Search

Introduction: Smokeless tobacco (SLT) is a significant contributor to tobacco-related harm in Pakistan but its control has lags behind that of combustible tobacco. We assessed the compliance of Naswar's (a widely used SLT product in the Southeast Asia) packaging and sales practices with the national legislations and relevant articles of the WHO framework convention on tobacco control (FCTC)., Aims and Methods: A cross-sectional observational audit was conducted in three districts of Pakistan. We recruited 286 general point of sale (GPOS) and exclusive Naswar sellers (ENS) through a multistage cluster sampling strategy. Data were gathered on packaging and labeling practices of Naswar and advertisement and promotion practices inside and outside the shops. Statistical tests for association between the dependent variable-advertisement practices, and independent variables-area and vendor types were conducted., Results: We analyzed 133 and 49 unique Naswar products sold in 229 GPOS and by 57 ENS, respectively. None of the local products had any written or pictorial health warning. More than half of retailers used one or two methods of advertising Naswar inside the shops while only 9% advertised outside the shops. ENS were more likely to be noncompliant with tobacco advertisement and promotion compared with GPOS., Conclusions: The study presents first insights on the compliance of Naswar packaging and sale practices with local regulations and WHO FCTC provisions in Pakistan. Almost all products were on display in the shops and none of the local products had any health warning or contents disclosure on the packages., Implications: Naswar is a form of SLT used extensively in Pakistan, Central Asia, and Pashtun populations across the globe. This study provides an important insight into the Naswar retail environment in a geographical setting where the use of Naswar is endemic. The study brings to fore previously unreported issues like an urban-rural disparity, and differences between exclusive and nonENS, with regards to Naswar advertisement and promotion. These findings have potential implication on the implementation of tobacco control retail policies. The lack of health warnings and free display of Naswar brands call for alignment of tobacco control efforts with the FCTC., (© The Author(s) 2020. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved.For permissions, please e-mail: journals.permissions@oup.com.)

