Cigarette Taxation Helps to Reduce Drinking Among Groups Considered Vulnerable

Tobacco use is the leading cause of preventable death and disability in the U.S., while heavy drinking ranks as the third leading cause of preventable death. Cigarette taxation has been recognized as one of the most significant policy instruments to reduce smoking. Given that smoking and drinking often occur together, a first-of-its-kind study has examined cigarette taxation and found that increases are associated with modest to moderate reductions in alcohol consumption among vulnerable groups.
Results will be published in the January 2014 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.
“Smoking and heavy drinking co-occur at alarmingly high rates,” said Sherry McKee, associate professor of psychiatry at Yale University School of Medicine as well as corresponding author for the study. “Tobacco can enhance the subjective effects of alcohol and has been shown to increase the risk for heavy and problematic drinking. Smokers drink more frequently and more heavily than non-smokers, and are substantially more likely than non-smokers to meet criteria for alcohol abuse or dependence. The co-occurrence of smoking and drinking is of particular clinical significance given evidence that health consequences exponentially increase with combined versus singular abuse of alcohol and tobacco.”
“Smoking and drinking are strongly linked for a host of reasons including complementary pharmacologic effects, shared neuronal pathways, shared genetic associations, common environmental factors, and learned associations,” added Christopher W. Kahler, professor and chair of the department of behavioral and social sciences at Brown School of Public Health. “However, it is possible to intervene through behavioral treatments, pharmacotherapy, and policy to affect both behaviors in a positive way.”
“Cigarette taxes have broad population reach and have been recognized as one of the most significant policy instruments to reduce smoking,” said McKee. “Increases in cigarette taxes predict decreases in smoking initiation, increases in quitting, and reductions in cigarette-related morbidity and mortality. By increasing the price of cigarettes, taxes are thought to encourage smokers to reduce their use of cigarettes or quit altogether, and discourage non-smokers from starting to smoke.”
McKee and her colleagues examined data gathered through personal interviews with 21,473 alcohol consumers as part the National Epidemiological Survey on Alcohol and Related Conditions, a survey conducted by the National Institute on Alcohol Abuse and Alcoholism. Analyses evaluated whether increases in cigarette taxes between Waves I (2001-2002) and II (2004-2005) were associated with reductions in quantity and frequency of alcohol consumption. These analyses were conducted by gender, hazardous drinking status, age, and income group, and were further adjusted for demographics, baseline alcohol consumption, and alcohol price.
“We hypothesized that the public health benefits of cigarette taxes would extend beyond smoking to reduce alcohol consumption,” said McKee. “Results suggest that increases in cigarette taxes were associated with reductions in alcohol consumption over time among male smokers. The protective effects were most pronounced among subgroups who are most at risk for adverse alcohol-related consequences, including male heavy drinkers, young adults, and those with the lowest income.”
“These findings suggest that if states increase taxes on cigarettes, they are not only likely to reduce smoking — based on a large body of literature — but they also may have a modest impact on heavy drinking rates among men, those with lower income, and those who drink most heavily,” said Kahler. “In other words, policies that target one specific health behavior may have broader benefits to public health by affecting additional health behaviors that tend to co-occur with the targeted health behavior.”
Kelly Young-Wolff, post-doctoral research fellow at Stanford Prevention Research Center, and one of the study’s co-authors, agreed, adding that these results support research that targets the interactions of tobacco and alcohol. “Results from our study can pave the way for a productive line of future research aimed at reducing secondary public health harms such as alcohol-related violence, drunk driving, and alcohol-related morbidity and mortality.”
“While the study does not show a causal association,” added Kahler, “in the context of laboratory, clinical, and policy studies conducted to date, it suggests that policy makers and clinicians may have significant opportunities to address heavy drinking and smoking together.”
http://www.sciencedaily.com/releases/2013/08/130810063508.htm

