Nicotine delivery capabilities of smokeless tobacco products and implications for control of tobacco dependence in South Africa.
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OBJECTIVES: Smokeless tobacco (SLT) use is popular among black South African women and children. The study sought to determine the nicotine delivery capability of popular industrialised and traditional SLT brands in South Africa, and to provide information for policy action by regulatory authorities. DESIGN: Laboratory chemical analysis of four industrialised and one traditional SLT products commercially available, using previously published analytical methods. Potential for dependence was inferred from nicotine delivery capabilities determined by the percentage free base nicotine. MEASUREMENTS: Moisture, pH, total nicotine, and percentage free base nicotine. RESULTS: Total nicotine content was between 6-16 mg/g. The pH varied between 7-10 and this correlated with percentage free base nicotine, which ranged between 10-99%. The nicotine delivery capability of the traditional product was lower than that of the industrialised products except for the recently introduced portion bag snus, which had comparable total nicotine but the lowest pH and percentage free base nicotine. The most popular SLT brands showed the highest percentage free base nicotine ever reported for any industrialised SLT or cigarette brands. Small cans contained higher nicotine than the large cans of the same brand tested. Findings from the study support a potential for limited "product graduation" by users. CONCLUSIONS: South African SLT users are mostly exposed to potentially very highly addictive levels of nicotine that may favour tobacco dependence and its consequent health risks. The increasing use of SLT by women of childbearing age support the need for intensified policy action to control its use. (+info)
Smokeless tobacco use, birth weight, and gestational age: population based, prospective cohort study of 1217 women in Mumbai, India.
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OBJECTIVE: To study the effect of using smokeless tobacco during pregnancy on babies' birth weight and gestational age at birth. DESIGN: Population based, prospective cohort study using a house to house approach. SETTING: Eight primary health post areas in the city of Mumbai (Bombay), India. PARTICIPANTS: 1217 women who were three to seven months pregnant and planning to deliver in the study area. 1167 women (96%) were followed up. MAIN OUTCOME MEASURES: Birth weight and gestational age in singleton births. RESULTS: Smokeless tobacco use was associated with an average reduction of 105 g in birth weight (95% confidence interval 30 g to 181 g) and a reduction in gestational age of 6.2 (3.0 to 9.4) days. The odds ratio for low birth weight was 1.6 (1.1 to 2.4), adjusted by logistic regression for maternal age, education, socioeconomic status, weight, anaemia, antenatal care, and gestational age. The adjusted odds ratio for preterm delivery (< 37 weeks) was 1.4 (1.0 to 2.1); for delivery before 32 weeks it was 4.9 (2.1 to 11.8) and before 28 weeks it was 8.0 (2.6 to 27.2). CONCLUSIONS: Consumption of smokeless tobacco during pregnancy decreases gestational age at birth and birth weight independent of gestational age. It should receive specific attention as a part of routine prenatal care. (+info)
Alert for an epidemic of oral cancer due to use of the betel quid substitutes gutkha and pan masala: a review of agents and causative mechanisms.
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In south-east Asia, Taiwan and Papua New Guinea, smoking, alcohol consumption and chewing of betel quid with or without tobacco or areca nut with or without tobacco are the predominant causes of oral cancer. In most areas, betel quid consists of a mixture of areca nut, slaked lime, catechu and several condiments according to taste, wrapped in a betel leaf. Almost all habitual chewers use tobacco with or without the betel quid. In the last few decades, small, attractive and inexpensive sachets of betel quid substitutes have become widely available. Aggressively advertised and marketed, often claimed to be safer products, they are consumed by the very young and old alike, particularly in India, but also among migrant populations from these areas world wide. The product is basically a flavoured and sweetened dry mixture of areca nut, catechu and slaked lime with tobacco (gutkha) or without tobacco (pan masala). These products have been strongly implicated in the recent increase in the incidence of oral submucous fibrosis, especially in the very young, even after a short period of use. This precancerous lesion, which has a high rate of malignant transformation, is extremely debilitating and has no known cure. The use of tobacco with lime, betel quid with tobacco, betel quid without tobacco and areca nut have been classified as carcinogenic to humans. As gutkha and pan masala are mixtures of several of these ingredients, their carcinogenic affect can be surmised. We review evidence that strongly supports causative mechanisms for genotoxicity and carcinogenicity of these substitute products. Although some recent curbs have been put on the manufacture and sale of these products, urgent action is needed to permanently ban gutkha and pan masala, together with the other established oral cancer-causing tobacco products. Further, education to reduce or eliminate home-made preparations needs to be accelerated. (+info)
Snuffing tobacco out of sport.
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Use of oral snuff has risen sharply among baseball players following a tobacco industry marketing campaign that linked smokeless tobacco with athletic performance and virility. Millions of adolescents have copied these professional role models and, today, are at risk of developing oral cancer and other mouth disorders. New policies and programs are needed to break the powerful grip that the tobacco industry has on professional sport. Health agencies, including the National Cancer Institute and the National Institute for Dental Research, have teamed up with major league baseball to help players quit and reduce public use of oral tobacco. If these efforts are successful, our national pastime will once again become America's classroom for teaching health and fitness, not nicotine addiction. (+info)
Smokeless tobacco, cardiovascular risk factors, and nicotine and cotinine levels in professional baseball players.