The city of Clarkston (Georgia) is home to many refugees and immigrants, including Bhutanese and Burmese populations. Use of gutka and paan masala is common in these populations. While gutka and paan masala contain toxic ingredients including carcinogens, little research has examined general use, perceptions of risk, cultural norms, and access to these products among Bhutanese and Burmese populations in the southern U.S. This study uses focus groups and key informant interviews to develop an understanding of gutka and paan masala use among Bhutanese and Burmese refugee populations residing in Clarkston, focusing in particular on knowledge and perceptions of harm, patterns of and reasons for use, access to gutka and paan masala, and resources for cessation and prevention of gutka and paan masala use. We conducted 21 focus groups with Bhutanese and Burmese youths and adults and 11 key informant interviews. We analyzed data using MAXQDA and a grounded theory approach. Emerging themes included mixed understandings of ingredients and harms associated with gutka and paan masala use. The continued use of paan masala was perceived to be due to cultural traditions. Youths, particularly Bhutanese, were perceived as a rising group of users of gutka and paan masala. Widespread availability and accessibility in Clarkston made it easy for both adults and youths to acquire and use gutka and paan masala. Few participants knew about prevention efforts or resources in their communities. In conclusion, culturally-relevant awareness and education programs as well as health promotion materials regarding gutka and paan masala are much needed in Bhutanese and Burmese communities. More regulatory actions are needed, such as better warning signs in businesses to inform customers of ingredients in these products and their health risks, age restrictions on gutka and paan masala purchase, and compliance checks., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Snus may present lower health risks than cigarettes, but its harm reduction potential may be undermined if used dually with cigarettes. The likelihood of exclusive snus use compared with dual use may depend in part on the capacity of snus to deliver nicotine in doses that are satisfactory to smokers. We examined characteristics of "American snus" products, including nicotine levels, and compared to snus products that are more typical of Sweden., Methods: Tobacco industry reports for snus products submitted to the Massachusetts Department of Public Health for the year 2014 were used to assess moisture (%), pH, total nicotine, and unionized (free) nicotine (both mg/g and percent of total). A total of 14 ("American") snus products made by American manufacturers Philip Morris USA (n = 6), R.J. Reynolds Tobacco Company (n = 6), and US Smokeless Tobacco Company (n = 2), were compared with Swedish-style ("Swedish") snus products (n = 10) made by Swedish Match North America., Results: Compared with Swedish snus, American snus brands contained significantly lower concentrations of unionized nicotine (median: 0.52 mg/g vs. 6.52 mg/g; p < .001) and proportion of unionized nicotine (median: 3.17% vs. 81.8%; p < .001). American snus brands also had significantly lower pH (median: 6.54 vs. 8.68; p < .001) and moisture (median: 30.3% vs. 53.4%; p < .001)., Conclusions: Swedish-made snus has higher unionized nicotine, measured by concentration and proportion of total nicotine, compared with snus products made by American manufacturers. These findings suggest that American snus products have lower addiction potential than Swedish snus, and may be more likely to be used dually with cigarettes than as a sole source of nicotine., Implications: American snus products contain significantly lower unionized nicotine, lower pH, and lower moisture, compared with Swedish snus products. Snus addiction potential and patterns of usage, including co-use with cigarettes, may differ between American and Swedish snus products due to differences in snus product characteristics., (© The Author(s) 2016. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Tobacco harm reduction involves advocating the use of a less harmful alternative to smoking for those users who are unwilling or unable to quit. The net effect of such an approach is unclear as it may create opposing incentives. Although some smokers may substitute toward this less harmful alternative, it may reduce the incentive to quit by undermining public health efforts and may act as a gateway to smoking. This research paper aims to answer the question: Does the availability of a less harmful alternative to smoking lead to cessation? To explore the opposing incentives created by a harm reduction approach to smoking cessation, I focus on the role of snus, a popular smokeless tobacco product in Scandinavia that is widely used in Sweden., Methods: This paper exploits a quasi-natural experiment to examine the net effect resulting from these opposing incentives. While two Scandinavian countries, Sweden and Finland, joined the European Union (EU) in 1995, Finland was subject to a pre-existing EU ban on oral tobacco products while Sweden received an exemption. A difference in differences framework is used to estimate the change in the smoking rate in Finland due to the implementation of the ban. A secondary analysis uses Finnish smoking data to test for a structural break in trend., Results: In the post-ban period, smoking was 3.47 percentage points higher in Finland relative to what it would have been in the absence of the ban., Conclusion: The availability of snus, a less harmful alternative to smoking, appears to have had a positive impact (reduction) on the smoking rate. Offering acceptable alternatives to cigarettes is critical in reducing smoking prevalence., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Background: Sales of smokeless tobacco products have increased in the USA. More than one in eight males in the 12th grade are current users of smokeless tobacco. Surveillance data examining nicotine levels of smokeless tobacco subsequent to 2006 have not been reported in the literature., Methods: Data on nicotine levels and design features (eg, pH, moisture content, leaf cut and flavour) of smokeless tobacco products sold in Massachusetts were obtained from manufacturers between 2003 and 2012. Design features, levels and temporal trends in unionised (free) nicotine and nicotine content of smokeless tobacco products were analysed overall and by manufacturer and product type., Results: The annual total number of moist snuff products increased from 99 in 2003 to 127 in 2012. The annual total number of reported snus products increased from 4 in 2003 to the highest level of 62 in 2011, before decreasing to 26 in 2012. Overall, mean unionised (free) nicotine remained relatively stable (β=0.018 (95% CI -0.014 to 0.050) mg/g dry weight/year) from 2003 to 2012. However, both levels and temporal trends of mean free nicotine varied significantly among manufacturers (p<0.001). Since 2003, the free nicotine content of snus has increased at an overall rate of 0.192 (95% CI 0.138 to 0.246) mg/g dry weight/year, but varied by manufacturer (p<0.001)., Conclusions: The number of smokeless tobacco products increased in the Massachusetts market. Further, mean unionised (free) nicotine levels in smokeless tobacco products of several manufacturers continued to rise despite decreasing levels from other manufacturers. The current success in tobacco control is very likely undermined without government surveillance, regulation and widespread public disclosure of nicotine levels in these products., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