Cigarette Taxes Linked to Binge Drinking

By Elbert Chu, Associate Producer, MedPage Today
Cigarette tax hikes were associated with a drop in the number of binge drinking bouts among male smokers and the amount of alcohol consumed when they did drink, investigators found.
Compared with male smokers who were not hit with any cigarette tax increases, those who were binged seven fewer times a year — a 22% drop — and drank 11% less — roughly a third of a drink — per “episode,” according to a study published online inAlcoholism: Clinical and Experimental Research.
Excessive drinking costs the U.S. about $234 billion each year, noted Sherry A. McKee, PhD, of Yale University School of Medicine and colleagues.
“We were surprised at the strength of the associations between increases in cigarette taxes and reductions in alcohol consumption,” McKee told MedPage Todayin an interview. She and her co-authors noted that to their knowledge, “no prior study has considered the potential for crossover association of cigarette taxation on drinking outcomes using a longitudinal, epidemiological U.S. sample.”
The researchers dug into prospective surveys of 21,473 U.S. alcohol drinkers from theNational Epidemiological Survey on Alcohol and Related Conditions. Two data sets provided the before-and-after cigarette tax increases. One set from 2001 and 2002, and another from 2004 and 2005.
Among the sample, 51% lived in the 31 states that increased cigarette taxes. Increases ranged from seven cents to $1.60 (mean = 61 cents, SD= 42 cents, median = 40 cents).
The investigators also accounted for alcohol prices, education, marriage status, and ethnicity. They further stratified their sample by age, drinking level, sex, and income.
The survey asked respondents about their drinking habits in the previous 12 months on a scale that ranged from “every day” to “never in the last year,” and how many drinks in consumed in each bout. Drinking was classified as “hazardous” when men reported downing more than 14 drinks per session, or women seven drinks. Also labeled as a “hazardous” drinker was anyone who binged at least once in the year they were surveyed.
Only people who said they smoked daily were included as smokers. Smokers who were also hazardous drinkers were more likely male, younger, and less likely to be married, compared with other drinkers.
Women drinkers showed no associated response to increased cigarette taxes. McKee attributed the difference between the sexes to higher rates of male drinkers in the U.S. population. “Eight percent of the population meets the criteria for alcohol use disorder. Out of that, five percent are men and three percent are women,” she told MedPage Today.
In young adults ages 18 to 29, increased cigarette taxes reduced the frequency of binge drinking (b= -0.19, P= 0.02). A similar effect was seen among smokers 50 and older (b = -0.23,P=0.04). Non-smokers showed no changes in their drinking habits.
“Nicotine acts with specific receptors in the brain unrelated to alcohol but have non-nicotine compounds that induce triggers and cues unrelated to nicotine receptors,” said Gregory N. Connolly, DMD, MPH, faculty director for the Center for Global Tobacco Control at the Harvard School of Public Health. “So the researchers may have found something big.
“We do know the opposite is true. Alcohol and the social acceptance of smoking in the bar induces relapse. The bar or pub has become the nicotine classroom for the young,” Connolly continued.
The primary limitation of the study was the reliance on people to accurately recall and record their drinking habits. In addition, the timing of the tax increases was not consistent across all states, nor does the data account for online or bulk purchases of alcohol that could be exempt from taxes.
“Absolute magnitude of increases in cigarette taxes was in the direction expected (greater increases in tax were associated with less heavy and less frequent drinking); however, the pattern of results was unchanged,” the authors wrote. It is unclear whether there’s any upper limit to the effect of increased taxes and associated drinking reductions, McKee said.
To be sure, there are other avenues for future research on other associated behaviors mentioned in the study like the rates of sex crimes and drunk driving among youth.
Although there are attempts to develop a safer cigarette underway, “smoking is the number one leading cause of morbidity in the U.S., and alcohol is the number three preventable cause of morbidity,” McKee said. “This study suggests that there are positive spillover effects to enacting these tax policies. If you can change one, you’re likely to change the other behaviour.”
Smokers are more likely to drink too much alcohol, particularly more vulnerable young men. With both behaviors so closely linked, what are the most effective strategies you use with your patients to curb binge drinking? Let us know by Adding Your Knowledge below. — Sanjay Gupta, MD
http://www.medpagetoday.com/theguptaguide/publichealth/40918

