Bimodal initiation of smokeless tobacco usage: implications for cancer education

Exploring the perceived sociocultural factors in the initiation of smokeless tobacco among adolescents: a qualitative systematic review protocol

OBJECTIVE

The objective of the review is to identify and explore the perceived sociocultural factors leading to smokeless tobacco initiation among the adolescent population.

INTRODUCTION

Smokeless tobacco use is associated with oral cancer and premalignant lesions. The initiation of smokeless tobacco often occurs in adolescence, with multiple sociocultural factors facilitating the commencement of this habit. An in-depth understanding of the factors influencing smokeless tobacco uptake can assist policymakers and tobacco-control units in establishing global policies and implementing control strategies to prevent adolescents' taking up smokeless tobacco.

INCLUSION CRITERIA

This review will consider qualitative studies conducted within the last 20 years on adolescent smokeless tobacco users, focusing on sociocultural factors influencing smokeless tobacco initiation. Studies involving cigarette smoking, other alternative forms of smoking, and any form of tobacco cessation intervention will be excluded.

METHODS

A systematic search will be conducted in MEDLINE, Scopus, CINAHL, Embase, PsycINFO, and the Cochrane CENTRAL databases, using a 3-step search process. ProQuest Dissertations and Theses, OAIster, and Google will be searched for unpublished studies. Only studies published from January 2002 until the present and in English will be considered. Study screening, extraction, and critical appraisal will be performed by 2 independent reviewers using the standardized JBI qualitative appraisal and data extraction tools. Data synthesis will involve aggregation of the review findings to generate a set of statements based on similarity of meaning.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42021240588.

Oral spit tobacco: addiction, prevention and treatment

The prevalence of smokeless tobacco is significant and reaches as high as 17% past month use in white males aged 18-25. Smokeless tobacco use is of concern because of the potential for addiction and the associated negative health consequences. This article reviews the basis for addiction to smokeless tobacco, examining the nicotine content in smokeless tobacco products, pharmacokinetics, psychoactive effects, tolerance, and withdrawal. It also explores the negative health consequences which include a number of oral pathologies and increased cardiovascular risk factors. Furthermore, it examines the factors associated with the initiation of smokeless tobacco use, and the current prevention programs that address these factors. Current smokeless tobacco treatment approaches are also discussed as well as predictors for abstinence. Finally, the future directions are discussed in light of the limited amount of research that has been conducted in the smokeless tobacco area, particularly related to prevention and treatment.

Cessation related perceptions and behavior of former and current smokeless tobacco users

Four hundred fourteen former and 73 current users of smokeless tobacco were questioned about their experiences in giving up smokeless tobacco. Their responses were compared with those of 463 ex-smokers to determine whether former smokeless tobacco users differed from former smokers in using specific cessation techniques. Of the smokeless tobacco users, 77% were interested in quitting, but only 7% wanted to quit "now." Seven percent of the daily users reported that a college-based health or fitness professional had advised them to quit. Former smokeless tobacco users were significantly more likely than former smokers to report that smoking cigarettes was related to their efforts to give up smokeless tobacco than former smokers were to report using smokeless tobacco as a strategy to stop smoking, Former smokeless tobacco users were also significantly more likely than former smokers to report current tobacco use. Smokeless tobacco cessation programs based on the transtheoretical approach to behavior change are recommended.

Transitions out of high school: time of increased cancer risk?

BACKGROUND

The effectiveness of lifestyle behavior interventions with children to reduce chronic disease risks in adulthood assumes stability in the lifestyle behaviors across time. The transition out of high school is a time when many changes occur in social roles, e.g., changing schools, leaving the parents' home, changing peers, finding employment, getting married, and becoming a parent. Cancer risk behaviors may increase as a result of some of these social role changes.

METHODS

Concepts relevant to the stability or change in lifestyle behaviors through the transition out of high school are presented. Literature concerning diet, smoking, smokeless tobacco, alcohol, physical activity, sexual practices, and sun exposure behaviors through the transition is reviewed.

RESULTS

Most lifestyle behaviors display increasing cancer risk around the transition out of high school. Different levels of change were associated with different pathways through the transition. Inconsistent findings were obtained in the pattern of co-occurrence of these behaviors.