The time has come for the world to acknowledge the unacceptability of the damage being done by the tobacco industry and work towards a world essentially free from the sale (legal and illegal) of tobacco products. A tobacco-free world by 2040, where less than 5% of the world's adult population use tobacco, is socially desirable, technically feasible, and could become politically practical. Three possible ways forward exist: so-called business-as-usual, with most countries steadily implementing the WHO Framework Convention on Tobacco Control (FCTC) provisions; accelerated implementation of the FCTC by all countries; and a so-called turbo-charged approach that complements FCTC actions with strengthened UN leadership, full engagement of all sectors, and increased investment in tobacco control. Only the turbo-charged approach will achieve a tobacco-free world by 2040 where tobacco is out of sight, out of mind, and out of fashion--yet not prohibited. The first and most urgent priority is the inclusion of an ambitious tobacco target in the post-2015 sustainable development health goal. The second priority is accelerated implementation of the FCTC policies in all countries, with full engagement from all sectors including the private sector--from workplaces to pharmacies--and with increased national and global investment. The third priority is an amendment of the FCTC to include an ambitious global tobacco reduction goal. The fourth priority is a UN high-level meeting on tobacco use to galvanise global action towards the 2040 tobacco-free world goal on the basis of new strategies, new resources, and new players. Decisive and strategic action on this bold vision will prevent hundreds of millions of unnecessary deaths during the remainder of this century and safeguard future generations from the ravages of tobacco use., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: In Norway, low-nitrosamine smokeless tobacco (snus) is allowed to compete with cigarettes for market share. We aimed to study how the availability of snus influenced overall tobacco consumption, smoking initiation and smoking cessation. We discuss whether the Norwegian experience with snus can have any transfer value for e-cigarettes., Methods: We analysed consumption data from registered and unregistered supply sources of tobacco. We calculated quit-smoking ratios across snus use status in nine datasets comprising a total of 19,269 ever-smokers. Trends in snus use and smoking were derived from time-series of annual; cross-sectional; nationally representative surveys for the period 1985-2013., Results: The market share for snus increased from 4% in 1985 to 28% in 2012, but overall tobacco consumption decreased by 20.3% over this same period. Snus was the most common method for smoking cessation. Compared with smokers with no experience of using snus, the quit ratio for smoking was significantly higher for daily snus users in seven of the nine datasets analysed. Among young male adults, the prevalence of smoking (daily + occasional) was reduced from 50% in 1985 to 21% in 2013. Over the same period, use of snus increased from 9% to 33%. This negative correlation (r = -0.900, p < 0.001) was also observed among young females (r = -0.811, p < 0.001), but the trend shift in tobacco preferences occurred some years later., Conclusions: The experience with snus in Norway might indicate what will happen when alternative nicotine products--are allowed to compete with cigarettes in the nicotine market.

Background: Gutkha and pan masala contain harmful and carcinogenic chemicals. Hence, Maharashtra Government banned their manufacture, storage, distribution and sale on 19 th July 2012 for a year., Objectives: The objective of this study is to determine the impact of the ban on gutkha and pan masala on its users and vendors., Materials and Methods: A cross- sectional study was conducted among gutkha and/or pan masala users and tobacco vendors in the selected area of Mumbai city, 4-6 months after the implementation of the ban. The parameters studied included knowledge regarding the ban, usage or discontinuation of use of the banned products, product availability, withdrawal symptoms among quitters, etc.,, Results: A total of 68 users and five tobacco vendors were enrolled in this study. Although all users were aware about the ban on gutkha, very few knew about the ban on pan masala. Only 5.9% of users knew that currently the ban had been declared for only 1 year. Electronic media was the main source of information regarding the ban as reported by 45.6% users. All users and vendors were in favor of the ban. After the ban, 23.53% gutkha users quit their habit while 55.88% reduced their gutkha consumption. Non-availability of gutkha was the most important reason stated by the gutkha users for quitting or reducing the consumption. In spite of the ban, gutkha is still available in the market, but at an increased cost or in a different form., Conclusion: Nearly 23.53% of gutkha users have quit their habit post-ban despite its availability through illegal sources.