New cigarette tax saves lives in Minnesota

By: Lindsay Aijala, Two Harbors, Lake County News Chronicle
I’m writing in support of the $1.60 increase in the cigarette tax, which was included in the tax bill passed in the recently completed legislative session. The $1.60 per pack increase means that 47,000 Minnesota kids will never become addicted to cigarettes and have to face the life-long health problems that result from the addiction. My family and I have lived in Lake County for most of my life and I have noticed how cigarettes are getting into the hands of high school students and even middle school students. This increase could help the youth in our county from becoming lifelong users.
Thanks to this increase, youth smoking will decrease by 16 percent and save 5,700 Minnesotans from premature, smoking-related deaths. This increase in the cost of a pack of cigarettes is important because tobacco is still a big problem in Minnesota. Smoking costs our state $3 billion a year. The number of deaths in Minnesota caused by smoking is more than alcohol, homicide, car accidents, AIDS, illegal drugs, and suicides combined. This increase has contributed toward my efforts to help others improve their health, including many family and friends.
http://www.twoharborsmn.com/event/article/id/25323/group/Opinion/#sthash.1CHRwcRX.dpuf
 

Employees Who Smoke Cost Businesses $6,000 Extra Per Year; Cigarette Breaks Big Factor In Loss of Productivity

By Zulai Serrano z.serrano@hngn.com
A new study reveals U.S. businesses pay almost $6,000 per year extra for each employee who smokes, according to Ohio State University researchers.
The researchers took an in depth look at the financial burden for companies that employ smokers, and the findings may surprise you.
“By drawing on previous research on the costs of absenteeism, lost productivity, smoke breaks and health care costs, the researchers developed an estimate that each employee who smokes costs an employer an average of $5,816 annually above the cost of a person who never smoked. These annual costs can range from $2,885 to $10,125,” University said in a news release.
One aspect researchers looked into was the loss of productivity.  According to the findings, smoke breaks were the biggest reason businesses were losing money, followed by health-care expenses that exceed insurance costs for nonsmokers.
The analysis used studies that measured costs for private-sector employers, but the findings would likely apply in the public sector as well, said lead author Micah Berman, who will become an assistant professor of health services management and policy in The Ohio State University College of Public Health.
“This research should help businesses make better informed decisions about their tobacco policies,” Berman said in a news release, who also will have an appointment in the Moritz College of Law at Ohio State. “We constructed our calculations such that individual employers can plug in their own expenses to get more accurate estimates of their own costs.”
The University made it clear the study focused solely on economics, and did not address ethical and privacy issues related to the adoption of workplace policies covering employee smoking.
However, researchers added providing smoking-cessation programs would be an added cost for employers.
“Employers should be understanding about how difficult it is to quit smoking and how much support is needed,” Berman said. “It’s definitely not just a cost issue, but employers should be informed about what the costs are when they are considering these policies.”
The research is published online in the journal Tobacco Control, click here to read the study.
http://www.hngn.com/articles/9653/20130808/employees-who-smoke-cost-businesses-6-000-extra-per-year.htm

