Snuff Tobacco Research Articles

A Troubling Diagnosis of Verrucous Squamous Cell Carcinoma (“the Bad Kind” of Keratosis) and the Need of Clinical and Pathological Correlations: A Review of the Literature with a Case Report

Verrucous carcinoma (also known as Ackerman tumor) is an uncommon exophytic low-grade well-differentiated variant of squamous cell carcinoma. This neoplasm typically involves the oral cavity, larynx, genitalia, skin, and esophagus. It is well known for its locally aggressiveness and for its clinically slow-growing behaviour with minimal metastatic potential. Verrucous carcinoma of oral cavity is so closely aligned with the use of snuff and chewing tobacco that it has been called the “snuff dipper's cancer”. Recent studies have proved the role of HPV. The typical clinical presentation of oral verrucous carcinoma has long been known, as its remarkably innocuous appearance and biological behaviour. In this work, we report a review of the scientific literature and describe a troublesome case of oral verrucous cancer.

Mungiki as youth movement

Like many other African countries, Kenya has a large and growing youth population. Some of the youths are mobilized into militant and political networks; one of these is the Mungiki movement. The article explores Mungiki’s combination of politics, religion and Kikuyu traditions. Using the examples of snuff tobacco, revolutionary talk and generational exclusion, it is argued that one way of understanding the connection between the various elements is to look at specific youth practices that cut across apparently separate activities. This reveals that youth in the Mungiki discourse is a highly gendered concept.

The concentrations of methaemoglobin, carboxyhaemoglobin and some haematological parameters in tobacco snuff addicts in Igbo of Nigeria

Methaemoglobin, carboxyhaemoglobin concentrations and some haematological parameters were studied in fifty tobacco snuff addicts (40 males and 10 females) in some villages of Anambra State, Nigeria. The aim was to investigate possible adverse effects of tobacco snuff in addicts in Igbos of Anambra State. Fifty apparently healthy persons (25 males and 25 females) who do not inhale snuff were used as controls. The age range of tests and control subjects was 25-65 years. The results showed no statistically significant difference when the tests group was compared with the control group. A comparison of the results on the basis of sex, age and period of exposure, showed no significant differences. Blood picture in test and control groups was normocytic and normochromic. The results suggest that tobacco snuff may not have any adverse effect on haemoglobin metabolism and erythropoiesis.

Cannabis, tobacco and domestic fumes intake are associated with nasopharyngeal carcinoma in North Africa

Background:The lifestyle risk factors for nasopharyngeal carcinoma (NPC) in North Africa are not known.Methods:From 2002 to 2005, we interviewed 636 patients and 615 controls from Algeria, Morocco and Tunisia, frequency-matched by centre, age, sex, and childhood household type (urban/rural). Conditional logistic regression was used to evaluate the association of lifestyles with NPC risk, controlling for socioeconomic status and dietary risk factors.Results:Cigarette smoking and snuff (tobacco powder with additives) intake were significantly associated with differentiated NPC but not with undifferentiated carcinoma (UCNT), which is the major histological type of NPC in these populations. As demonstrated by a stratified permutation test and by conditional logistic regression, marijuana smoking significantly elevated NPC risk independently of cigarette smoking, suggesting dissimilar carcinogenic mechanisms between cannabis and tobacco. Domestic cooking fumes intake by using kanoun (compact charcoal oven) during childhood increased NPC risk, whereas exposure during adulthood had less effect. Neither alcohol nor shisha (water pipe) was associated with risk.Conclusion:Tobacco, cannabis and domestic cooking fumes intake are risk factors for NPC in western North Africa.

Smokeless tobacco use among men in the United States, 2000 and 2005

Compared with smoking, there is much less information about smokeless tobacco (ST) use in the United States. The purpose of this study is to characterize and compare ST use among American men in 2000 and 2005. We used US National Health Interview Surveys from 2000 and 2005 to estimate the prevalence of ST use, describe the demographic and socioeconomic profile of ST users and evaluate ST use according to product type and with respect to smoking. The prevalence of ST use among American men was 4.4% in 2000 and 4.3% in 2005. Almost all ST users were white, about half were 25-44 years old and 80% lived in the South or Midwest, commonly in small metropolitan and rural areas. Educational and income levels of ST users were lower than those of never users of tobacco. One-third of ST users also smoked; cigarette consumption was lower among dual users than among exclusive smokers. In 2005, 1.3 million current ST users were former smokers but 3.2 million smokers were former ST users. ST users were evenly distributed between snuff (43%) and chewing tobacco (44%) in 2000 and 13% used both products. By 2005 snuff use was clearly dominant. The prevalence of ST use among men is low but stable; dual use of cigarettes and ST is common, and snuff has become the dominant ST product.

