Preliminary study on reducing oral moist snuff use

Hatsukami, Dorothy K.; Edmonds, Amanda; Schulte, Susan; Jensen, Joni; Le, Chap T.; Losey, London; Carmella, Steven G.; Hecht, Stephen S.

doi:10.1016/s0376-8716(03)00006-1

Cited by 11 publications

(6 citation statements)

References 9 publications

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“…A reduction in the incidence of adverse health consequences associated with ST use could theoretically be achieved through a reduction in ST toxicant exposure. In a previous preliminary ST reduction study, we observed a significant reduction in amount of tobacco use and biomarkers for tobacco toxicant exposure over an 8-week treatment period and 12-week follow-up (Hatsukami et al, 2003). This finding suggests the potential efficacy of a tobacco reduction strategy for reducing disease incidence associated with ST use.…”

Section: Introductionsupporting

confidence: 52%

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Smokeless tobacco reduction: Preliminary study of tobacco-free snuff versus no snuff

Hatsukami

Ebbert

Edmonds

et al. 2008

CNTR

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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.

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Section: Introductionsupporting

confidence: 52%

“…Total urinary cotinine concentrations were determined by gas chromatography/mass spectrometry, as described previously (Hecht et al, 1999). Analysis for total NNAL was conducted as described previously (Hatsukami et al, 2003).…”

Section: Methodsmentioning

confidence: 99%

Smokeless tobacco reduction: Preliminary study of tobacco-free snuff versus no snuff

Hatsukami

Ebbert

Edmonds

et al. 2008

CNTR

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“…The toxicant analyzed was the tobacco-specific carcinogen 4-(methylnitrosamino)-l-(3-pyridyl)-l-butanone (NNK) (Hecht et al, 1999). NNK metabolite measurements were analyzed and reported as total NNAL consisting of 4-(methylnitrosamino)-l-(3 pyridyl) l-butanol (NNAL) and its glucuronides (NNAL-Glucs; Hatsukami et al, 2003).…”

Section: Methodsmentioning

confidence: 99%

Smokeless tobacco reduction with the nicotine lozenge and behavioral intervention

Ebbert¹,

Edmonds²,

Luo³

et al. 2010

Nicotine & Tobacco Research

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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...

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“…A number of small studies have reported levels of total NNAL in the urine of smokeless tobacco users (7)(8)(9)(10)(11)(12), and one compared total NNAL in smokeless tobacco users (n = 13) and smokers (n = 27; ref. 13), but there have been no reported comparisons of total NNAL in the urine of smokeless tobacco users and smokers in larger studies.…”

Section: Introductionmentioning

confidence: 99%

Similar Exposure to a Tobacco-Specific Carcinogen in Smokeless Tobacco Users and Cigarette Smokers

Hecht

Carmella

Murphy

et al. 2007

Cancer Epidemiology, Biomarkers &Amp; Prevention

103

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Smokeless tobacco has been proposed as a reduced risk substitute for smoking, but no large studies have investigated exposure to the powerful carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) in smokeless tobacco users versus smokers. The purpose of this study was to carry out such a comparison. Levels of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol and its glucuronides (total NNAL), a biomarker of NNK exposure, and cotinine, a biomarker of nicotine exposure, were quantified in the urine of 420 smokers and 182 smokeless tobacco users who were participants in studies designed to reduce their use of these products. The measurements were taken at baseline, before intervention. Levels of total NNAL per milliliter of urine were significantly higher in smokeless tobacco users than in smokers (P < 0.0001). When adjusted for age and gender, levels of total NNAL per milligram of creatinine were also significantly higher in smokeless tobacco users than in smokers (P < 0.001). Levels of cotinine per milliliter of urine and per milligram of creatinine were significantly higher in smokeless tobacco users than in smokers (P < 0.001). These results show similar exposures to the potent tobaccospecific carcinogen NNK in smokeless tobacco users and smokers. These findings do not support the use of smokeless tobacco as a safe substitute for smoking. (Cancer Epidemiol Biomarkers Prev 2007;16(8):1567 -72)

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Preliminary study on reducing oral moist snuff use

Cited by 11 publications

References 9 publications

Smokeless tobacco reduction: Preliminary study of tobacco-free snuff versus no snuff

Smokeless tobacco reduction: Preliminary study of tobacco-free snuff versus no snuff

Smokeless tobacco reduction with the nicotine lozenge and behavioral intervention

Similar Exposure to a Tobacco-Specific Carcinogen in Smokeless Tobacco Users and Cigarette Smokers

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