Users Of Smokeless Tobacco Products Research Articles

Impact of Smokeless Tobacco on Cardiovascular Disease Risk in a Nigerian Metropolitan City.

The use of smokeless tobacco products (STP) as a substitute for tobacco smoking is driving increasing consumption of these products especially in developing countries. The study sought to make comparison of cardiovascular risk profile between chronic STP users and suitably matched tobacco-naïve controls. This is a preliminary report from the cross sectional part of a two-arm prospective study of Smokeless Tobacco Products Composition and Exposure Outcome in Enugu metropolis, Nigeria. Consecutively recruited current Smokeless tobacco users, who had no history of cigarette smoking, aged 18years and above, residing in selected communities in Enugu metropolis, Nigeria were recruited for the study from October 2022 to July 2023. Age and sex matched non-tobacco users from same localities as the study subjects served as controls. Written informed consent to participate in the study was obtained from all study participants. All participants were screened by the investigators, using the study case report forms, to obtain data on medical history, demographic, clinical, laboratory, and electrocardiographic evaluation. Data from 54 STP-users and 54 non-STP-users (mean age 56.58 ± 8.15years) were analyzed. Anthropometric parameters were similar in both groups. Smokeless tobacco users had higher erect and supine blood pressure indices as well asgreater postural drop in systolic blood pressure. The occurrence of diabetes mellitus (20.37% versus 5.56%) and hypertension (25.93%; 11.11%) was significantly higher in the STP-users than in the non-user population, (p = 0.02192 and 0.04751 respectively). Electrocardiographic evaluation showed significantly increased QTc and dispersions of P-wave, QRS and QT intervals as well as reduced PR interval in STP users. Electrocardiographic abnormalities observed in STP users include left ventricular hypertrophy, left atrial enlargement, ST-segment elevation, short PR interval and long QTc. Use of smokeless tobacco products is associated with increased risk burden of diabetes mellitus and hypertensive heart disease. Electrocardiographic findings linked to STP-use in this study are features consistent with arrhythmia, ventricular repolarization abnormality, myocardial hypertrophy and ischaemia, suggesting that smokeless tobacco products are not safe substitutes for tobacco smoking.

On the results of the coordinated state policy in the field of tobacco control among young people

Introduction. Trend analysis of tobacco consumption rates is important for assessing the effectiveness of national tobacco control measures in Belarus. 
 Materials and methods. The study aims to monitor tobacco smoking among adolescents in Belarus by three repeat national cross sectional surveys conducted before and after introduction the regulatory act tobacco measures entered into force. Prevalence of smoking tobacco, cigarettes, electronic cigarettes and other aspects related to smoking among 13–15 years adolescents were estimated from the 2004, 2015 and 2021 Global Youth Tobacco (GYT) Surveys (n = 4523, 
 n = 2992, n = 3493 respectively) conducted in Belarus. 
 Results. The data evidenced a successful anti-tobacco policy and an improvement in the tobacco consumption and tobacco consumption by 13–15 years adolescents, expressed in reduction of many indicators. Prevalence of current cigarettes smokers significantly decreased from 26.5% in 2004 to 4.7% in 2021. Despite of current reduction of various types of tobacco smokers current GYTS data revealed that electronic cigarettes are extremely popular among adolescents – around 15%. The number of smokeless tobacco users significantly increased by 3 times. 
 Limitations. In order to study the tobacco consumption levels and other aspects related to smoking a survey of 11,000 adolescent students in 2004, 2015 and 2021 was conducted among schoolchildren (13–15 years old), which is a sufficient reference sample.
 Conclusions. Thus, the identified positive trends in tobacco smoking (5-fold reduction in the number of cigarette smokers, decrease in susceptibility to smoking, reducing the number of tobacco products smokers and decrease the number of ever tobacco smokers and ever cigarette smokers, decreasing the number of frequent cigarette smokers) indicated the effectiveness of a complex multidisciplinary anti-tobacco measures in Belarus. New challenges and negative trends were determined. Amount of electronic cigarettes users were significantly greater than current cigarette smokers’ amount. Moreover, prevalence of users of smokeless tobacco products is getting increased. Despite of extensive legislative framework for the tobacco control there remains substantial potential to strengthen them.
 Keywords: smoking; tobacco; tobacco use; cigarettes; electronic cigarettes; adolescents; smokeless tobacco; GYTS
 Compliance with ethical standards: the Local ethics committee of the Republican unitary enterprise «Scientific and Practical Centre of Hygiene» of the Ministry of Health.
 Patient consent. Each participant of the study (or his/her legal representative) gave informed voluntary written consent to participate in the study and publish personal medical information in an impersonal form in the journal "Gigiena i Sanitariya (Hygiene and Sanitation, Russian journal)".