Use of tobacco products among rural older adults: Prevalence of ever use and cumulative lifetime use

Tobacco use is a well-documented contributor to morbidity and mortality in the US and worldwide. Information on the comprehensive use of tobacco products is lacking, particularly smokeless tobacco in its various forms. Data from 635 older (≥ 60 years) African American, American Indian and White adults in rural North Carolina were analyzed to assess current and lifetime use of cigarettes, cigars, pipe, snuff and chewing tobacco. Participants were classified as being current, former or never users of each product. Lifetime use of each product was determined by asking about typical intensity of use per day and length of time the product has been used. About 70% of participants were current or former users of any tobacco product, and about one-third of participants currently used at least one product. Variations in use were observed by ethnicity and sex, particularly for cigarettes, snuff and chewing tobacco. Variations were also seen according to other demographic and health characteristics. These data add to a limited body of literature on lifetime use of smoked and smokeless tobacco products, and are useful in identifying the impact of these products on morbidity and mortality, particularly for vulnerable populations.

Sphenoid sinus aspergillosis simulating pituitary tumor in immunocompetent patient

Aspergillosis of the sphenoid sinus is rare in immunocompetent patients. It may be mistaken for a sellar region tumor. A 65-year-old, human immunodeficiency virus-negative man presented with a 3-week history of cranial nerve III paresis and visual deterioration. The patient had a long-term history of tobacco snuff abuse. CT scans and MRI demonstrated a space-occupying lesion of the sellar and sphenoid sinus region. Presumptive diagnosis of pituitary macroadenoma was made and the patient was operated on via a transnasal–transsphenoidal approach. After the sphenoid sinus was opened, a yellow-brownish gluey material with crumbly debris extruded and was aspirated. The dura was intact. Histopathology revealed numerous Aspergillus hyphae without tissue invasion. Postoperatively, the cranial nerve III paresis resolved in a few days and visual acuity improved. Sphenoid sinus aspergillosis should be included in the differential diagnosis of sellar region processes, even in immunocompetent patients. Early diagnosis and transsphenoidal removal provides good results without the need for systemic antifungal therapy in non-invasive aspergillosis.

Chemical and toxicological characterization of commercial smokeless tobacco products available on the Canadian market

Some health experts are recommending that smokers who refuse to quit or refuse to use nicotine replacement therapy (NRT) such as nicotine-containing chewing gum switch to certain types of smokeless tobacco products (STP) such as Swedish snus. Other health experts disagree citing the uncertainty in the composition of commercially available STP, the lack of governmental regulations to ensure that STP advertised to meet certain standards (i.e., GothiaTek ®) do actually meet such standards, and the uncertainty that any STP can provide as safe as alternative to smoking as NRT. One reason for uncertainty is the dearth of detailed chemical and toxicological information on contemporary STP. Unlike the situation with cigarettes, there are few standardized methods for analytical and toxicological studies of STP. Consequently, the objective for this work was to characterize several types of STP available on the Canadian market using the modifications of the Official Health Canada chemical and toxicological methods developed for cigarettes. Moist snuff samples tested had TSNA and B[ a]P levels somewhat above the GothiaTek ® standard while samples of Swedish snus, low-moisture snuff, and US-style chewing tobacco did not. Use of in vitro assays to assess STP toxicity was of limited utility in distinguishing product types.

Oral cancer risk and smokeless tobacco products – clouded by smoke?

Medline, Embase, Cancerlit, Toxline were searched, followed by the reference lists of identified reviews and articles. Human cohort or case-control studies in peer-reviewed journals or that were publicly available were selected if they specified study location; examined any form of oral cancer as the outcome; and described use of chewing tobacco, orally used moist snuff or unspecified smokeless tobacco as the exposure. Studies in Asian populations and those with insufficient power where risk estimates and confidence intervals were not reported or could not be calculated were excluded. Standard information was abstracted from each study. Whole-population data were used to estimate numbers of never-smokers. Separate figures for males and females were obtained where possible. Estimates were made of effect size and precision since these were not presented in original studies. Separate meta-analyses were conducted for chewing tobacco, for snuff and for overall smokeless tobacco. Sensitivity analyses for smokers/ nonsmokers were carried out. Heterogeneity was investigated and publication bias assessed using a funnel plot. The 32 studies meeting the inclusion criteria provided 38 heterogeneous study-specific estimates of odds or relative risk ratios (see Tables 1, 2). An increase in risk was mainly evident in studies conducted before 1980. No increase was seen in studies in Scandinavia. The pattern of estimates suggests some publication bias. Smokeless tobacco, as used in America or Europe, carries at most a minor increased risk of oral cancer, but elevated risks in specific populations or from specific products cannot definitely be excluded.

Free nicotine content and strategic marketing of moist snuff tobacco products in the United States: 2000–2006

Background:From 2000 to 2006, moist snuff sales have increased and now account for 71% of the smokeless tobacco market. Previous research has shown that major manufacturers of smokeless tobacco products...

