NCI monographs : a publication of the National Cancer Institute最新文献

The results of this study indicate that father education, father use of smokeless tobacco, and adolescent risk perception contribute to the use of smokeless tobacco by white males 12 to 14 years of age. However, risk perception does not account for the correlation between parent characteristics and child behavior. Father education and child smokeless tobacco use are inversely related if the father does not use it, and they are directly related if the father does; this finding is consistent with theories of modeling but is contrary to the common observation that the use of some abusive substances is relatively low among adolescents in higher social and economic levels. We concluded that father characteristics should be considered in research and in programs pertaining to the use of smokeless tobacco by white adolescent males.

Four activity participation variables (clubs, sports, church, and parties); two indices of "risk-taking" (preference for risk-taking, getting into trouble at school); three demographic variables (sex, ethnic group, socioeconomic status); and two drug use variables (trial of cigarettes and alcohol) were examined as correlates and prospective predictors of trial of smokeless tobacco in two cohorts of seventh graders in urban Los Angeles. The data were analyzed separately for males and females. Cross-sectional logistic regression analyses indicated that correlates of trying smokeless tobacco among the seventh-grade cohorts or among these same cohorts in the eighth grade (considering those persons who had not tried smokeless tobacco in seventh grade) generally included being white, trying cigarettes, risk-taking, and attending parties. Prospective logistic regression analyses with data from subjects who had not tried smokeless tobacco in the seventh grade indicated that predictors of subsequent trial of it generally included only being white and having tried cigarettes. Sports participation predicted onset only in one cohort of female subjects but not in males. Some activities that have been proposed as being predictive of smokeless tobacco use (e.g., sports participation) are generally irrelevant for a large sample of young adolescents in urban Los Angeles. White male cigarette smokers, regardless of the activities they have engaged in, are most likely to try smokeless tobacco.

Smokeless tobacco (chewing tobacco and snuff) contains known carcinogens shown to increase the risk for oral cancer. The effect of snuff has been more fully documented than other forms of smokeless tobacco, although the carcinogenic potential of all such products is acknowledged. Risk increases with increasing length of exposure, with risks greatest for anatomic sites where the product has been held in contact the longest time. In some studies, other organs, such as the esophagus, larynx, and stomach, have been shown to be at increased risk for cancer from the use of smokeless tobacco, although at present the data are insufficient to substantiate fully a causal association. Numerous reports have shown an association between snuff use and leukoplakia, with less evidence at present linking chewing tobacco use with leukoplakia. The documented early onset of the smokeless tobacco habit and reports of increases in certain oral cancers among young men raise serious concerns of an impending oral cancer epidemic in this population. In addition, synergistic interactions with other oral cancer risk factors, e.g., smoking and alcohol, and a high rate for second primaries observed for these cancers add to the concern. Unless the tide of its use is stemmed, long-term use can be expected to produce an increase in oral cancers, and perhaps cancers of other sites, as youthful users mature and accumulate exposure to this carcinogenic agent.

Prevalence of smokeless tobacco use is reported for adults aged 21 years and older in the Adult Use of Tobacco Surveys, 1964-1986. Data from the 1986 survey on prevalence, beliefs, ages of initiation, and demographic correlates of use by males aged 17 years and older are also reported. The prevalence of smokeless tobacco use declined slightly among persons aged 21 and older between 1966 and 1986. However, 5.2% of the males aged 17 and older used smokeless tobacco in 1986, and prevalence was highest among those 17 to 19 years old (8.2%). The median age of initiation for both products was 19 years. Smokeless tobacco use was most common among white men who were 1) living in the southeastern United States, 2) unemployed, and 3) in blue-collar or service/labor employment. Most users (77.4%) and nonusers (83.4%) believe that smokeless tobacco is a health hazard. Many current users (39.1%) had attempted to quit. Some current (6.4%) and former smokers (7.0%) have used smokeless tobacco as an aid to smoking cessation. National survey data such as these permit the identification of high-risk groups, so that interventions against smokeless tobacco use may be specifically targeted.