Most youth who use smokeless tobacco are smokers, too

By Anne Harding, Reuters
NEW YORK (Reuters Health) – Most young people in the U.S. who use newer smokeless tobacco products are smoking cigarettes too, according to new research.
“These findings are troubling, but not surprising, as tobacco companies spend huge sums to market smokeless tobacco in ways that entice kids to start and encourage dual use of cigarettes and smokeless tobacco,” Vince Willmore, vice president of communications at the Campaign for Tobacco-Free Kids, a Washington, D.C.-based advocacy organization, told Reuters Health in an email.
“From 1998 to 2011, total marketing expenditures for smokeless tobacco increased by 210 percent – from $145.5 million to $451.7 million a year, according to the Federal Trade Commission,” he added.
Swedish-style “snus,” introduced to the U.S. in 2006, and dissolvable tobacco products, introduced in 2008, are arguably less harmful than conventional chewing tobacco because they contain fewer nitrosamines, and have been promoted as safer alternatives.
But public health experts have been concerned that these products could serve as a “gateway drug” to use of conventional smokeless tobacco and to cigarette smoking.
To better understand the prevalence of smokeless tobacco use among young people, Dr. Gregory Connolly of the Harvard School of Public Health in Boston and his colleagues looked at data from the 2011 National Youth Tobacco Survey, which included nearly 19,000 sixth- to 12th-graders from across the country.
Overall, the researchers found, 5.6 percent of young people reported using any type of smokeless tobacco. Five percent used chewing tobacco, snuff or dip, just under two percent used snus and 0.3 percent used dissolvable products.
Among young people who were current smokeless tobacco users, about 72 percent reported smoking cigarettes too, while almost 81 percent of young people who used only snus or dissolvables were also smoking cigarettes.
Just 40 percent of smokeless tobacco users said they had plans to quit using tobacco, according to findings published in Pediatrics.
“We found higher current use than we expected. It’s just not experimentation, it looks like it’s taken hold among adolescents,” Connolly told Reuters Health.
“The most distressing finding was that this is not resulting in children or in young adolescents switching from smoking to these new products that may or may not be safer when used alone. They’re using both in very high numbers.”
Little information had been available on trends in the use of novel smokeless tobacco products, so studies like this one are important, Dr. Neal Benowitz, who has studied the health effects of smokeless tobacco at the University of California, San Francisco, told Reuters Health.
“To me the fact that 72 percent of users concurrently smoke cigarettes is a serious issue,” he said. “These would be safer alternatives only if people used them exclusively, and as soon as you’re talking about dual use you virtually negate any reduction of harm.”
Benowitz, who was not involved in the current research, noted that studies have shown use of smokeless tobacco among U.S. youth can indeed be a gateway to cigarette smoking.
“The most disturbing finding is that a huge percentage of youth smokeless tobacco users also smoke cigarettes,” Willmore said.
“This indicates that smokeless tobacco compounds the problem of overall tobacco use in the United States, rather than helping to solve it as some tobacco companies claim.”
RJ Reynolds, which makes Camel Snus and dissolvable tobacco products including Camel Orbs, Sticks and Strips, did not respond to a request for comment by press time.
“The tobacco industry is facing the 21st century with a whole new strategy, and that is to bring in new products that they claim to be safer,” Connolly told Reuters Health.
He pointed out that under the Family Smoking Prevention and Tobacco Control Act, passed in 2009, the U.S. Food and Drug Administration is charged with regulating tobacco products, including smokeless tobacco.
“When we look at this data I think it is very disturbing to realize that the law has not kept them out, and at least in this data set they’re gaining traction among young people,” Connolly said.
SOURCE: http://bit.ly/13INoAt Pediatrics