Introduction: Epidemiological and toxicological evidence suggests lower risk of smokeless tobacco (ST) products compared to cigarettes. Less is known, however, about consumer perceptions and use of novel forms of ST, including snus and dissolvable tobacco., Methods: In this study, we conducted in-person experimental auctions in Buffalo, NY, Columbia, SC, and Selinsgrove, PA with 571 smokers to test the impact of information and product trials on smokers' preferences. Auctions were conducted between November 2010-November 2011., Results: We found no evidence of an impact of product trials on demand in our auctions. Anti-ST information increased demand for cigarettes when presented alone, but when presented with pro-ST information it decreased demand for cigarettes. It did not decrease demand for ST products. Anti-smoking information increased demand for ST products, but did not affect cigarette demand., Conclusions: These findings suggest that credible and effective communications about tobacco harm reduction should reinforce the negative effects of smoking., (Copyright © 2013 Elsevier Inc. All rights reserved.)

The use of smokeless tobacco (ST) is linked to poor health outcomes, including oral and esophageal cancers. Adolescents who use ST are also more likely to use cigarettes and develop lung cancer later in life. Evidence shows that proximity to tobacco retailers increases youth initiation of use. We assessed availability of ST in neighborhoods surrounding ten high schools in New York City. Three hundred and twenty-one retailers were visited. Sixty-three percent of likely tobacco-selling businesses surrounding schools sold cigarettes. About 20 % sold snus, while 3 % sold snuff. Culturally-linked ST products, such as paan and gutka, were largely confined to ethnic neighborhoods, while snuff was more prevalent in neighborhoods with predominantly US born residents. A variety of ST products are easily accessible to adolescents and are located within close proximity to schools, perhaps facilitating use, as has been documented with youth smoking. Further research is needed on adolescent use of culturally-linked ST products. This research can serve as a foundation for development of interventions to reduce ST use among adolescents and for policy recommendations.

While the prevalence of smokeless tobacco (ST) is low relative to smoking, the distribution of ST use is highly skewed with consumption concentrated among certain segments of the population (rural residents, males, whites, low-educated individuals). Furthermore, there is suggestive evidence that use has trended upwards recently for groups that have traditionally been at low risk of using ST, and thus started to diffuse across demographics. This study provides the first estimates, at the national level, of the effects of magazine advertising on ST use. The focus on magazine advertising is significant given that ST manufacturers have been banned from using other conventional media since the 1986 Comprehensive ST Act and the 1998 ST Master Settlement Agreement. This study is based on the 2003-2009 waves of the National Consumer Survey (NCS), a unique data source that contains extensive information on the reading habits of individuals, matched with magazine-specific advertising information over the sample period. This allows detailed and salient measures of advertising exposure at the individual level and addresses potential bias due to endogeneity and selective targeting. We find consistent and robust evidence that exposure to ST ads in magazines raises ST use, especially among males, with an estimated elasticity of 0.06. There is suggestive evidence that both ST taxes and cigarette taxes reduce ST use, indicating contemporaneous complementarity between these tobacco products. Sub-analyses point to some differences in the advertising and tax response across segments of the population. The effects from this study inform the debate on the cost and benefits of ST use and its potential to be a tool in overall tobacco harm reduction., (Copyright © 2013 Elsevier B.V. All rights reserved.)

The burden of smokeless tobacco (ST) use disproportionally impacts males in rural Ohio Appalachia. The purpose of this study was to describe the cultural factors contributing to this disparity and to articulate the way in which culture, through interpersonal factors (i.e. social norms and social networks) and community factors (i.e. marketing and availability), impacts ST initiation and use of ST among boys and men in Ohio Appalachia. Fifteen focus groups and 23 individual qualitative interviews were conducted with adult (n = 63) and adolescent (n = 53) residents in Ohio Appalachian counties to ascertain factors associated with ST use and the impact of ST marketing. Transcriptions were independently coded according to questions and themes. ST use appears to be a rite of passage in the development of masculine identity in Ohio Appalachian culture. Interpersonal factors had the greatest influence on initiation and continued use of ST. Ohio Appalachian boys either emulated current ST users or were actively encouraged to use ST through male family and peer networks. Users perceived their acceptance into the male social network as predicated on ST use. Community factors, including ST advertisement and access to ST, reinforced and normalized underlying cultural values. In addition to policy aimed at reducing tobacco marketing and access, interventions designed to reduce ST use in Ohio Appalachia should incorporate efforts to (1) shift the perception of cultural norms regarding ST use and (2) address male social networks as vehicles in ST initiation.

