Kathleen L. Schroeder

An Interpretative Review of Smokeless Tobacco Research in the United States: Part II:

This is the second part of a two-part series reviewing the published literature of smokeless tobacco in the United States. The article explores smokeless tobacco as a pharmacologically addicting substance, educational interventions designed to prevent use or help users quit, and outlines areas of future research.

Implications of Smokeless Tobacco Use Among Athletes.

In brief: This literature review delineates the current status of smokeless tobacco. It discusses the prevalence and terminology as well as periodontal effects, buccal mucosal and soft-tissue alterations, leukoplakia, cancer, carcinogenic components, hemodynamic alterations, and potential addiction. It is clear that physicians and dentists should discourage their patients from using smokeless tobacco. Young people particularly may be influenced by popular sports figures and celebrities who convey the erroneous impression that smokeless tobacco is harmless.

The Effects of Smokeless Tobacco on Heart Rate and Neuromuscular Reactivity in Athletes and Nonathletes.

In brief: To determine the acute effects of smokeless tobacco on heart rate and neuromuscular performance, heart rate was monitored in college men as they performed perceptual-motor tasks. Two stud...

Bimodal initiation of smokeless tobacco usage: Implications for cancer education

One hundred fifty (150) randomly chosen adult male subjects (average age 37) drawn from a university general dental clinic were classified by self-report into three equal categories of fifty smokeless tobacco users, fifty cigarette smokers (non-smokeless tobacco users), and fifty non-tobacco users. According to questionnaire results, a bimodal curve was exhibited among smokeless tobacco users with the two peaks of initiation at ages 12 and 18 compared to a unimodal age of initiation for cigarette smokers at age 16. Two different cohorts of smokeless tobacco users based on age of initiation were observed with differences reported in level of education, urban versus rural origin, average length of time in using smokeless tobacco, and the type of smokeless tobacco product used. Young initiators appeared to be primarily from rural communities having a strong parental or familial influence when initiating smokeless tobacco usage, whereas older initiators appeared to be primarily from more urbanized regions with peer influences as the most significant for initiating smokeless tobacco usage. Other characteristics associated with one or the other cohort were also reported, pointing to different educational measures that may be necessary for prevention and intervention, based on the age of initiating smokeless tobacco usage, as well as place of residence.

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.

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 Cattells 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.

An analysis of print and audiovisual materials to prevent smokeless tobacco use

We analyzed 28 examples of smokeless tobacco educational print and audiovisual materials based on two criteria: (1) strength of the scientific bases for the selected materials, and (2) appropriateness of the materials for the known populations at risk to smokeless tobacco ever-use. We concluded that these materials in general are authoritative and provide the cancer educator with a solid scientific basis to initiate a primary prevention strategy. Nonetheless, some updating of materials to include the latest scientific findings (eg, cardiovascular and physiological/addictive effects) is needed. In terms of appropriateness of materials, we noted that the focus of materials was correctly targeted to young, white males; however, most materials tended to be aimed at seventh grade and beyond reading and social levels. Few, if any, materials were aimed at the other group at risk to smokeless tobacco adoption, namely youth in the early elementary grades. Consequently, while smokeless tobacco educational materials are generally authoritative, the cancer educator must still customize both the selection of materials and the educational approach to populations at risk.