Therapeutic uses of Aloe L. (Asphodelaceae) in southern Africa

Ethnopharmacological relevance The African-Arabian succulent genus Aloe L. (Aloaceae/Asphodelaceae) is represented by approximately 120 infrageneric taxa in southern Africa, including A. ferox Mill., a species long used in commercial natural products. Aims of the study To assess the documented ethnobotanical knowledge and biocultural value of utility in the genus in southern Africa. Materials and methods A survey of over 350 multidisciplinary publications was undertaken. Results Local uses for medicine and wellbeing were identified for over half the species of Aloe occurring in the Flora of Southern Africa region. The most frequently cited medicinal uses were the treatment of infections and internal parasites, digestive ailments and injuries. Numerous species were recorded for their social uses, notably as ingredients in tobacco snuff. Conclusion The exceptional infrageneric diversity of Aloe, and extensive therapeutic uses in southern Africa, indicate its cultural importance in the subcontinent. These factors highlight the need for the conservation of the species as well as their potential as a source of natural products.

Snuff use and the risk for hypertension among black South African women

AbstractBackground: Snuff or smokeless tobacco, used orally or by nasal application, is the predominant form of tobacco used by black South African women. Little is known about the risk of cardiovascular disease associated with the use of snuff in developing countries. This study therefore sought to determine the association between snuff use and hypertension among black South African women.Methods: This study involved secondary data analysis of a cross-sectional representative sample of black women aged 25 to 70 years (n = 4092) who participated in the 1998 South African Demographic and Health Survey, the largest to date. Data analysis included chi-square statistics, t-tests, ANOVA and multiple logistic regression analysis. The outcome measure was hypertension, defined as presenting with an average blood pressure (BP) of ≥ 160/95 mmHg, and/or reporting the use of antihypertensive medication.Results: The prevalence of snuff use and hypertension was 14.6% and 18.0% respectively. Compared to non-users of sn...

A grounded theory of snuff-dipping behaviour (use of Swedish ‘snus’) in a Norwegian population

In Scandinavia, use of oral moist snuff tobacco (Swedish ‘snus’) has increased in popularity over the last two decades. However, there is a general lack of qualitative research investigating causal factors and motivations for snuff use in different populations. The objective is to examine how snuff-dipping is acquired, developed and maintained in a Norwegian population. A structured grounded theory approach was used. Fourteen participants were interviewed for the study, aged between 18 and 38 years, with an average age of 26 years. The interviews focused on what role snuff-dipping played in participants’ lives, and the aim was to establish how snuff-dipping was acquired, developed and maintained. Context-specific mood modification emerged as the core category for snuff-dipping behaviour. This involved an urge for stimulation and arousal at specific times or in certain settings. Snuff-dipping behaviour was acquired either through conformity to a social group ritual or for smoking cessation purposes. Rationalisation served to maintain the behaviour, and helped weaken incentives to quit snuff-dipping. Snuff-dipping behaviour was acquired through conformity to a social group ritual or as a replacement for cigarettes. Context-specific mood modification was identified as the prime motivation for continuing the behaviour, while rationalisation also led to behaviour maintenance. Limitations of the study and implications for snuff prevention and intervention are discussed, while suggestions for future research are provided.

Angioedema due to type I allergy to snuff tobacco

A 67-year-old male patient twice developed severe angioedema after enjoying a meal and an after-dinner snuff. The cause for these allergic reactions was a type I allergy to tobacco contained in the snuff. In addition to positive prick tests to tobacco, specific serum IgE antibodies (CAP-FEIA) to snuff were found, while prick tests and RASTs for suspected foods were negative. Tobacco belongs to the family Solanaceae which includes tomatoes and potatoes and comes from South America. Whenever allergic reactions together with tobacco snuff use occur, a possible type I allergy should be considered and investigated.

Sensitivity and specificity of a reagent-impregnated test strip in identifying smokeless tobacco users

This study was designed to determine the sensitivity and specificity of a reagent-impregnated test strip in identifying habitual snuff users and tobacco chewers. Urine specimens were obtained from smokeless tobacco users and controls and blind tested on-site using a reagent-impregnated test strip. Samples also were sent to our university hospital lab for cotinine and nicotine analysis by gas chromatography (GC). The test strip results were compared with GC results and self-reported use of snuff and chewing tobacco. A total of 61 subjects enrolled in the study: 26 snuff users, 25 tobacco chewers, and 10 nonconsumers of nicotine. Using GC assessment of nicotine and cotinine (>or=200 ng/ml) as the standard, we found the sensitivity of the test strip to be 96% (25/26) for snuff users and 96% (24/25) for tobacco chewers. When compared with self-report, the sensitivity of the test strip was 92.3% (24/26) for snuff users and 84% (21/25) for tobacco chewers. The specificity for nonusers of nicotine was 100% (10/10) for both the self-report and GC conditions. These results suggest that a reagent-impregnated test strip is a rapid, valid, and user-friendly means of differentiating smokeless tobacco users from nonconsumers of tobacco. The intensity of the pink color on the test strip is proportional to the amount of nicotine or its metabolites present in urine and therefore offers a semiquantitative measure of nicotine consumption.

