by restriction enzyme/Southern blot methods. Linear regression was employed to estimate telomere shortening as an indicator of the maternal age of conception. Interactions among the various factors were analyzed by logistic regression. Result: We found an association between the use of smokeless chewing tobacco and shorter telomere length among women who experienced meiosis I nondisjunction at gametogenesis; the effect is seen across all maternal age groups. In contrast, oral contraceptive use alone did not exhibit a statistically significant association with maternal telomere length, but there was an interaction with the use of smokeless chewing tobacco in the older mothers who experienced meiotic II nondisjunction. Conclusion: Environmental/habitual factors interact with molecular components of the oocyte, which ultimately increases the risk of chromosome 21 nondisjunction and subsequently of giving birth to a child with Down syndrome.

OP144: Prevalence of oral cancer, potentially malignant lesions and oral habits among patients visiting dental school, Sana’a University

Qat chewing, Smoking, smokeless tobacco (locally known as shammah) and waterpipe smoking (locally known as madaah) are common habits in Yemen. The aim of this study was to investigate the prevalence of oral cancerous and precancerous lesions, and to investigate the prevalence of oral risk habits among Yemeni adults attending outpatient dental clinic, Sana‘a university. This cross sectional study involved 304 adults aged 14–87 years, who attended outpatient clinic, Faculty of Dentistry, Sana‘a university, Yemen. The participants were interviewed individually for socioeconomic status, behavioral information, oral risk habits, oral hygiene practices, systemic health, and history and current use of medications. Detail oral examination of the oral cavity was done by a single examiner based on international criteria and WHO codes. There were more males 206 (67.8%) than females 98 (32.2%). The mean age for the study population was 42.61 years. The prevalence of Qat-associated white lesion, Smokeless tobacco-related lesions, leukoplakia, Lichen Planus, and oral cancer was 8.9%, 2.3%, 0.7%, 0.7%, 0.3% respectively. The prevalence of Qat chewing, smoking, waterpipe smoking, smokeless tobacco chewing was 58.2%, 24.3%, 7.6%, and 7.6% respectively. Oral precancerous lesions were significantly higher in males than females ( P < 0.05). Likewise, an association was found between occurrence of oral precancerous lesions and practicing of oral habits ( P < 0.05). This study provided information about the habit trends in the patients visiting this institution. it also reinforces the association between tobacco products and oral precancerous lesions.

Changes in buccal micronucleus cytome parameters associated with smokeless tobacco and pesticide exposure among female tea garden workers of Assam, India

Assam is the highest tea producing state in India. A large number of workers are engaged in various units of tea industry. There are few reports on the health status of the tea garden workers. The present cytogenetic biomonitoring study was undertaken to investigate the genotoxic effect associated with workers in tea industries in southern Assam. Smokeless tobacco chewing along with betel nut is very common practice among the workers. Workers also get exposed periodically to mixture of pesticides. Employing buccal micronucleus cytome assay, exfoliated buccal cells were analyzed in 90 female tea garden and compared to 90 age and sex matched non-chewer control as well as 70 chewers who are not tea garden workers. Statistically significant (p<0.001) increase in genotoxic and cell death parameters was observed in tea garden workers compared to both the control groups. The frequency of cell proliferation biomarkers was highest in the chewer controls whereas genotoxic and cell death parameters were highest in tea garden workers. Linear correlation analysis revealed strong positive correlation between the duration of occupation and the frequency of micronucleus (r=0.597; p<0.001) as well as cell death parameters (r=0.588; p<0.001). Amount of chewing also had significant positive correlation with micronucleus frequency (r=0.243 or 5.9%; p<0.05) and cell death parameters (r=0.217; p<0.05). A statistically significant decrease in total RBC count, haemoglobin content as well as acetylcholine esterase in the blood of exposed individuals was observed. The average BMI among the tea garden workers was relatively lower compared to the control group. Pesticide exposure and chewing areca nut along with smokeless tobacco use may be responsible for changes in cytome parameters in exfoliated buccal cells.