Background: Naswar is a niche smokeless tobacco product from Pakistan. There is little information about its availability and user characteristics., Methods: This cross-sectional survey identified outlets selling Naswar in two wards of one London borough and interviewed a purposively recruited sample of 73 Naswar purchasers. Data were analysed using descriptive and chi-square tests (significance, P ≤ 0.05)., Results: Of 65 outlets identified 15 sold Naswar. The purchasers' mean (SD) age was 32 (± 10) years and 63% had completed only secondary education. Naswar consumption was significantly associated with tobacco dependency, whilst starting Naswar use at a younger age, having lower education levels, using Naswar more frequently and being of Pakhtunkhwa origin was associated with high monthly consumption (P ≤ 0.05)., Conclusions: Naswar was widely available. Naswar purchasers of Pakistani origin were employed and young, but with limited education and little knowledge of Naswar's health impacts. Naswar dependency and consumption was linked to behavioural and socio-demographic factors. Further evidence is needed to support policy development.

Background: The carcinogenicity of chewing tobacco is well established. It is predominantly used by the South Asian community in England. Little is known about the accessibility of the products available for use in England., Methods: Wards with high proportions or numbers of residents from the South Asian community were identified using 2001 Census data. Within each ward product purchasers identified retail outlets and purchased chewing tobacco products from them., Results: Chewing tobacco products were found in a broad variety of premises in all but one ward, and were easily accessible. Ninety-eight products were identified and purchased with a mean price of pound1.82. Of the ninety four pre-packaged products purchased only 15% (95% CI: 8%, 22%) complied with legal health warning requirements., Conclusion: The study indicates the need to improve compliance with legal controls and enforcement to protect the South Asian community from health risks associated with chewing tobacco products.

The Food and Drug Administration (FDA) is reissuing a final rule restricting the sale, distribution, and use of cigarettes and smokeless tobacco. As required by the Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act), FDA is issuing a final rule that is identical to the provisions of the final rule on cigarettes and smokeless tobacco published by FDA in 1996, with certain required exceptions. The rule prohibits the sale of cigarettes and smokeless tobacco to individuals under the age of 18 and imposes specific marketing, labeling, and advertising requirements. Elsewhere in this issue of the Federal Register, FDA is issuing an advance notice of proposed rulemaking to obtain information related to the regulation of outdoor advertising of cigarettes and smokeless tobacco.

Introduction and Aims: There has been little research published on the use of smokeless tobacco (SLT) in Australia. This study aimed to determine the prevalence of SLT use and the potential for harm reduction in current SLT users and smokers., Design and Methods: We undertook secondary analysis of data from a national household survey of drug use and surveyed 108 Australian SLT users about their patterns of SLT use and tobacco smoking., Results: The low prevalence of SLT use in the past year in Australia (0.57%; 95% confidence interval 0.48–0.66) might reflect the difficulty in importing these products. Prevalence of recent use was highest among males aged 18–29 who were current weekly smokers. US style oral snuffs were the most popular SLT products in Australia. Most of those surveyed were introduced to SLT by a personal contact and about half had used SLT to quit smoking. Australians who import SLT pay per can AU$21.30 on average and face substantial delays before receiving the product., Discussion and Conclusions: Cost and poor access present a substantial barrier to SLT use as a tobacco harm reduction measure for Australian smokers. Permitting low nitrosamine varieties of SLT to be sold in Australia might reduce harm in current SLT users and provide a viable alternative to cigarettes for some current smokers.

