# Presentation: 813175

## Measures and Determinants of Smokeless Tobacco Use Prevention and Cessation

- Mark Parascandola, PhD, MPH
- Tobacco Control Research Branch
- Division of Cancer Control and Population Sciences
- National Cancer Institute

## Purpose of the RFA 

- Understand the progression to ST use and its relationship to other tobacco use
- Identify and evaluate factors that mediate initiation and use of ST in high risk populations
- Develop and apply methods for characterizing the properties of a range of ST products and related behaviors
- Encourage new and experienced tobacco researchers to focus on ST

## Smokeless Tobacco Use (%) Among U.S. Adults and High School Students, 1992-2005

- 7.7 million ST users 12 years and over in the U.S**.**

**Source:** Adults: Current Population Survey - Tobacco Use Supplement, 1992/93, 1995/96, 1998-2000, 2001/02; NHIS 2005
-               Youth: National Youth Risk Behavior Survey, 1995-2005

**Youth**

**Adult**

## Smokeless Tobacco: At Risk Populations

**Source:** Nelson et al. Trends in smokeless tobacco use among adults and adolescents in the U.S.. Am J Public Health 2006;96(5):897-905; Nelson et al. Trends in smokeless tobacco use among men in four states, 1988 through 1993. Am J Public Health 1996;86(9):1300-3.

**Midwestern and Southern States**
- 6.7% and 4.4% of Adults in South and Midwest
**Racial/Ethnic Groups**
- 9% of Native Americans
- 22% of Alaska Natives

**Young Males **
- 12.6% of 12th Grade Boys
- 15.1% of White 12th Grade Boys
**Military Personnel**
- 24% of White Active Military Men

## Prevalence of Current Smokeless Tobacco Use among Male Adolescents and Adults. 

**Source:** Data from Nelson, D.E., et al., Trends in smokeless tobacco use among adults and adolescents in the U.S. Am J Public Health, 2006. 96(5): p. 897-905; Tobacco Use Among Middle and High School Students -U.S., 2002. MMWR CDC Surveill Summ, 2003. 52(45): p. 1096-1098.

- % Current ST Users

## Total ST Sales and Advertising & Promotional Expenditures as reported by FTC, 1985-2005

**Total ST Sales and Advertising & Promotional Expenditures as reported by FTC, 1985-2005**

- FTC. Smokeless Tobacco Report for the Years 2002–2005.  Washington, DC: Federal Trade Commission; 2007. Available from: http://www.ftc.gov/reports/tobacco/02-05smokeless0623105.pdf. Accessed: July 2007

**2005: ****$251 m**

**2000: ****$225 m**

**2000: ****$2 b**

**2005: ****$2.6 b**

**1985: ****$731 m**

**1985: ****$80 m**

- $ InMillions

- $ InMillions

## New Smokeless Tobacco Products

**New Smokeless Tobacco Products**

- Cigarette brand extensions from major manufacturers
- Marlboro Snus
- Camel Snus
- Attractive flavorings
- Mint, spices
- Tobacco pouches that don’t require spitting
- Novel formulations
- Ariva tobacco lozenge

## Smokeless Tobacco Product Marketing

**Smokeless Tobacco Product Marketing**

## What We Know about Smokeless Tobacco

- Smokeless tobacco causes oral and pancreatic cancer in humans. Over 28 carcinogens identified in ST.
- ST use is higher among adolescents and may interact with initiation of cigarette smoking
- Limited evidence for the effectiveness of some behavioral counseling interventions for ST cessation
- However, pharmacotherapies have not been shown to be effective for ST use cessation

## What We Don’t Know about Smokeless Tobacco

- What is the overall public health impact of ST use
- What are the key determinants of initiation and use in high risk groups
- What are the best measures of smokeless tobacco use and behavior
- How does marketing of new products impact prevalence

- 	"The paucity of evidence about smokeless tobacco in the U.S. leaves many questions unanswered.“
- Smokeless tobacco use is associated with numerous health risks
- There are limited data about the effect of smokeless tobacco on public health
- New products and aggressive marketing may increase use of smokeless tobacco
- More research is needed to determine the overall effect of marketing and use of these products

- NIH SOS Conference Statement on Tobacco Use: Prevention, Cessation, and Control. NIH Consens State Sci Statements, 2006. 23(3): p. 1-26.; 1. Effective Strategies for Tobacco Cessation Underused, Panel Says NIH Press Release June 14, 2006  [cited 2007 July 5]; Available from: http://www.nih.gov/news/pr/jun2006/od-14.htm.

## Potential Research Questions 

- What are the best measures for smokeless tobacco use behavior and exposure?
- How do the characteristics of different smokeless tobacco products affect behavior?
- What key factors contribute to initiation and prevalence of use among high risk groups?
- How does ST use interact with other forms of tobacco use?
- To what extent does ST act as a gateway to cigarette smoking?
- How does marketing of new ST products impact prevalence of tobacco use?

## Evaluation 

- Increase the number of new applications received focusing on smokeless tobacco and bring new researchers to the field.
- Identify at least four key determinants of smokeless tobacco use in high risk groups.
- Support at least one study to directly address whether smokeless tobacco acts as a gateway to smoking among youth and young adults.
- Develop at least two new measures of smokeless tobacco use and exposure.

## Scope of RFA Initiative   

- This RFA will support 8-10 grants over four years
- Both R01 and R21 mechanisms
- The projected cost for this initiative is $2.5 million in FY2009, with a total investment over four years of $8-10 million