Composition and Ecological Functionality of Fungal Communities Associated with Smokeless Tobacco Products Mainly Consumed in India.

ABSTRACTThe microbial communities present in smokeless tobacco products (STPs) perform critical steps in the synthesis of carcinogens, mainly tobacco-specific nitrosamines (TSNAs). Most studies emphasize the bacterial component, and the mycobiome of STPs has not been well characterized. In this study, we investigated the fungal communities in the different categories of STPs by sequencing the internal transcribed spacer (ITS) rRNA region of the fungal genome. The ecological character of the fungal community associated with STPs was determined by using FUNGuild. Our results indicated that Ascomycota and Basidiomycota were the most abundant fungal phyla across all STPs. The predominant fungal genera in STPs were Pichia, Sterigmatomyces, and Mortierella. The α-diversity varied significantly across the STPs based on observed, Fisher, and Shannon indices. Using SparCC cooccurrence network analysis, significant positive correlations of 58.5% and negative connections of 41.5% were obtained among fungal genera identified in STPs. Furthermore, the functional predictions by FUNGuild determined that STPs possessed high abundances of saprotroph and pathotroph-saprotroph-symbiotroph fungal trophic groups. At the functional guild level, the qiwam samples contained high abundances of soil saprotrophs, while plant pathogens were prevalent in pan-masala samples. These results suggest that various fungal populations reside in STPs and interrelate with each other and can contribute to the synthesis of TSNAs. This study has established the basis for future large-scale investigations of STP-associated mycobiota and the impact of such mycobiota in oral carcinogenesis in STP users via inflammation and carcinogens (TSNAs and mycotoxins).IMPORTANCE Smokeless tobacco products (STPs) contain complex microbial communities that influence the synthesis of carcinogens, such as tobacco-specific nitrosamines (TSNAs). Research on STP-associated bacterial populations revealed connections between bacterial metabolism and TSNA synthesis. The abundance of the fungal population may also have an impact on the production of TSNAs. This study examined STPs popularly used in India, and diverse fungal communities were identified in these STPs. Pichia, Sterigmatomyces, and Mortierella were the predominant fungal genera in the STPs. High abundances of saprotroph and pathotroph-saprotroph-symbiotroph trophic groups in STPs could affect the degradation of tobacco products and the synthesis of TSNAs.

Perception towards tobacco consumption and its usage among auto rickshaw drivers of Udupi District, Karnataka, India: A cross- sectional study

BackgroundTobacco usage has become a major public health problem. It is a leading cause of preventable disease and death. The hazard related to tobacco consumption is also increasing. Therefore, the present study aimed to assess the perception towards tobacco consumption and the pattern of usage of tobacco products among auto-rickshaw drivers. MethodsA cross-sectional study was conducted from November 2019 to August 2020 among 161 auto-rickshaw drivers of Udupi Taluk, Karnataka using the purposive sampling technique. A pretested, valid and reliable self-administered questionnaires were used to collect data on usage of tobacco and perception towards tobacco consumption. Data were analysed using SPSS version 16. ResultsA total of 99 (62%) auto-rickshaw drivers were users of smoking tobacco products and 38 (24%) were smokeless tobacco products users. The majority 118 (73%) were daily tobacco users and 83 (52%) auto-rickshaw drivers did not use any tobacco products in the work area. Nearly 52 (32%) participants consumed tobacco products due to work pressure. Around 91 (57%) auto-rickshaw drivers were not interested to quit tobacco products. Mean perception score of 139.81 ± 11.45 shows that the majority of them perceive tobacco consumption as hazardous for health. ConclusionDifferent forms of tobacco products were used despite knowing the hazardous effect on health. Intervention programs to control tobacco consumption should be planned by the health care professionals and strict enforcement of tobacco control policy is critical to address tobacco-related morbidity and mortality.