Background: Convincing scientific evidence exists that smoking has devastating effects on health. The use of smokeless tobacco (snuff) as a tobacco habit has been reported to be considerably less harmful, and has been suggested as an aid to smoking cessation, among other things., Methods: Cross-sectional data on general health and tobacco habits were obtained through a self-administered mail questionnaire in 2002 representing 50-year-old (n = 6236) and 60-year-old (n = 6232) Swedes in two counties. Participation rates were 70.2 and 75.7% in the both age cohorts, respectively. Of all participants 46.2% were male and 53.8% female. A general health index encompassing five items (score 0-5) was designed, with the best general health attributed to those scoring 5., Results: Male daily smokers accounted for 15.6% of the 50-year-olds and 18.7% of the 60-years-olds compared with 21.1 and 16.6%, respectively, for females. Corresponding figures for daily snuffing were 21.1 and 11.9% for men and 1.7 and 0.4% for women. When adjusting for age, sex, place of living, social network, education, and marital status, and related to subjects who never used tobacco, 'best general health' score 5, significant differences were found for ex-smokers (OR 0.82; 95% CI 0.74-0.90; P < 0.001) and ex-snuffers (OR 0.74; 95% CI 0.61-0.90; P < 0.01)., Conclusion: Those who have stopped smoking or snuffing seem to be in a vulnerable condition with respect to general health and in need of extra support and health-promoting activities.

Objective: To identify predictors of smokeless tobacco (ST) initiation among young adults., Methods: A military cohort (N=28,229) was analyzed to identify variables associated with ST initiation., Results: Baseline current cigarette smoking at baseline was a strong predictor for any ST use (OR 3.88; 95% CI: 3.33-4.52) and daily ST use (OR 3.01, 2.34-3.88) as was experimental ST use for any (OR 2.39, 2.09-2.73) and daily ST use (OR 2.41, 1.93-3.01)., Conclusions: Smoking and previous ST use are strong predictors for ST use in adults. Research is needed to characterize ST initiation and changes in smoking behavior over time.

Background: To describe patterns and correlates of tobacco product use other than cigarettes in adolescents 12-17 years of age., Methods: Adolescent respondents (N = 6090) to the 1999 California Tobacco Survey provided estimates of ever and current use (in last 30 days) of smokeless tobacco, cigars, and bidis, which were examined by cigarette smoking experience, demographics, and known predictors of cigarette use., Results: Only 3% of adolescents who never smoked cigarettes experimented with other tobacco products. Among ever smokers who were not current smokers, the rate was 35%. Nearly 60% of current cigarette experimenters had tried another tobacco product, but almost 90% of current established smokers had experimented with one. Over 40% of current established smokers used another tobacco product in the last 30 days. Factors predictive of cigarette smoking were also highly associated with other tobacco use. In ever cigarette smokers, having peers who used other tobacco products was most highly associated with other tobacco use. Problem or risky behaviors, beliefs that cigarettes are safe or beneficial, and receptivity to tobacco promotions were also independently associated with other tobacco product use., Conclusions: Adolescent smokers who use other tobacco products may be prone to risky behavior and such use may hasten the development of nicotine tolerance.

Objectives: This study identified mutually exclusive groups of men at high and low risk for use of chewing tobacco and for quitting., Methods: Analyses used a national sample of 1340 non-Hispanic Black, 1358 Mexican American, and 1673 non-Hispanic White men, aged 25 to 64, who participated in the National Health and Nutrition Examination Survey III from 1988 to 1994. Signal detection analysis was used to delineate high- and low-risk subgroups; survival analysis was used to estimate hazard curves for comparing age at onset for chewing tobacco use with that for smoking., Results: Rural, lower-income Black and White men had the highest regular use of chewing tobacco (33.3%), followed by rural, higher-income men regardless of race/ethnicity (14.9%). Southern men who began using chewing tobacco during adulthood had the lowest quit rate (22.5%). In sharp contrast to smoking, chewing tobacco showed a continued onset throughout adulthood., Conclusions: Because subgroups of men show highly different chewing tobacco use and quit rates and because age at chewing tobacco onset occurs across the life span, prevention and cessation programs should be specific to different risk groups and distinct from smoking programs.