Letter: Harm-reduction not best public policy for tobacco

There has been a good deal of talk about “harm-reduction” strategies (promoting alternative tobacco products, such as chewing tobacco or e-cigarettes, as safer alternatives to smoking cigarettes) as being good options for tobacco users to reduce the risk of using tobacco while maintaining the addiction to nicotine.
Reducing-harm strategies can be an option for an individual who wants to try to reduce his or her own risk of harm while maintaining an addiction. However, when it comes to tobacco use, harm-reduction strategies are not the best public policy to use to address the population-based well-being that public health strategies must address.
• How would it be if the public health professionals advocated for food handlers to wash their hands most of the time after using the bathroom rather than every time? After all, it would reduce the chances of contracting disease from someone who never washed his/her hands. One could say it is better than never washing one’s hands. The public policy must continue to be the best method of preventing disease transmission, that is: wash one’s hands every time, not just sometimes.
• I hear a lot about smokeless tobacco being a good alternative for adult smokers who don’t want to quit using tobacco. Consider this: It is not just adults who use chew. The sweeteners added and new products that have come on the market make it an easy way to addict our next generation to tobacco. North Dakota’s youth consume smokeless tobacco at a rate almost twice the national average (N.D., 13.6 percent, U.S., 7.7 percent). In addition, smokeless tobacco is not without its health hazards.
• E-cigarettes are often touted as a good alternative to tobacco use. We are told by some that the vapor is harmless. This is not true. It has not been regulated or studied enough to know how dangerous it is, but it is not harmless. There is another issue to consider. Have you ever noticed how candy cigarettes and now e-cigarettes mimic the activity a smoker would do with a cigarette? It models the smoking behavior and should not be discounted as harmless.
One of the core functions of public health is to promote strategies that protect the health and safety of the community. Public health providers are accountable to the community to provide up-to-date information and advocate for tried-and-true strategies to improve or maintain a community’s health status.
As a public health nurse, I cannot support harm-reduction policies that supports maintaining one’s addiction to tobacco. Harm- reduction policy is not sound public health policy.
The rationale that was brought up recently in a letter to the editor, that the tobacco user who is not willing or able to quit should have chewing tobacco or e-cigarettes researched and funded with tobacco prevention dollars in the state of North Dakota, falls short. The evidence is readily available regarding what works and how to gain access to help. The options are available, and they are FDA-approved and researched for safety and effectiveness. They are called nicotine replacement therapy and NDQuits at (800)-QUIT-NOW.
Knox, RN, is master of public health and certified tobacco treatment specialist with the Grand Forks Public Health Department Tobacco Prevention Program.
http://www.inforum.com/event/article/id/408308/