Simultaneous preconcentration of toxic elements in artificial saliva extract of smokeless tobacco product, mainpuri by cloud point extraction method

It has been extensively investigated that smokeless tobacco chewing can lead mainly to inflammation of oral cavity. In present study, the total and artificial saliva extracted toxic elements, arsenic, cadmium, nickel and lead were estimated in smokeless tobacco product, mainpuri. Cloud point extraction has been used for the preconcentration of arsenic, cadmium, nickel and lead in artificial saliva extract, using complexing reagent, ammonium pyrrolidinedithiocarbamate. Total and extractable toxic elements were measured by electrothermal atomic absorption spectrometry. The chemical variables of cloud point extraction were optimized. The validity of methodology was tested by simultaneously analyzing certified reference material (Virginia tobacco leaves) and spike recovery test. The artificial saliva extractable levels of arsenic, cadmium, nickel and lead ranged from 15–22, 45–70, 35–58, and 18–32%, respectively, of total elemental contents in mainpuri samples. It was estimated that intake of 10g of different brands of mainpuri contributing the 5.88, 55.0, 45.0 and 40.3% of the provisional maximum tolerable daily intake for arsenic, cadmium, nickel and lead, respectively for adults of ~60kg.

Genotoxicity assessment in smokeless tobacco users

India has a long history of tobacco, which includes chewing tobacco and smoking tobacco in various forms. Initially, the smokeless tobacco chewing habit was seen among the majority of the farmers who cultivated tobacco; but in recent years, smokeless tobacco is available in many forms and is cheaper as well and hence it is widely being used among literate and illiterate people. The subjects of our study are living in hilly regions of Yerkaud in Salem district, South India. Most of the inhabitants of our study area are illiterate and more particularly they are unaware of the health effects due to tobacco use. Recent epidemiological reports have strongly indicated the association of cancer risk with usage of smokeless tobacco. The prime aim of our study is to evaluate the genotoxic effects of tobacco use by analysing the cytogenetic end points such as chromosome aberrations in peripheral blood and micronucleus in peripheral blood and buccal cells. About 85 smokeless tobacco users were enrolled for the study and same numbers of age- and sex-matched nontobacco users were also enrolled to serve as controls. The result of our study revealed that tobacco users displayed varied levels of elevated chromosomal damage and micronucleated cells than nontobacco users. The variation in the extent of genetic damage was dependent on the duration of the tobacco use. In conclusion, this study might be helpful in creating awareness on the hazards of the smokeless tobacco products among the global population as a whole for those who chose such products as a cheap alternative to tobacco smoke.

Epidemiology of Down Syndrome: New Insight Into the Multidimensional Interactions Among Genetic and Environmental Risk Factors in the Oocyte

Down syndrome birth is attributable to multiple maternal risk factors that include both genetic and environmental challenges, but there is limited understanding of the complicated interactions among these factors. In the present study, a case-control analysis of approximately 400 infants with or without suspected Down syndrome reported between 2003 and 2009 and their parents in and around Kolkata, India, was conducted. Maternal exposure to 2 environmental risk factors (smokeless chewing tobacco and oral contraceptive pills) was recorded, and families were genotyped with microsatellite markers to establish the origin of nondisjunction errors as well as recombination patterns of nondisjoined chromosome 21. With logistic regression models, the possible interactions among all of these risk factors, as well as with maternal age, were explored. Smokeless chewing tobacco was associated with significant risk for meiosis II nondisjunction and achiasmate (nonexchange) meiosis I error among young mothers. By contrast, the risk due to oral contraceptive pills was associated with older mothers. Study results suggest that the chewing tobacco risk factor operates independently of the maternal age effect, whereas contraceptive pill-related risk may interact with or exacerbate age-related risk. Moreover, both risk factors, when present together, exhibited a strong age-dependent effect.

Environmental effects on head and neck cancer in India

e17059 Background: Head and neck cancer in India has unique demographic profile, environmental exposure, dietary habits, and personal and family history. Methods: 1,000 cases were analysed. Results: Males dominated (82%) in fifth (29%) and sixth (33%) decades. Majority was uneducated (76%) and poor. Passive tobacco smoking was seen in-house (85%) as well as in the work-place (80%). Approximately 69% smoked more than 100 cigarettes/bidis in their lifetime. Majority acquired regular smoking habit in second (73%) and third (18%) decades and continued smoking for more than 20 years (66%) with 10–20 cigarettes daily (range 1 to 43). However 30% never used tobacco. The main alternative forms were bidi (27%) and smokeless-tobacco chewing products (47%). A past history of cancer and the subsequent radiation treatment was found in 3% while GERD in 33%. Multivitamins/minerals for chemoprevention was used in 65% for 1 to 12 months. Alcohol consumption was seen in 26% where the age of initiation was in second and third decade and the total years of consumption mainly varied from 10–30 years. Having a predominant agriculture-based-economy, the majority of males (38%) were farmers with significant exposure to pesticides and fertilizers; while females predominantly housewifes (17%). The family history was appreciated in 1% with natural parents known in all. The most common sites involved were oral cavity (28%), oropharynx (30%), and larynx (32%). Majority presented with advanced stage (III = 39%; IV = 23%). The consumption of fruit and vegetable juice was less common as compared to fresh consumption as such. Green salads, potatoes, and fiber cereals were significantly used (4–6 times a week). Beans, peas, and corn was not common while beef and pork consumption rare owing . The ‘staple’ diet was wheat, rice, pulses with additional meat mainly in Muslims (once a day). The use of cooking oil, butter, eggs biscuits, cheese, cakes, and cookies was uncommon (less than once a week), but milk was abundant. Conclusions: Hence, it seems that poor, education/literacy, poor socioeconomic status, tobacco smoking (passive and active) at an early age for prolonged duration, tobacco-related products and exposure to pesticides/fertilizers predispose Indian population for head and neck cancer, rather than a positive family history, dietary factors, radiation exposure, or alcoholism. No significant financial relationships to disclose.