Smoking cessation counseling and treatment: An American Dental Association Clinical Evaluators Panel survey

BackgroundGiven the oral health implications of smoking, vaping, and using smokeless tobacco products (STPs), the dental office can be an effective setting for clinicians to offer smoking cessation counseling and treatment (SCCT). MethodsA survey tool was developed to assess dentists’ approach and experience with SCCT. This survey was deployed electronically on May 21, 2021, to the American Dental Association Clinical Evaluators (ACE) Panel (N = 982), and 1 week later, nonresponders were sent reminders. Results were summarized in SAS Version 9.4. ResultsOf the 283 survey responders, one-half offered SCCT to their patients. Of those who offered SCCT, 69% would be willing to prescribe pharmacologic agents to help with cessation. Nine of 10 times, SCCT conversations included the dentist. Of the 49% of respondents who did not offer SCCT, one-quarter were current or past smokers, vapers, or STP users. Out of all of the survey respondents, 40% were aware that SCCT is part of most medical benefits. Most respondents (82%) perform surgeries on patients who smoke, vape, or use STPs. ConclusionsImplementation of SCCT in the dental office was split among ACE panelists, but when it was offered, the dentist was almost always involved. Awareness about SCCT medical benefits and surgical protocols for current smokers, vapers, and STP users differed among this sample. Practical ImplicationsDentists can benefit from more formal training and resources around SCCT and access to reimbursement for having these crucial conversations with their patients.

Microbial communities and gene contributions in smokeless tobacco products.

Smokeless tobacco products (STP) contain bacteria, mold, and fungi due to exposure from surrounding environments and tobacco processing. This has been a cause for concern since the presence of microorganisms has been linked to the formation of highly carcinogenic tobacco-specific nitrosamines. These communities have also been reported to produce toxins and other pro-inflammatory molecules that can cause mouth lesions and elicit inflammatory responses in STP users. Moreover, microbial species in these products could transfer to the mouth and gastrointestinal tract, potentially altering the established respective microbiotas of the consumer. Here, we present the first metagenomic analysis of select smokeless tobacco products, specifically US domestic moist and dry snuff. Bacterial, eukaryotic, and viral species were found in all tobacco products where 68% of the total species was comprised of Bacteria with 3 dominant phyla but also included 32% Eukarya and 1% share abundance for Archaea and Viruses. Furthermore, 693,318 genes were found to be present and included nitrate and nitrite reduction and transport enzymes, antibiotic resistance genes associated with resistance to vancomycin, β-lactamases, their derivatives, and other antibiotics, as well as genes encoding multi-drug transporters and efflux pumps. Additional analyses showed the presence of endo- and exotoxin genes in addition to other molecules associated with inflammatory responses. Our results present a novel aspect of the smokeless tobacco microbiome and provide a better understanding of these products' microbiology. KEY POINTS: • The findings presented will help understand microbial contributions to overall STP chemistries. • Gene function categorization reveals harmful constituents outside canonical forms. • Pathway genes for TSNA precursor activity may occur at early stages of production. • Bacteria in STPs carry antibiotic resistance genes and gene transfer mechanisms.

Bacterial contamination of packaged smokeless tobacco sold in India.

INTRODUCTIONAbout 21.4% of India’s population uses smokeless tobacco products (SLT), yet limited data are available on their microbial contamination. To understand the potential microbiological risks associated with SLT use, the present study aims to investigate bacterial contamination of tobacco and the types of microbes that could be cultured from SLT products.METHODSTwenty-two brands of SLT products, including paan masala, khaini, gutka and tobacco-containing dentifrices were examined and cultured by using appropriate selective and differential media including MacConkey agar and CLED agar. This was followed by a sequence of further identification by biochemical tests.RESULTSAll 22 types of SLT products showed growth of aerobic bacteria. The most common bacteria isolated were Pseudomonas aeruginosa followed by Streptococcus faecalis. Other bacteria that were isolated from products, in traces, included Klebsiella spp., E. coli, and Bacillus subtilus.CONCLUSIONSThis study raises and addresses the issue of bacterial contamination of packaged SLT products. SLT users might be subjected to a significant health hazard, especially those who are immunocompromised.

