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Most youth who use smokeless tobacco are smokers, too

By Anne Harding

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, online August 5, 2013.

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