The prevalence and patterns of smokeless tobacco use and its correlates were assessed in the National Institute on Drug Abuse National Household Survey of residents 12 years of age and older. Overall, 11% of the general population have "ever tried" chewing tobacco, snuff, or other smokeless tobacco. Of these, 5% were former users and 3% used smokeless tobacco almost daily in the past year. Rates of its use differed significantly by sex, age group, race, region, and metropolitan area size. Although females were far less likely to try it, those who did were as likely as males to be daily users. Smokeless tobacco users were also more likely to use alcohol, cigarettes, and marijuana. In general, those who used smokeless tobacco almost daily were more likely to report poor health and hospitalization for illness or injury in the past year, even when other substance use was controlled. Smokeless tobacco users also were more likely to report symptoms of depression. Finally, some substituted smokeless tobacco for cigarettes, but youths (12-17 yr old) were more likely than older tobacco users to use both forms of tobacco regularly.

Most surveys of smokeless tobacco use have been limited to young people, and in the few studies of adults, researchers have not considered age, race, and gender simultaneously, although broad age groups have been used. Data on smokeless tobacco use by race and gender for 5-year age groups up to age 70 and older were compiled from 21,203 households in 10 Standard Metropolitan Statistical Areas of the southeastern United States.

In the first phase of a 5-year research project aimed at curtailing smokeless tobacco use among youth, we examined the marketing of smokeless tobacco within California. Observational data were collected from almost 200 retail stores located near high schools and colleges in 14 California counties. Interviews were conducted with over 100 school personnel and youth leaders in 13 counties and with seven retailers from 4 counties. Overall, 81% of the stores in the sample carried smokeless tobacco, and even in urban areas most stores (71%) had these products for sale. Urban stores were more likely to have materials promoting them (e.g., posters, displays, coupon offers). Almost all (98%) stores that carried smokeless tobacco sold moist snuff. Most (78%) school personnel and youth leaders, especially in urban areas, were aware of advertisements for it, particularly on television and in magazines. Rogers' theory regarding the diffusion of innovations was the basis of the discussion of our results. The implications of marketing for the development of health education programs are examined.

Chewing tobacco, snuff, and total smokeless tobacco use from the 1985 Current Population Survey (CPS) are reported. The CPS is the only survey capable of providing national, regional, and individual state tobacco use estimates for all 50 states and the District of Columbia. The prevalence of smokeless tobacco use varies considerably among and within regions of the country, by division and state. Smokeless tobacco use is highest in the South and lowest in the Northeast. Individual states with the highest smokeless tobacco use among males are West Virginia (23.1%), Mississippi (16.5%), Wyoming (15.8%), Arkansas (14.7%), and Kentucky (13.6%). In all regions of the country, use of smokeless tobacco among women is considerably less than men. Nationally, male use of such products was 5.5%; less than 1% of women use them. Snuff consumption is predominantly a behavior characteristic of white males; less than 1% of black or Hispanic males consume this product. Higher percentages of blue-collar and service workers use it compared with white-collar workers. Snuff and chewing tobacco use among teenage boys in the United States increased dramatically between 1970 and 1985, a time when their use of cigarettes was declining. The significance of individual state level estimates is discussed.

The effects of fractionated doses, in vivo thiol modulation, and antifibrinolytic therapy on the expression of lung damage induced by cyclophosphamide (Cy) were evaluated in C3H mice. The protein content of lung lavage samples taken 4 days after Cy treatment was used as an early indicator of damage. In fractionation studies, little difference in lung protein was observed when 200 mg of Cy/kg was administered as a single dose or as two or four equal doses given daily, suggesting that little sparing effect occurred with fractionated doses of Cy. In experiments that tested the effects of exogenous thiol administration, mice treated with WR-2721 before Cy were protected against lung damage, whereas the use of sodium thiosulfate or mesna did not give this protection. Treatment with epsilon-aminocaproic acid, which inhibits the breakdown of fibrin clots, did not result in enhanced Cy damage as measured by lung lavage or breathing rate; this suggests that the extended presence of fibrin per se did not contribute to Cy-induced pulmonary damage.