Tobacco-product usage as a risk factor for dental implants.

The oral cavities of tobacco smokers and users of smokeless tobacco products are exposed to high concentrations of nicotine. A limited number of animal studies have assessed the effect of nicotine on osseointegration. Results from experimental studies have reported a statistically significant decrease, at 4weeks of follow-up, in bone-to-implant contact among rats exposed to nicotine compared with unexposed rats. Nicotine increases the production of inflammatory cytokines (such as interleukin-6 and tumor necrosis factor-alpha) by osteoblasts. Waterpipe, pipe, and cigarette smokers are at increased risk of developing oral cancer, periodontal disease, and alveolar bone loss. One explanation for this is that smokers (regardless of the type of tobacco product) are exposed to similar chemicals, such as nicotine, tar, oxidants, polyaromatic hydrocarbons, and carbon monoxide. Moreover, raised levels of proinflammatory cytokines have been identified in the gingival crevicular fluid of cigarette smokers with peri-implant diseases. Therefore, it is hypothesized that nicotine and chemicals in tobacco smoke induce a state of oxidative stress in peri-implant tissues (gingiva and alveolar bone), thereby increasing the likelihood of peri-implant disease development via an inflammatory response, which if left uncontrolled, will result in implant failure/loss. In this regard, tobacco smoking (including cigarettes, waterpipe, and pipe) is a significant risk factor for peri-implant diseases. The impact of vaping electronic cigarettes using nicotine-containing e-juices remains unknown. Habitual use of smokeless tobacco products is associated with oral inflammatory conditions, such as oral precancer, cancer, and periodontal disease. However, the effect of habitual use of smokeless tobacco products on the success and survival of dental implants remains undocumented.

Association of Smokeless Tobacco Use and Oral Cancer: A Systematic Global Review and Meta-Analysis.

Smokeless tobacco products have been linked to precancerous and cancers of oral cavity for long. Evidence was available on the association between smokeless tobacco (SLT) products and oral cancers at regional but not at global level. Present meta-analysis is aimed to evaluate the risk of oral cancer with the use of SLT products among "ever" versus "never" users. Studies published for the period (1960-2016) are retrieved using Pubmed, Indmed, EMBASE, and Google Scholar search engines for the subject "ever" versus "never" users of SLT products and estimated the risk association with oral cancer. Summary odds ratios (relative risk) are estimated and meta-analysis was performed using random-effects model. Thirty-seven studies from four of six WHO regions, Southeast Asia region (SEAR), the Eastern Mediterranean Region (EMR), Europe, and region of Americas (North and South) are included in the analysis. Significant risk with SLT products with oral cancer was found for SEAR (4.44, 95% CI = 3.51 to 5.61) and for EMR (1.28, 95% CI = 1.04 to 1.56). Significantly higher risk (p < .001) was found for females (5.83, 95% CI = 2.93 to 11.58). Product wise analysis for different SLT products revealed various levels of risk viz. gutkha (8.67, 95% CI = 3.59 to 20.93), pan tobacco / betel liquid (7.18, 95% CI = 5.48 to 9.41), oral snuff (4.18, 50% CI = 2.37 to 7.38), Mainpuri tobacco (3.32, 95% CI = 1.32 to 8.36), and snus (0.86, 95% CI = 0.58 to 1.29). A significant positive association was observed between SLT use and the risk of oral cancer, in SEAR, EMRs, and among women users. The present meta-analysis demonstrates SLT product use and the risk of oral cancer at global level. Moreover, the present analysis provided data on the risk associated with individual SLT product. The results fulfil the gap in the data on independent effect of individual SLT product use on the outcome of oral cancer at global level, conclusively. Chewing SLT products was associated with higher risk of oral cancer than other types of SLT. This can serve as a useful tool for policy makers in forming strict policies in controlling SLT menace. Hence, we propose that in addition to smoking, efforts should be directed towards SLT product cessation as well in reducing oral cancer incidence.

Prevalence and factors associated with use of hookah tobacco among young adults in the U.S.

