Two large prospective studies of mortality among men who use snuff or chewing tobacco (United States)

Henley, S. Jane; Thun, Michael J.; Connell, Cari J.; Calle, Eugenia E.

doi:10.1007/s10552-004-5519-6

Cited by 187 publications

(197 citation statements)

References 26 publications

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“…40 The mechanisms, including the possibility of confounding, are yet to be established. The effect-modification by attained age might suggest that at least 60 years of exposure is required for the effect.…”

Section: Discussionmentioning

confidence: 99%

Cancer and mortality among users and nonusers of snus

Roosaar

Johansson

Sandborgh‐Englund

et al. 2008

Intl Journal of Cancer

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Scandinavian moist snuff (snus) is claimed to be a safer alternative to smoking. We aimed to quantify cancer incidence among male snus users and to shed light on the net health outcome by studying their overall mortality. A cohort, comprised of 9,976 men who participated in a population-based survey, was compiled in 1973-74. Follow-up until January 31, 2002, was accomplished through record-linkages with nation-wide and essentially complete registers of demographics, cancer and causes of deaths. Adjusted relative risks among exposed relative to unexposed men were estimated using Cox proportional hazards regression. The cohort members contributed more than 220,000 person-years at risk for cancer. A statistically significant increase in the incidence of the combined category of oral and pharyngeal cancer among daily users of snus (incidence rate ratio 3.1, 95% confidence interval 1.5-6.6) was found. Overall mortality was also slightly increased (hazard ratio 1.10, 95% confidence interval 1.01-1.21). Although the combined previous literature on snus and oral cancer weigh toward no association, this population-based prospective study provided suggestive evidence of snus-related risks that cannot be lightly ignored.

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Section: Discussionmentioning

confidence: 99%

Cancer and mortality among users and nonusers of snus

Roosaar

Johansson

Sandborgh‐Englund

et al. 2008

Intl Journal of Cancer

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“…ST use in the U.S. has been associated with periodontal disease (Ernster et al, 1990;Fisher, Taylor, & Tilashalski, 2005) and precancerous oral lesions (Mattson & Winn, 1989). ST use has also been associated with oral and extra-oral cancer (Goodman, Morgenstern, & Wynder, 1986;Henley, Thun, Connell, & Calle, 2005;Muscat, Hoffmann, & Wynder, 1995;Stockwell & Lyman, 1986) as well as cardiovascular and cerebrovascular disease (Henley et al, 2005;Teo et al, 2006). Evidence also suggests that smokeless tobacco may be a gateway drug for smoking initiation in adolescent and young adult males (Haddock et al, 2001;Severson, Forester, & Biglan, in press;Tomar, 2003a), although conflicting results have been reported in other studies (O'Connor, Kozlowski, Flaherty, & Edwards, 2005).…”

Section: Introductionmentioning

confidence: 99%

Prevalence of alternative forms of tobacco use in a population of young adult military recruits

Weg

Peterson

Ebbert

et al. 2008

Addictive Behaviors

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Recent evidence suggests that the popularity of certain alternative forms of tobacco may be increasing in adolescents. Little is known, however, about the use of these products among young adults. This study examined the use of alternative tobacco products including bidis, cigars, kreteks (clove cigarettes), pipes, and smokeless tobacco in a large sample of young adult military recruits (N=31107). Overall, 18.5% of participants were using some form of alternative tobacco product prior to entry into Basic Military Training. Results revealed a relatively high prevalence of cigar (12.3%) and smokeless tobacco use (6.7%). Use of other products was less common, including 1.1% for pipes, 2.0% for bidis, and 3.0% for kreteks. With the exception of kreteks, which did not differ by gender, the prevalence of use of alternative tobacco products was greater for males than for females ( p<. 001). Patterns of use also differed according to other demographic characteristics including race, ethnicity, age, and income. Implications for surveillance and tobacco control efforts are discussed.

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“…Male users of smokeless or chewing tobacco have also been shown in US prospective studies to have higher death rates from all causes compared with non-users (CPS-I and II studies) and also higher death rates from cancer of the gastrointestinal tract overall (CPS-I study), but separate data on the upper gastrointestinal tract were not shown [13].…”

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confidence: 99%

Use of tobacco products and gastrointestinal morbidity: an endoscopic population-based study (the Kalixanda study)

et al. 2010

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There is little knowledge regarding the relationship between gastrointestinal symptoms and snus. The nicotine intake is usually higher than in smokers, and a great deal of tobacco juice contaminated saliva is swallowed during use. In a Swedish cross-sectional study of symptoms in 130,000 construction workers, smokers reported "ulcer-like" dyspepsia three times as often 5 as the non tobacco users, while snus users reported significantly fewer symptoms than both smokers and non tobacco users [10].It has been shown both in studies on patients and in population-based studies that smoking is a risk factor for peptic ulcer disease (PUD) [8,11], but there are no data concerning snus on this issue. Data from the US show that cigarette smokers have a markedly increased risk for gastric cancer and that use of more than one tobacco product increases the risk in men [12].Male users of smokeless or chewing tobacco have also been shown in US prospective studies to have higher death rates from all causes compared with non-users (CPS-I and II studies) and also higher death rates from cancer of the gastrointestinal tract overall (CPS-I study), but separate data on the upper gastrointestinal tract were not shown [13].Although there is extensive exposure to swallowed tobacco juice contaminated saliva, and high serum levels of nicotine and nitrites, there have been no studies in terms of oesophageal or gastric histology or Helicobacter pylori infection in snus users.The aim of the study was to investigate whether smoking cigarettes and snus use are associated with gastrointestinal symptomatology, macroscopic findings on endoscopy or histological signs of inflammation or cancer risk markers in the esophagus or stomach, including the prevalence of Helicobacter pylori. MATERIALS AND METHODS SettingThe Kalixanda study setting consisted of two neighbouring communities in Northern Sweden (Kalix and Haparanda) with 28,988 inhabitants (December 1998). The distribution of age and sex was similar to the national average in Sweden in both communities; although proportion of unemployment, income, and the proportion with a higher education were slightly lower [14]. ParticipantsBy using the computerized national population register, covering all citizens in the two communities by date of birth order, a representative stratified sample was generated. Every seventh adult (n=3,000) from the target population (18-80 years of age, n=21,610 in September 1998) was drawn. The sampled subjects were given an identification number (1-3,000) in a random order [14]. Study design and logisticsThe original study population (n=3,000) was invited by mail to take part. The invitation included information of the study design and of the aims of the study and a validated questionnaire, the Abdominal Symptom Questionnaire (ASQ) to be returned by mail [15]. Up to two remainders were sent when necessary; 140 subjects were unavailable at the time for invitation, thus 2,860 of the original study population were eligible for inclusion [14]. The overall response rate was 7...

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Two large prospective studies of mortality among men who use snuff or chewing tobacco (United States)

Abstract: These two prospective studies provide limited evidence that current use of chewing tobacco or snuff may increase mortality from heart disease and stroke.

Cited by 187 publications

References 26 publications

Cancer and mortality among users and nonusers of snus

Cancer and mortality among users and nonusers of snus

Prevalence of alternative forms of tobacco use in a population of young adult military recruits

Use of tobacco products and gastrointestinal morbidity: an endoscopic population-based study (the Kalixanda study)

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