CONCLUSION

Priority research includes establishing the pattern of co-occurrence of lifestyle behaviors through the transition, identifying the pattern of tracking of each behavior through the transition, and identifying the primary influences on the group values and tracking of the behaviors. Longitudinal research is needed to control for preexisting differences between pathways through the transition.

Demographic and predictive correlates of smokeless tobacco use in elementary school children

BACKGROUND

To assess the basic demographics and predictive correlates of smokeless tobacco use in school-age children, a stratified random sample of 559 rural and urban first, third, fifth, and seventh graders in western North Carolina was surveyed regarding experimentation with smokeless tobacco.

METHODS

Two versions of a survey were developed: a shorter version administered orally to first graders and a longer version provided to others. Reported percentages across demographic variables were broken down in a 4 x 2 x 2 analysis of variance; correlations were used to assess the relationships among potentially predictive variables.

RESULTS

Results indicated that 36 percent of male rural first graders had tried smokeless tobacco, increasing to 70 percent by the seventh grade. Overall, rural males were more likely to have tried or be regularly using smokeless tobacco than were urban males or females. Other questions correlating with smokeless tobacco use indicated that it is predicted by three general concerns: a) perceived flavor, b) self-concept and presentation to peers, and c) family influence.

DISCUSSION

Educational interventions must begin at the kindergarten or first grade levels. Programs for adolescents must provide for alternative ways of receiving perceived social image benefits of smokeless tobacco use. Familial support must be considered in all programming.

The inside scoop on the stuff called snuff: an interview study of 94 adult male smokeless tobacco users

This interview study collected information from 94 adult males about a variety of factors related to their smokeless tobacco (ST) habit. Eighty-nine percent of this sample used moist snuff and most analyses focused on this group. Three measures of self-reported snuff use were intercorrelated and compared to a saliva cotinine assay. Correlations demonstrated potential usefulness of measures such as number of dips per day when biochemical measures are not practical. A majority (68%) of the Ss reported attempts to quit smokeless tobacco use, but relapsed from 1 to 3 months later. Ninety-six percent of snuff users reported awareness of cancer and other oral health risks and 56% reported an intention to quit in the next 12 months. A majority (67%) of subjects report receptivity to receiving advice to quit from medical and dental providers although only one-third had received such advice. The results are discussed in terms of designing an effective cessation intervention in dental clinics for ST users.

Psychosocial factors in the use of smokeless tobacco and their implications for P.L. 99-252

This article briefly reviews the prevalence of smokeless tobacco use by males in the United States, the relationship of smokeless tobacco use to cigarette use, and patterns of use that include dosage, topography, products, and function of use. The primary focus of the article is to describe the concurrent and predictive factors associated with onset, use, and cessation of smokeless tobacco. The implications of P.L. 99-252, the Comprehensive Smokeless Tobacco Act of 1986, are discussed in the context of what is known about the psychosocial variables associated with the use of smokeless tobacco.

Evaluating the impact of P.L. 99-252 on decreasing smokeless tobacco use

Literally, Public Law 99-252 (otherwise known as the Comprehensive Smokeless Tobacco Health Education Act of 1986) includes provisions that are informational in nature. Implicitly, however, this law is considered part of the federal effort in disease prevention and health promotion. This paper reviews the societal and legislative context of that act and presents a plan to evaluate the impact of this law on decreasing smokeless tobacco use. The uniqueness of this plan is its incorporation of nine disciplinary perspectives in the derivation of indicators to measure process, impact, and outcome measures for decreasing smokeless tobacco use. A basic prevention strategy is suggested by this interdisciplinary approach. In addition, specific lessons could be applied from the history of successes in public health to decreasing smokeless tobacco use.

P.L. 99-252--implications for dentists and their clinical practice

This paper is one of a series attempting to determine the impact of Public Law 99-252, the Comprehensive Smokeless Tobacco Health Education Act of 1986, on decreasing smokeless tobacco use. Potential indicators are discussed that could be used by the dental profession to determine the efficacy of the profession's involvement in existing and future prevention and cessation efforts relative to this law. In this review, six major areas are considered for measuring declines in smokeless tobacco use relative to the role of the dental health practitioner. These areas encompass the following: (1) the dental profession's knowledge of smokeless tobacco health hazards, (2) dental practitioners' involvement in measuring changes in use patterns, (3) the influence dentists have with their patients and community in decreasing smokeless tobacco use, (4) the general attitude and intention to quit on the part of dental patients, (5) active governmental involvement efforts, and (6) health effects of smokeless tobacco that might be used for identifying decreasing smokeless tobacco use. Within each of these six broad categories, more specific indicators for measuring the impact of P.L. 99-252 relative to the dental profession were considered.