IntroductionAmong young adults, use of hookah tobacco (HT) is an emerging health-risk behavior. The goals were to demonstrate that (1) the prevalence of ever-use and current use of HT increased among U.S. young adults (18–30 years old) in the period from 2010 to 2015 and (2) the patterns of HT use differed across diverse demographic subpopulations of young adults. MethodsWe merged and analyzed data from the 2010–2011 and 2014–2015 Tobacco Use Supplement to the Current Population Survey. The sample (n = 55,352) was representative of the young adult population in the U.S. Two binary measures were the ever and current use of HT. The significance level was 5%. ResultsThe rate of current use of HT increased from 1% in 2010–11 to 2% in 2014–15 (CI = 0.6%:1.1%). The rate of ever-use increased from 7% to 12% (CI = 4.2%:5.6%). The over-time increase was not uniform: the increase was most rapid among 26–30 year-old adults, non-Hispanic Black and African American adults, and in Northeastern and Midwestern U.S. regions. HT ever-use, overall, was associated (all p's < 0.001) with many sociodemographic factors and current tobacco-use behaviors. The rate of HT ever-use was 16% for daily and 23% for occasional cigarette smokers, 23% for users of smokeless tobacco products, 37% for cigar smokers, and 55% for smokers of regular pipe (filled with tobacco). Discussion/conclusionHT use is becoming increasingly more popular among young adults in the U.S. Methods should target not only cessation of cigarette smoking but use of all tobacco products.

Comprehensive survey of radionuclides in contemporary smokeless tobacco products

There is considerable interest in the chemical composition of smokeless tobacco products (STPs), owing to health concerns associated with their use. Previous studies have documented levels of 210Po, 210Pb and uranium in STP samples. Here, the levels of 13 α-particle and 15 β-radiation emitting radionuclides have been measured in a broad and representative range of contemporary STPs commercially available in the United States and Sweden. For each radionuclide, the level of radioactivity and calculated mass per gram of STP are reported. The results indicate that, among 34 Swedish snus and 44 US STPs, a more complex radionuclide content exists than previously reported for these products. Of the 28 radionuclides examined, 13 were detected and quantified in one or more STPs. The most frequently identified radionuclides in these STPs were 40K, 14C, 210Po and 226Ra. Over half the STPs also contained 228Th, and an additional 8 radionuclides were identified in a small number of STPs. The presence of 14C, 3H and 230Th are reported in tobacco for the first time. The activity of β-emitters was much greater than those of α-emitters, and the β-emitter 40K was present in the STPs with both the greatest radioactivity and mass concentrations. Since the three radionuclides included in the FDA’s HPHC list were either not detected (235U), identified in only three of 78 samples (238U), and/or had activity levels over fifty times lower than that of 40K (210Po, 238U), there may be a rationale for reconsidering the radionuclides currently included in the FDA HPHC list, particularly with respect to 40K. Using a model of the physical and biological compartments which must be considered to estimate the exposure of STP users to radionuclides, we conclude that exposure from α-emitters may be minimal to STP users, but 40K in particular may expose the oral cavities of STP users to β-radiation. Although a more comprehensive picture of the radioisotope content of STPs has emerged from this study, epidemiological evidence suggests that the levels of radionuclides measured in this study appear unlikely to present significant risks to STP users.

Bacterial Populations Associated with Smokeless Tobacco Products.

It is estimated that there 8 million users of smokeless tobacco products (STPs) in the United States; however, there are limited data on microbial populations that exist within these products. The current study was undertaken to better understand the potential microbiological risks associated with STP use and provide a baseline microbiological profile of STPs. Several bacterial species were identified that are of possible concern due to their potential to cause opportunistic infections. In addition, some species have abilities to reduce nitrates to nitrites, which may be an important step in the formation of carcinogenic tobacco-specific N'-nitrosamines. Overall, this report provides a microbiological baseline to help fill knowledge gaps related to the microbiological risks of STPs and to inform potential regulations regarding the manufacture and testing of STPs.

Pitfalls in the assessment of smoking status detected in a cohort of South African RA patients.