The Role of the Dental Team in Preventing and Diagnosing Cancer: 4. Risk Factor Reduction:Tobacco Cessation

Tobacco use contributes to many oral and general health disorders.While cigarette smoking is the most hazardous and prevalent form of tobacco use in the industrialized countries, consideration also needs to be given to non-cigarette use such as bidi smoking in India, reverse smoking by several rural populations and use of snuff and chewing tobacco. Health professionals should encourage and aid cessation of tobacco use as a part of prevention of oral and other cancers.

The prospects for tobacco harm reduction

Tobacco harm reduction (THR) policies aim to reduce the prevalence of tobacco-related harm by encouraging smokers who are unable or unwilling to quit to adopt less harmful ways of obtaining nicotine, such as pharmaceutical nicotine and oral tobacco snuff. Proponents of THR argue that the effects of tobacco control policies have reduced smoking as much as they reasonably can and that we can best reduce tobacco-related harm by encouraging smokers to use these methods, which substantially reduce the health risks of smoking. Critics argue that THR policies will undermine the two traditional tobacco control goals of preventing the uptake of smoking by young people and encouraging smokers to quit. I assess the main arguments and evidence advanced for and against THR.

Two large prospective studies of mortality among men who use snuff or chewing tobacco (United States)

Few prospective studies have examined the health risks associated with use of snuff and chewing tobacco. We studied the association between the use of spit tobacco (snuff or chewing tobacco) and mortality among men enrolled in Cancer Prevention Study I (CPS-I) in 1959 or Cancer Prevention Study II (CPS-II) in 1982. Analyses were based on men who reported exclusive use of snuff or chewing tobacco (7745 in CPS-I, 3327 in CPS-II) or no previous use of any tobacco product (69,662 in CPS-I, 111,482 in CPS-II) at baseline. Twelve-year follow-up of CPS-I, and 18-year follow-up of CPS-II identified 11,871 and 19,588 deaths, respectively. Cox proportional hazards models were used to control for age and other covariates. Men who currently used snuff or chewing tobacco at baseline had higher death rates from all causes than men who did not in both CPS-I (hazard ratio [HR]=1.17, 95% CI=1.11-1.23) and CPS-II (HR=1.18, 95% CI=1.08-1.29). In CPS-I, current use of spit tobacco was statistically significantly associated with death from coronary heart disease (CHD), stroke, and diseases of the respiratory, digestive, and genitourinary systems, but not with death from cancer. In CPS-II, use of these products was significantly associated with death from CHD, stroke, all cancers combined, lung cancer, and cirrhosis. The associations with cardiovascular and other non-malignant endpoints were attenuated, but not eliminated, by controlling for measured covariates. Former use of spit tobacco was not associated with any endpoint in CPS-II. No clear dose response was observed with either the frequency or duration of usage for any endpoint. These two prospective studies provide limited evidence that current use of chewing tobacco or snuff may increase mortality from heart disease and stroke.

Hemodynamic and autonomic effects of smokeless tobacco in healthy young men

The aim of this study was to investigate the acute hemodynamic and autonomic effects of smokeless tobacco. Smokeless tobacco use is increasing. Its cardiovascular effects are not well understood. Sixteen healthy, male, habitual snuff tobacco users (aged 22 +/- 1 year) were studied, using a randomized, double-blind, placebo-controlled, crossover design with two separate experimental sessions: placebo and tobacco. Muscle sympathetic nerve activity (MSNA), electrocardiogram, blood pressure, calf blood flow, nicotine, and catecholamines were measured. Snuff tobacco increased plasma nicotine from 2.8 +/- 0.5 ng/ml to 10.4 +/- 1.1 ng/ml. Mean blood pressure increased by 10 +/- 1 mm Hg, and heart rate increased by 16 +/- 2 beats/min. Peripheral vascular resistance, MSNA, and norepinephrine concentration did not change with tobacco, but epinephrine increased by approximately 50%. Oral snuff tobacco increases heart rate, blood pressure, and epinephrine. Despite the increase in blood pressure, there is no decrease in either MSNA or peripheral vascular resistance. Smokeless tobacco is a powerful autonomic and hemodynamic stimulus. Catecholamine release from the adrenal medulla likely contributes to this response.

Smokeless tobacco use among professional baseball players: survey results, 1998 to 2003

Objective: The use of smokeless tobacco (ST) (snuff and chewing tobacco) has long been associated with baseball in the USA. This article reviews six years of survey data from major...