'Cowboys get cancer, too,' says speaker at smokeless tobacco summit in Missoula

By Alice Miller
For nine months, James Capps didn’t have a bite of food. He had to pour nutrition drinks into a feeding tube to get nourishment while he underwent and recovered from treatment for oral cancer.
Smokeless tobacco is dangerous, and Capps’ story is the testament.
Capps is featured in a short video and advertising campaign in Oklahoma that shares his story. After the video’s first week on television, the number of people requesting tobacco-cessation aids jumped 300 percent.
Capps said he loves his new role as an advocate and hopes his story gives people the push they need to quit.
“You don’t need that crutch to be someone you want to be,” he said. “You should do it without tobacco.”
Capps traveled to Missoula from his hometown of Atoka, Okla., to receive the Cliff Niles Creative Media Award during the seventh National Smokeless and Spit Tobacco Summit, held at the University of Montana this week.
The summit, held every other year, focuses on prevention and research about smokeless tobacco. Hundreds of people from around the country are attending the summit, which features more than 70 presentations.
UM’s College of Health Professions and Biomedical Sciences hosted the event and received $32,250 from the National Association of Chronic Disease to plan the summit, which is the only national conference of its kind.
Smoking takes center stage when people talk about tobacco use, said Patricia Nichols, an independent consultant for Montana’s Tobacco Use Prevention Program and co-chairperson of the summit’s smokeless advisory board.
However, smokeless tobacco is just as dangerous. It causes cancer and contributes to cardiovascular disease, Nichols said.
“We want people to know that this isn’t a safe habit, even if your grandpa did it,” she said.
Smokeless tobacco use tends to be more common in rural areas because it allows manual laborers to get the kick tobacco provides without tying up their hands, she said.
And smokeless tobacco requires people to spit.
“Which is a lot easier in rural locations,” she said.
***
Tobacco companies are constantly putting new products on the market, she said, and the rise in smoke-free public spaces and businesses equates to a resurgence in use of smokeless tobacco products.
As with other tobacco products, companies are targeting the younger generation, because they need more people to replace those who have quit or died, Nichols said.
One way Montana is fighting back against tobacco company advertising to younger people is through a tobacco-free rodeo program.
In 2010, the Montana High School Rodeo Association agreed to the Montana Tobacco Use Prevention Program’s request for the organization to adopt a more stringent tobacco-free policy, said Crissie Hansen, a prevention specialist out of Dillon.
Most parents, rodeo workers and fans abide by the policy, which prohibits tobacco use by anyone during rodeo events.
“We really have not had any friction on it,” Hansen said in response to a question about community feedback on the policy during a presentation Tuesday at the summit.
In addition to the policy, about 200 rodeo athletes have taken a pledge not to use tobacco. Athletes must sign the pledge if they want to participate in the reACT rodeo series and have a chance at end-of-season prizes. reACT is a student-based program advocating against tobacco use.
The rodeo program is a way for health workers to reach kids where they play – venues where tobacco companies have traditionally excelled, said Alison Reidmohr, a health educator with the Montana Tobacco Use Prevention Program.
Changing how kids look at tobacco and its use helps alleviate peer pressure to do something that has been associated with the rodeo scene, she said, adding some athletes are sharing their personal stories through commercials.
***
Capps, the Oklahoman who’s speaking out against smokeless tobacco, said he knows well the pressure cowboys feel to use tobacco.
Capps was hooked by the time he was 15, and he began dipping because that’s what every good Oklahoma cowboy did.
“So I thought dipping snuff was the way to fit in,” he said.
Girls thought it was nasty.
“Well, we’d just get another girlfriend,” he said.
Thirty years after he began dipping snuff, Capps got oral cancer at the base of his tongue. Because doctors couldn’t get to the tumor surgically, they put a port in his neck and pumped chemotherapy drugs directly to the tumor – 24 hours a day, seven days a week for seven weeks.
He received radiation therapy five days a week over the same time. Now, he has difficultly speaking, suffers from dry mouth and must wash down every bite of food with water.
The risks of getting cancer were there for him to see.
“I believe everybody knows there’s that chance,” he said. “But the key thing is this: It will never happen to me.”
Today, Capps knows differently.
“Now I know cowboys get cancer, too,” he said.
http://missoulian.com/news/local/cowboys-get-cancer-too-says-speaker-at-smokeless-tobacco-summit/article_5445e1e2-ff04-11e2-b71d-0019bb2963f4.html

Smoking Ban Tilts Odds Against Ambulance Calls From Casinos

by DEBORAH FRANKLIN
Public health advocates have lobbied hard in recent years to clear restaurants, bars and other workplaces of tobacco smoke, and the winds seem to be at their back.
Already, 36 states and the District of Columbia have enacted some version of an indoor smoking ban to protect the health of workers and patrons, and many local communities in other states have followed suit.
But state-regulated casinos are often exempted from such restrictions (as are, of course, the casinos on tribal lands).
“It’s politics,” says the University of California, San Francisco’s Stanton Glantz, who has spent decades tracing the damaging effects of secondhand smoke to the heart and lungs. “Tobacco and gaming interests really fight for these exemptions,” he tells Shots.
To get a rough measure of whether those exemptions for casinos actually hurt health, Glantz and a colleague scrutinized 13 years’ worth of ambulance call data from Colorado. In particular, they focused on Gilpin County — the high-country home to more than two dozen casinos within about three square miles. The researchers compared the number of calls for ambulances in the county before and after Colorado extended its workplace smoking bans to include casinos in 2008.
The effect seemed “surprisingly strong,” Glantz says of his finding published online this week in the journal Circulation. After the smoking ban in restaurants, bars and most other workplaces was initially enacted in 2006, the number of ambulance-summoning phone calls that were made from any location but casinos dropped by 22.8 percent.
But the number of such calls made from casinos stayed as high as it had been the year before. Then, two years later — after casinos banned smoking, too — the number of such emergency calls made from the grounds of a casino dropped by a little over 19 percent. Such calls from all locations have continued to stay down, years after the implementation of the smoking ban.
Considered in isolation the findings confirm only a correlation, not a causal link, Glantz says. Other factors, such as high gas prices, for example, or tough economic times could have slightly reduced the number of patrons who visited casinos during some of the years studied. Fewer patrons might need fewer emergency calls.
Plus, the database Glantz looked at didn’t reveal the nature of each emergency. Surely some childbirths, dizzy spells and panic attacks were mixed in with the heart attacks, asthma attacks and strokes.
But a study of nine other states, published last week and covering much the same time period, suggests that, contrary to the fears of some business owners, “smoke-free laws did not have an adverse economic impact on restaurants or bars in any of the states studied,” according to the authors.
And in the context of what’s known about how smoke affects physiology, the way the number of calls decreased after each ban makes it “very likely,” Glantz says, that curtailing smoking inside the casinos was what reduced the phone calls about health emergencies.
“All the pieces fit together,” he says.
Many other studies have shown that, in addition to aggravating lung conditions, inhaled smoke can very quickly make platelets stickier and irritate the lining of blood vessels in ways that can lead to the sudden formation of artery-clogging clots that can cause strokes or heart attacks, Glantz says. Last fall two other studies showed that once smoking was banned in bars and workplaces, the number of deaths from heart attacks dropped within months.
http://www.npr.org/blogs/health/2013/08/05/209149956/smoking-ban-in-casinos-linked-to-fewer-caller-for-ambulances