This study was conceived in an attempt to explain the unexpectedly high frequency of elevated levels of serum cotinine measured retrospectively in a cohort of predominantly black South African females with rheumatoid arthritis (RA), findings that were inconsistent with the smoking histories derived from health questionnaires. The discrepant findings suggested either a greater tendency towards underreporting of smoking status in the study cohort, or possible confounding effects of the use of smokeless tobacco products. In addition to the cohort of RA patients (n=138, of whom 115 (83%) were female), blood samples were also taken from a second cohort consisting of 29 declared smokers, 18 (62%) of whom where females, 29 smokeless tobacco (SLT) users (all female), and 22 non-users of any tobacco products, 18 (82%) of whom were females. Serum cotinine levels were determined using an ELISA procedure. Cotinine levels of >10.0ng/ml were detected in serum specimens from 43 (31%), RA patients of whom 35 (81%) were female, with a median value of 50.1ng/ml and interquartile range (iqr) of 68.6. Only 18 of the 35 females indicated that they smoked. The groups of declared smokers and SLT users had equivalent median serum cotinine levels of 88.0ng/ml (iqr=10.8ng/ml) and 87.0ng/ml (iqr=15.6ng/ml), respectively, while cotinine was undetectable in specimens from non-tobacco product users (<0.2ng/ml). Users of SLT products in South Africa are predominantly female and have serum cotinine levels which are comparable with those of current smokers, raising concerns about the validity of measurement of cotinine as the sole objective marker of smoking status in populations with high usage of SLTs. This situation can be rectified by ensuring that usage of SLT products is accurately recorded in health questionnaires, while inclusion of measurement of one or more additional, objective biomarkers of smoking in combination with cotinine may enable reliable distinction between smoking and usage of SLTs which, given the associated risks, is a strategy of particular relevance in RA.

The ban on smokeless tobacco products is systematically violated in Chennai, India.

India is the world's third largest consumer of tobacco. There are twice as many users of smokeless tobacco products (STPs) as cigarette smokers. The Government of Tamil Nadu has banned the sale of gutkha and pan masala in 2013. Our aim was to identify the varieties of illegal STP available in Chennai, India. In systematically chosen zones and regions of Chennai city, we randomly identified three kinds of kiosks (n = 18) and asked for "gutkha" and "pan masala," one of each product available. Details of each product were reviewed based on the information printed on the sachets. Totally 65 STPs were collected; 26 distinct products and 23 brands. All products were claimed to be "tobacco" by the shop keepers. Sixty-five percent of the products informed to contain tobacco and 15.4% to contain pan masala. Five sachets did not inform about the content; 30.8% did not have a pictorial warning; a text warning was printed on 80.8%, but only two products had the messages in Tamil; 70% had promotional messages printed, and 57% had their registration numbers printed. The ban on STP is being systematically violated in Chennai. STP are cheap and easily available and due to promotional laudatory messages and lacking information about the content and warning of health damage, the consumers are left with the perception that they buy more or less harmless product. The Indian Government must introduce policies to control production, import, and sale of illicit STP but we also call for a coordinated international solution.

A receiver operated curve-based evaluation of change in sensitivity and specificity of cotinine urinalysis for detecting active tobacco use

Tobacco use has been associated with various carcinomas including lung, esophagus, larynx, mouth, throat, kidney, bladder, pancreas, stomach, and cervix. Biomarkers such as concentration of cotinine in the blood, urine, or saliva have been used as objective measures to distinguish nonusers and users of tobacco products. A change in the cut-off value of urinary cotinine to detect active tobacco use is associated with a change in sensitivity and sensitivity of detection. The current study aimed at assessing the impact of using different cut-off thresholds of urinary cotinine on sensitivity and specificity of detection of smoking and smokeless tobacco product use among psychiatric patients. All the male subjects attending the psychiatry out-patient department of the tertiary care multispecialty teaching hospital constituted the sample frame for the current study in a cross-sectionally. Quantitative urinary cotinine assay was done by using ELISA kits of Calbiotech. Inc., USA. We used the receiver operating characteristic (ROC) curve to assess the sensitivity and specificity of various cut-off values of urinary cotinine to identify active smokers and users of smokeless tobacco products. ROC analysis of urinary cotinine levels in detection of self-reported smoking provided the area under curve (AUC) of 0.434. Similarly, the ROC analysis of urinary cotinine levels in detection of self-reported smoking revealed AUC of 0.44. The highest sensitivity and specificity of 100% for smoking were detected at the urinary cut-off value greater than or equal to 2.47 ng/ml. The choice of cut-off value of urinary cotinine used to distinguish nonusers form active users of tobacco products impacts the sensitivity as well as specificity of detection.