Objective: To examine the potential explanatory effect of various demographic, social influence, sanction, and tobacco availability variables on the use of smokeless tobacco (ST) by adolescent males., Design: The data used in our analyses are from a community-based tobacco policy intervention trial that included a 60-item baseline school survey. During Spring 1993, all 8th, 9th, and 10th-grade students enrolled in 14 school districts in small Minnesota cities were surveyed. We used mixed-model logistic regression to determine which variables were significantly correlated with smokeless tobacco use by males in the past week., Results: Of this sample of 2924 adolescent males, 10% (n = 291) reported using smokeless tobacco in the past week. Compared to the overall sample, smokeless tobacco users reported higher family and friend use of smokeless tobacco. In addition, 64% of users reported smoking in the past 30 days, and almost half (49.1%) said they had attempted to purchase tobacco in the past 30 days. Variables found to be significantly associated with smokeless tobacco use in the past week included younger age, having a best friend using tobacco, inflated perceptions of their peers' use of tobacco products, beliefs that school and parental sanctions are not high for tobacco use, recent tobacco purchase, and perceived belief that tobacco is not difficult to obtain from social sources., Conclusions: This study confirms previous research correlating demographic and social influence factors with ST use and demonstrates the role that sanction and availability variables play in ST use.

Health consequences associated with use of smokeless tobacco (SLT) (i.e., snuff or loose-leaf or fine-cut chewing tobacco) products include halitosis, leukoplakia, and oral cancer. Periodontal degeneration and soft tissue lesions are early indicators of these conditions and diseases among persons who use SLT. Since October 1992, the sale of tobacco products to minors (i.e., persons aged < 18 years) has been prohibited by law in Florida, and since May 1994, Florida law has required businesses to post warning signs stating that tobacco sales to minors are illegal and that proof of age is required to purchase tobacco products such as SLT. To assess the impact of these laws on over-the-counter access to SLT by minors in Broward County (1990 population: 1,244,531), during March-June 1996 faculty from Florida Atlantic University's Department of Exercise Science/Wellness Education conducted a study to measure vendor compliance with tobacco minimum-age sale laws and with the sign statute. This report summarizes the findings of the assessments, which indicated that nearly one third of attempts by minors to purchase SLT products were successful.

Approximately 90% of all initiation of tobacco use occurs among persons aged < or = 18 years, and the prevalence of tobacco use among adolescents is increasing. Despite laws prohibiting the sale of tobacco to minors in all states and the District of Columbia, most minors are able to purchase tobacco products. To determine current prevalences of the use of cigarettes and smokeless tobacco products (i.e., chewing tobacco and snuff) by high school students, the usual source of cigarettes among those who smoked, and the percentage of students who were asked to show proof of age when buying cigarettes, CDC analyzed data from the 1995 Youth Risk Behavior Survey (YRBS). This report summarizes the results of the analysis, which indicate a higher prevalence of smoking among high school students in 1995 than in 1993 and 1991, a doubling of the prevalence of current smoking among non-Hispanic black male students during 1991-1995, and that most high school students aged < or = 17 years who buy cigarettes from stores are not asked to show proof of age.

Approximately 75% of adults who have regularly smoked cigarettes tried their first cigarette before their 18th birthday, and about half became regular smokers by age 18 years. Despite the importance of reducing smoking among adolescents, the prevalence of smoking among high school seniors has not decreased substantially from 1981 through 1991. National health objectives for the year 2000 have targeted substantial reductions in smoking among persons aged < 20 years, and reducing access to cigarettes through laws or statutes is an important strategy in reaching this goal. This report describes the results of efforts in two states--Missouri and Texas--to characterize access of minors to cigarettes and other tobacco products.

This study describes the prevalence and patterns of smokeless tobacco and cigarette use among adolescents with a specific focus on those living in a high tobacco production area. The subjects were 582 male and 485 female students in grades 7 through 12, with 54% living in a rural (nonmetro) area and the remainder living in an urban (metro) area. Self-reports of tobacco usage were validated using biochemical tests. High smokeless tobacco usage rates were found among nonmetro males--90% had tried one or more smokeless tobacco products and 33% had used at least one of the products in the last 6 days. Students' tobacco usage increased dramatically as the degree of personal involvement in raising tobacco increased. Of senior high boys who had household involvement in tobacco, 100% had tried snuff and 42% had used it in the last 6 days; 80% had tried cigarettes and 53% had used them in the last 6 days. Some other results were: (1) use of snuff was more popular than chewing tobacco, (2) the average grade for initiation to tobacco was the fourth grade for nonmetro students and the fifth grade for metro students, and (3) a large number of male smokeless users also reported cigarette use. Students from tobacco-raising households are at high risk for tobacco use. Future research should focus on effective prevention methods for high-risk students.