Gastric DNA damage through tobacco chewing: In vitro mechanistic studies of DNA nitrite attack

Smokeless chewing tobacco or snuff has been linked to carcinogenic effects in upper aerodigestive organs. The presence of nitrite within the tobacco product is suspected to foster carcinogenic DNA mechanisms at lower pH. We studied the impact of sodium nitrite on DNA damage at single-strand conformers or hairpin loops, known to be present at fragile sites that have been shown to cause methyltransferase stalling and that can lead to chromosomal breakage. At a pH of 4.2, two base-damage products could be demonstrated at significant levels (1-5% of total nucleotides), with greater sensitivity to hairpin loops compared to a control Watson-Crick duplex. Pyrimidine-rich strands (CCG, CTG) were more reactive than purine-rich strands (CAG, CGG). The data support a mechanism for allele-specific predisposition to DNA damage. This mechanism may be of significance in gastric cancer initiation due to chewing tobacco.

Role of reactive oxygen species in the development of cytotoxicity with various forms of chewing tobacco and pan masala

The oral use of chewing tobacco has greatly increased in recent years, and this usage is associated with cancers of the mouth, lip, nasal cavities, esophagus and gut. Use of chewing tobacco is extremely popular in Far East and Middle East countries. In some of these countries, these chewing tobaccos are mixed with areca nut, lime and catechu and sold as pan masala. In this study, we examined three different forms of commercially available pan masala, and examined the development of cytotoxicity using primary culture of normal human oral keratinocytes (NHOKs). NHOK cells were treated with three different forms of pan masala, gutkha, pan masala with saccharin and pan masala as well as Kentucky smokeless chewing tobacco (STE) and the development of oxidative stress, and DNA damage were monitored. The results of our study demonstrated significant amount of the superoxide anion production, lipid peroxidation, DNA fragmentation and DNA ladders with all of the chewing tobacco materials tested. Laser scanning microscopy revealed concentration-dependent effects of STE on the modulation of intracellular redox states. The results, thus, document that the cytotoxic effects of the chewing tobaccos including pan masalas are mediated through the production of the reactive oxygen species.

The Patterns and Predictors of Smokeless Tobacco Onset Among Urban Public School Teenagers

This study describes the patterns and predictors of smokeless tobacco (ST) use in a large sample of urban public school students in Los Angeles and San Diego. The use of ST is more common among men than women and among Caucasians than African Americans, Hispanics, and others. Approximately 20% of the male respondents and 5% of the female respondents reported use of ST at least once, and 10.1% of male students and 3.1% of female students who had never tried ST by seventh grade started to use it by eighth grade. Among Caucasians, about 30% of boys reported trying ST at least once and 13.7% of those who had never used ST by seventh grade initiated experimentation by eighth grade. These data are used to examine the family, peer, and intrapersonal predictors of ST onset. The family risk factors for ST onset include living with a single parent, parent-child conflicts, and parental alcohol use. The peer risk factors for ST use include peer drug use and activities with friends, such as parties and participation in sports. The intrapersonal risk factors include poor grades in school, risk taking, and stress. The study also shows that those who use cigarettes, alcohol, or marijuana are at higher risk of using ST and vice versa. This study supports a problem-prone behavior perspective of ST use and cigarette smoking. We suggest that both products be targeted because the same programs are likely to apply to both products to counteract problem-prone type variables. Medical Subject Headings (MeSH): tobacco, smokeless chewing tobacco, adolescent behavior.