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BACKGROUND: The use of smokeless tobacco (ST), which has increased in popularity over the past 2 decades, results in considerable systemic exposure to nicotine. Nicotine might contribute to atherosclerosis by an effect on cardiovascular risk factors. METHODS: The effects of ST use on cardiovascular risk factors and cotinine and nicotine levels were studied in 1061 professional baseball players during spring training in 1988 and 1989. RESULTS: Of the study participants 477 (45%) were users. ST use was more common among Whites (55%) than among Blacks (29%) or Hispanics (21%), and users reported heavier consumption of alcohol (p less than .001) and had higher mean serum caffeine levels (p less than .001) than nonusers. ST users did not differ from nonusers in adjusted levels of systolic and diastolic blood pressure, pulse, and total or HDL-cholesterol. Among ST users, participants using snuff had higher mean serum cotinine levels than those who used chewing tobacco (p less than .001). There was no association between serum cotinine levels and adjusted levels of any cardiovascular risk factor studied. However, higher diastolic blood pressures were associated with higher mean serum nicotine levels (p = .02). CONCLUSIONS: Smokeless tobacco use has at most a modest effect on cardiovascular risk factors in young physically fit men. (+info)
Factors related to abstinence in a telephone helpline for smoking cessation.
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BACKGROUND: Studies indicate that shortage of cessation counsellors may be a major barrier for tobacco prevention among physicians. Telephone helplines (quitlines) may be an option. The effectiveness of the Swedish quitline and factors related to abstinence from smoking 12 months after the first contact were assessed. METHOD: Subjects included 694 smokers calling a reactive (no contact initiated by the counsellors) and 900 smokers calling a proactive (four or five contacts initiated by the counsellors after the first call) quitline for smoking cessation. The subjects were followed up 12 months after the first call using a mailed questionnaire assessing current abstinence, stages of change and factors potentially related to abstinence rates. RESULTS: The questionnaire was returned by 70% of the subjects. Women receiving the proactive treatment reported 34% abstinence rates compared with 27% for those receiving the reactive treatment (p=0.03). For men the abstinence rates were 27% and 28%, respectively (p=0.80). Factors significantly related to abstinence in the adjusted analysis included no nicotine use at base-line, the adjusted odds ratio with 95% confidence interval being 6.4 (2.1-19.4), additional support from a health care professional 3.5 (1.0-12.3), additional social support 3.1 (1.6-6.1), stress or depressive mood 2.7 (1.6-4.7), nicotine replacement therapy for five weeks or more 2.1 (1.1-4.0), and exposure to second-hand smoke 1.9 (1.1-3.3). The use of oral tobacco did not significantly increase current abstinence. CONCLUSION: Quitlines are effective as an adjunct to the health care system. For women a proactive treatment may be more effective than a reactive treatment. (+info)
Tobacco survey among youth in South India.
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BACKGROUND: Smoking of cigarettes and, particularly, of "bidis" (which consist of about 0.2-0.3 gm of tobacco rolled up in the leaf of another plant (temburni) has been widespread for many decades among men in India. There have, however, been no substantial studies on the prevalence of tobacco use among youth in India. Hence a Global Youth Tobacco Survey was conducted in schools in Tamil Nadu as part of on-going Global Youth Tobacco survey in over 150 countries in the world. METHODS: The two-stage cluster sample method was used to select 100 schools with standards 8, 9 and 10 in Tamil Nadu. The survey used self administered questionnaires, which consisted of 88 multiple choice questions. RESULTS: A total of 4820 students participated (a response rate of 90.1%) in the 99 of 100 schools selected for the survey. About 10% of students aged 13-15 in Tamil Nadu had ever used tobacco. Significantly higher percentages of current tobacco users (one in three students) compared to never tobacco users thought smoking or chewing tobacco makes a boy or girl more attractive. About 3 in 4 current smokers expressed a wish to stop smoking and a similar proportion have already tried to quit the habit. About 80% of students considered using tobacco (smoking or chewing tobacco) to be harmful to their health. Only about half of the students reported that they have been taught in school the health effects of tobacco use during the year preceding the survey. Exposure to environmental tobacco smoke and pro-tobacco advertisements is high. CONCLUSIONS: The tobacco prevalence among girls is alarming. The results of the survey show the need to increase awareness about health hazards of tobacco use among students. Tobacco control programs focusing on youth are essential in order to reduce the burden of tobacco related diseases in India. Repeat surveys would help in monitoring the tobacco epidemic in the school and to evaluate the efficacy of state level tobacco control programs. (+info)
Smokeless tobacco and oral cancer: a review of the risks and determinants.
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Smokeless tobacco has been associated with oral cancer for many decades. The purpose of this article is to review research relevant to this association, including epidemiologic studies, studies of putative carcinogens such as tobacco-specific nitrosamines (TSNAs) and other contaminants, and possible cancer inhibitors. Epidemiologic studies addressing this issue primarily consist of case-control studies. They show that the use of chewing tobacco and moist snuff is associated with very low risks for cancers of the oral cavity and related structures (relative risks [RR] from 0.6 to 1.7). The use of dry snuff is associated with higher RRs, ranging from 4 to 13, while the RRs from smokeless tobacco, unspecified as to type, are intermediate (RR = 1.5 to 2.8). With regard to TSNAs, historical levels in American moist snuff products were higher than those in their Swedish counterparts, but levels in contemporary products are uniformly low. TSNA levels in chewing tobacco have always been low, but levels in dry snuff have been higher, including some very high levels in current products. In general, smokeless tobacco users are not exposed to significant levels of cadmium, lead, benzo(a)pyrene, polonium-210, and formaldehyde, when compared with concentrations of these compounds in foods. Finally, low oral cancer risk from smokeless tobacco use may be influenced by the presence of cancer inhibitors, mainly anti-oxidants, in smokeless tobacco products. (+info)