This preliminary study examined the effects of tobacco-free snuff (intervention, n = 52) compared with no snuff (control, n = 54) for reducing tobacco use among smokeless tobacco (ST) users not interested in quitting. Both groups received behavioral instructions, and intervention subjects received tobacco-free snuff for 8 weeks. Participants were required to reduce their intake by 50% during the first 4 weeks and by 75% during the subsequent 4 weeks. Follow-up occurred at 12 weeks. Significant reductions were observed from baseline to week 8 (end of treatment) for both treatment groups in the amount of ST use (tins/week and dips/day, p<.001); mean urinary cotinine (p<.001); and mean urinary total NNAL, a carcinogen biomarker (p<.001). At week 8 the intervention resulted in a lower mean total NNAL (p = .048). Compared with the control condition, the intervention resulted in a higher percentage of subjects achieving at least a 50% reduction in cotinine (p = .046) and total NNAL (p = .002) at the end of treatment, more quit attempts (p = .030), and a longer mean duration of abstinence (p = .013) through follow-up. An ST reduction intervention incorporating tobacco-free snuff could potentially reduce risk for ST-related disease beyond that achieved with no snuff by increasing the number of patients who achieve significant reductions in carcinogen exposure and, more important, by facilitating tobacco abstinence by increasing quit attempts and abstinence duration.

on nicotine and toxicant exposure reduction and tobacco cessation (Hatsukami et al., 2008). Significant reductions in nicotine and toxicant exposure were observed with both approaches.Cigarette consumption reduction can be facilitated by the use of nicotine replacement therapy (NRT; Hughes & Carpenter, 2006). NRT can maintain serum concentrations of nicotine while reducing tobacco exposure (Shiffman, Mason, & Henningfield, 1998). No studies have examined the effects of NRT on ST reduction.The nicotine lozenge is an attractive NRT option for ST users since it can provide oral sensory stimulation (Muramoto, Ranger-Moore, & Leischow, 2003) while providing more nicotine than the nicotine gum (Choi, Dresler, Norton, & Strahs, 2003). We conducted a pilot study to determine if the nicotine lozenge with a behavioral intervention would reduce ST use and toxicant exposure compared with a behavioral intervention alone. We were also interested in determining the potential impact of the lozenge for increasing ST abstinence, number of quit attempts, and duration of tobacco abstinence. Methods Subject recruitmentSubjects were recruited from the Minneapolis, MN, metropolitan area through news media advertisements and flyers. After telephone screening, potential subjects visited our research center to submit informed consent and complete baseline measures. Potential subjects were eligible for enrollment if they were (a) between the ages of 18 and 70 years, (b) interested in reducing ST use but not quitting (i.e., not having an established quit date within the next 90 days), and (c) using ST daily use (≥2 tins per week) for the past 6 months. Tobacco use rate as an inclusion criteria was used to target heavy ST users so that a reduction in toxicant exposure could be observed. Patients were excluded if they had an unstable medical condition or were taking psychotropic medications, other tobacco or nicotine products, or pregnant or lactating. AbstractIntroduction: Studies have evaluated smoking reduction with nicotine replacement therapy to reduce tobacco exposure and facilitate abstinence among cigarette smokers, but none have evaluated a reduction approach in smokeless tobacco (ST) users. Methods:We conducted an open-label pilot study to determine if the 4-mg nicotine lozenge with a behavioral intervention could facilitate ST use reduction among ST users compared with a behavioral intervention alone. Eligible subjects were ST users not interested in quitting. Results:One hundred and two subjects were randomized. Both interventions were associated with significant decreases in ST use and toxicant exposure and with increased abstinence, quit attempts, and duration of abstinence. However, no significant differences were observed between groups for these outcomes.Discussion: A behavioral intervention with or without the nicotine lozenge may be effective for decreasing both ST use and toxicant exposure and for increasing tobacco abstinence, quit attempts, and duration of abstinence. The use of reduction strategies for ST users not int...

Background-Smokeless tobacco is an efficient delivery vehicle for nicotine and can contain significant amounts of carcinogens. However, few studies have examined factors that might moderate levels of nicotine or carcinogen exposure.

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