1 in 20 School-Aged Kids Use Smokeless Tobacco

Susan E. Matthews, Everyday Health Staff Writer
Approximately 1 in 20 school-aged U.S. kids use smokeless tobacco products such as dip, chewing tobacco or snuff, a new study found. While smokeless products are often promoted by tobacco companies as “healthier” options, the study also found that teens who use them are not replacing traditional tobacco with smokeless tobacco, but instead are using both.
Since young people aren’t switching products and are instead combining them, any potential health benefits associated with switching to smokeless brands are lost. In fact, by using both types of products, young adults may actually be increasing their risks for tobacco-associated illnesses.
And in a blow to the idea that transitioning to smokeless products might help teens quit tobacco, the survey showed that less than half — 40.1 percent — of smokeless tobacco users intended to quit.
Researchers from the Harvard School of Public Health used data from the 2011 National Youth Tobacco Survey, which included more than 18,000 students in grades 6 through 12 who were asked about their use of a variety of tobacco products over the previous 30 days. Of the surveyed students, 5.6 percent used smokeless tobacco products, and 72.1 percent of these students also used conventional tobacco products including cigarettes, cigars, and water pipes.
In recent years, several novel forms of smokeless tobacco have come onto the market, such as snus, which is moist snuff, and dissolvable tobacco. Of the students using smokeless tobacco, 5 percent used traditional products, while 1.9 percent used snus, and 0.3 percent used the dissolvable tobacco. Compared to traditional smokeless tobacco and cigarettes, these products contain fewer carcinogenic nitrosamines, and may pose less health risk. As a result, tobacco companies have promoted them as a better tobacco alternative.
Males in the survey more likely to use smokeless tobacco products than females (9 percent versus 2 percent), and students over 18 were also more likely to use them than students aged 9 to 11 (10.8 percent compared to 2.2 percent). Smokeless tobacco use has stayed relatively consistent, at around 5 percent, while cigarette use has declined over the past decade, the researchers noted.
“Promotion of snus or dissolvable tobacco products at a population level may not have benefits and might even cause harm from dual use with combustible and/or conventional smokeless tobacco products,” the researcher wrote in the study, published in Pediatrics. Student who reported noticing warning labels on the products were actually more likely to use tobacco, suggesting that these warning aren’t effective, according to researchers.
The American Academy of Pediatrics has called for further regulation of novel tobacco. The study authors suggested more effective warning labels on smokeless products, and that physicians take more initiative in bringing up the harms of smokeless tobacco in consultations with young adults.
Based on the survey results, the researchers concluded that peer pressure was the most likely influence on smokeless tobacco use. If a close friend used these products, an individual was almost 10 times more likely to also use them, the study found.
Another study out today in Pediatrics found that children of smokers were 3.2 times more likely to smoke than children of non-smokers, even if the smoking parent had quit before the child was born. For children over age 11, smoking prevalence ranged from 23 to 29 percent of children whose parents had once smoked, compared to 8 percent of children of parents who had never smoked. The researchers, from Purdue University and Pennsylvania State University, suggested the study supported the idea of genetic predisposition towards smoking.
http://www.everydayhealth.com/stop-smoking/1-in-20-school-aged-kids-use-smokeless-tobacco-7884.aspx