An in-depth analysis of male adolescent smokeless tobacco users: interviews with users and their fathers

Male adolescent smokeless tobacco (ST) users (N = 191) were extensively interviewed, then followed over a 6-month period with monthly telephone interviews. In addition, their fathers (N = 137) were interviewed by telephone. Based on these data, ST use appears similar to cigarette smoking with respect to onset, patterns of use, social influences, attempts to quit, and indications of addiction. Onset and continued use of ST largely occur in a social context. Parents are reportedly aware (73%) of their sons' ST use but appear tolerant. The great majority of S's (92%) believe that there is some health risk associated with ST use. Over half report noticing ST-related changes in their oral cavities, although their dentists generally had not discussed ST use with them. Over one-third of the current users report unsuccessful quit attempts. ST use appears to be part of a more general pattern of substance use, including marijuana and alcohol.

Smokeless tobacco use by youth in the U.S

Oral snuff and chewing tobacco, commonly referred to as smokeless tobacco, are being used by many adolescent and young adult males, and no indication exists that use by this group is declining. Users are at risk for oral cancer, noncancerous oral pathology such as leukoplakias, and addiction. Information about patterns of smokeless tobacco use and motivations of users may help planners develop and implement interventions. Variables include the importance of peer and family influences, social image, knowledge of harmful effects, regional differences, use of other substances, and addiction. Due to the addictive nature of smokeless tobacco, older youth may need cessation programs. Health educators are encouraged to include smokeless tobacco in their tobacco use prevention programs and to develop and implement comprehensive tobacco interventions appropriate for their youth population.

An interpretative review of smokeless tobacco research in the United States: Part I

The first part of a two-part series reviewing the published literature of smokeless tobacco in the United States and concomitant health effects associated with its use. This article delineates the current status of its prevalence, behavioral psychosocial factors associated with use, and review of the negative health effects associated with regular use.

Personality profiles associated with smokeless tobacco use patterns

The purpose of this study was to examine the personality characteristics of male dippers and chewers of smokeless tobacco. The study objective was to determine any differences in personality characteristics between dippers and chewers of smokeless tobacco and nonusers. A survey at a southeastern university provided a sample of 289 males, of which 55 (19%) were smokeless tobacco users. Each subject was administered a demographic data sheet and Cattell's Sixteen Personality Factor Questionnaire (16 PF). Smokeless tobacco users were categorized as snuff dippers or tobacco chewers, and comparisons of personality characteristics were made between persons who exclusively dipped, persons who exclusively chewed, persons who dipped and chewed, and persons who did neither. The results of the study indicated that smokeless tobacco use is primarily a White male habit; very few Blacks or other racial groups consumed smokeless tobacco among this population. Significant (p less than 0.05) personality differences between snuff dippers and tobacco chewers were noted. Snuff dippers were more socially outgoing, enthusiastic, imaginative and group dependent than chewers. Chewers were found to be more uncompromising, critical in outlook and practical and less easily influenced by others than dippers.

Screening for smokeless tobacco-associated lesions: recommendations for the dental practitioner

The increasing use of smokeless tobacco and the accumulating list of associated health hazards including cancer and cardiovascular effects should be of concern to the dentist. This study documents both concern from patients' perceptions and clinical examinations of their smokeless tobacco-associated lesions. Implications for the dentists' practice among adolescents and young adults are discussed.

Prevalence and patterns of smokeless tobacco use in a southeastern university

The purpose of this study was to determine prevalence and patterns of use for tobacco products, especially, the use of smokeless tobacco among students at a university in the Southeastern United States. Six-hundred and thirty-two students, representing both sexes, participated in the survey, which elicited information regarding current and former use of tobacco products. Smokeless tobacco use was considerably more prevalent among male students than among female students; the reverse was true for cigarette smoking. Overall, the prevalence of tobacco use in this study indicates a need to begin health education programs regarding the adverse health effects of smokeless tobacco use with males and to revise smoking education programs to place more emphasis on female usage.