Association of tobacco products use and diabetes mellitus-results of a national survey among adults in saudi arabia.

To compare the tobacco products use patterns of known diabetics and non diabetics. A community-based cross-sectional study using STEPwise approach among adults using a multistage, stratified, cluster random sample. Data was collected using a questionnaire which included sociodemographics; tobacco products use habits, history of diabetes, biochemical and anthropometric measurements. Of the total of 4654 subjects who participated in the study, 1016 (21.8%) were ever smoked tobacco products users and 65 (1.4%) were ever smokeless tobacco products users. Known Diabetes prevalence was 15.3% (712 known diabetics). There were no significant differences in diabetic status and smokeless tobacco products use for both ever and current use. For smoked products diabetics are fewer in current smokers and more in ex smokers. Diabetics started smoking significantly older, smoked for longer duration and higher intensity than non diabetics. Diabetes appears to be associated with smoked but not smokeless tobacco products use.

Developing smokeless tobacco products for smokers: an examination of tobacco industry documents

Objective:To investigate whether development of smokeless tobacco products (SLT) is intended to target current smokers.Methods:This study analysed internal tobacco industry documents to describe research related to the smokeless tobacco market....

Personality characteristics of users of smokeless tobacco compared with cigarette smokers and non-users of tobacco products

This study compares the personality characteristics of men who use smokeless tobacco (ST) products with smokers and non-users. The Eysenck Personality Questionnaire (EPQ), the State-Trait Personality Inventory (STPI), and the Anger Expression (AX) Scale were given to a heterogeneous sample of 755 men residing in Florida and Texas, consisting of 275 ST-Users, 272 smokers, and 208 non-users. Participants were screened to ensure adequate reading ability, and were tested individually at convenience stores, gun and boat shows, barbecue and truck-stop restaurants, and a county fair. ST-Users and smokers had significantly higher mean EPQ Psychoticism and STPI Trait Anger scores than non-users. Smokers also had significantly higher EPQ Neuroticism and Anger-In scores, and were lower in trait curiosity than non-users; the scores of the ST-Users on these measures fell between those of the smokers and non-users, and did not differ significantly from either group. Although no differences in Extraversion were found between ST-Users, smokers and non-users, Occasional ST-Users had significantly higher E scores than Regular Users of smokeless tobacco products.

Effectiveness of video instruction in educating teenagers about the health risks of smokeless tobacco use.

Smokeless tobacco use, especially among adolescents, appears to have gained increased recent popularity. A resurgence in the use of this product was identified in the mid-1970s. Surveys in the United States have documented that between 8% and 30% of all high school males are regular users of smokeless tobacco products. Investigators have identified specific clinical lesions associated with smokeless tobacco use that appear most frequently as wrinkled mucosal surfaces with delicate white stria. Such lesions have been termed smokeless tobacco keratoses. Gingival inflammation and periodontal inflammation have also been associated with the use of this product. The purpose of the current investigation was to determine the effectiveness of a specific intervention aid, video instruction, for providing teenagers with information concerning the health risk of smokeless tobacco use. The video provided new information to students and appeared to be an effective tool for student health education. It is, however, unclear at this point how well the information will be retained or whether or not viewing the videotape will encourage the student to reconsider the habit and decrease the likelihood that he or she will begin or continue it. These aspects and the long-term impact of the video instruction need to be addressed by a longitudinally designed study and future research on smokeless tobacco use among teenagers.

Smokeless tobacco use and attitudes toward smokeless tobacco among Native Americans and other adolescents in the northwest.

A survey of 1,180 sixth, ninth, and eleventh graders in three school districts in the State of Washington found that 34 per cent of male Native Americans, 24 per cent of female Native Americans, 20 per cent of male non-natives and 4 per cent of female non-natives are current users of smokeless tobacco products. In all areas and groups, the best predictor of whether an adolescent is a user is the use pattern of friends.