Parental smoking tied to kids' risk of lighting up

By Andrew M. Seaman
NEW YORK (Reuters Health) – Children born to parents with a history of cigarette smoking are more likely to light up than kids of people who never smoked, according to a new U.S. study.
Despite falling smoking rates across age groups, researchers found that children raised by current or even former smokers were about three times more likely to be smokers themselves during their teenage years than kids raised by parents who never smoked.
“Things are getting better, but we can see it’s best among the consistent non-smoking households,” said Mike Vuolo, the study’s lead author from Purdue University in West Lafayette, Indiana.
Previous research has produced similar results, but the new study was based on 23 years of data on the smoking patterns of the parents in the study – 214 people who were ninth grade students in 1988 – to see whether their habits from adolescence onward were tied to their children’s risk of smoking.
For example, Vuolo and his colleague, who published their findings in Pediatrics, were able to compare the children of never-smokers and people who had smoked consistently since high school.
They had data on 314 children of the original group of teens. In 2011, the kids of the second generation – all at least 11 years old – were asked if they had smoked cigarettes within the last year. Sixteen percent said yes.
Among the children of parents who had never smoked, about 8 percent reported smoking cigarettes during the past year.
That compared to between 23 percent and 29 percent of the children of current or former smokers.
The researchers also looked at the parents’ “trajectories” of smoking for clues about the parental influence on the children’s behavior.
They found that 23 percent of kids whose parents had smoked as adolescents but quit or reduced their smoking as young adults were smokers themselves.
Among kids whose parents had smoked little or not at all in high school but started smoking in adulthood, 29 percent were smokers.
And 25 percent of children whose parents had smoked consistently since high school were smokers.
In addition, children who said they had smoked during the last year were more likely to be older, to display more symptoms of depression and to have low grades and low self-esteem. They were also more likely to feel distant from their parents and to have an older sibling who smoked.
While the study can’t prove that parental smoking caused the children to adopt the habit, Dr. Jonathan Winickoff, who has studied teen smoking behavior but wasn’t involved in the new research, said the new results support past findings.
“I think the first confirmatory result is that if you are a parent who smokes, your teenage child has a three-fold increased risk of smoking,” Winickoff, an associate professor in Harvard Medical School’s Department of Pediatrics in Boston, said.
He added that there are several theories on why children of smokers may be at an increased risk of picking up the habit, including modeling their parents’ behaviors, easy access to cigarettes and being “primed” for an addiction through second-hand smoke exposure.
He cautioned, however, that the new study can’t determine whether a child’s risk of becoming a smoker falls if the parents stop smoking early-on, such as in their early adult years, because the group that contained those early quitters also included some current light smokers.
“They can’t say – based on these data – whether earlier parental quitting is associated with less smoking in their kids,” he said.
The researchers also warn that their findings may not apply to all smokers, because only 15 percent of the people included in their survey had a bachelor’s degree or more education and most had their first child at a fairly young age.
Vuolo added that they don’t know whether these smoking rates in the second generation are an improvement over the past because they’re only looking at one point in time. Going forward, they will be able to look at smoking rates over time as they collect more data.
“We’re going to be able to answer that question,” he said.
http://kfgo.com/news/articles/2013/aug/05/parental-smoking-tied-to-kids-risk-of-lighting-up/