dual tobacco use bob anderson

Outline

  Dual User Study   Background   Purpose   Methods   Results   Conclusions

  Expert Panel

Acknowledgement

  West Virginia Bureau for Public Health, Division of Tobacco Prevention

Background – West Virginia

  90% of WV adults know that SHS is a health hazard

  72% of WV adults ban smoking in their home

  24% of WV adults – current smokers

  8% of WV adults – current ST users

  WV Dual Tobacco Use   11.4% of smokers use ST   34.8% of ST users smoke

WV 2012 Adult Tobacco Survey

Background -‐ Industry

  Aggressive industry promotion of snus and other tobacco products (OTPs) as a “solution” for smokers

  Convenience Stores   OTPs: 10% of tobacco sales   OTPs: 31% gross profit margin   Cigarettes: 14% gross profit margin   25% of OTP customers also buy cigarettes

Convenience Store News: http://www.csnews.com/top-‐story-‐tobacco-‐otp_becoming_increasingly_important_for_c_stores-‐62283.html


  Swedish Match   "Taking care of your OTP shopper can go a long way to

taking care of your cigarette shopper.” Joe Teller, Director, Category Management


  Reynolds American   Camel Snus sales 8-‐10%/year   Cigarette sales 3%/year   $14 billion “profit pool”—85% from combustibles   Vuse—a “digital cigarette”

http://www.bizjournals.com/triad/news/2012/11/12/reynolds-‐american-‐touts-‐efforts-‐to.html


  Vuse—a “digital cigarette”—"We're not looking to make a little splash in the category, we're looking to make a big splash in the category.” Daan [sic] Delen, President and CEO, Reynolds American

Non-‐combustible Tobacco

  Snuff

  Chew

  Snus

  Dissolvable tobacco   Sticks, Strips, Orbs (Camel)   Java – Stonewall   Ariva (Star Scientific)

But Wait, There’s More!

Non-‐combustible Tobacco

  Tobacco-‐derived Discs   Verve (Altria)   Flex (RJR)   Velo (RJR)

“No matter how cynical you get, it’s impossible to keep up.”

Lily Tomlin

Hancock 22 West Virginia Counties With All Workplace Protection

Barbour

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BLUE : Smoking banned in all public and private places and places of employment, including restaurants, bars, gambling, and vehicles when used as place of employment.

Purpose

  Explore with current adult dual tobacco users   Usage patterns   Opinions

  Nicotine   Health risks

  Rules at home & work   Experience with snus   Tobacco cessation history

Methods

  Recruitment with Wellness Council of WV

  Interviews, 10-‐20 minutes

  Gift cards to participants

  Approved by WVU IRB as exempt research

  Interviews transcribed, imported into NVivo 9 software

  Coded by both investigators

  Congruence between the investigators

Participants

  16 men; 1 woman

  Ages: 20-‐58

  16 Caucasian; 1 African American

Patterns of Use

  Initial use

  ST: snuff or snus; no chew

  Principal reasons for dual use   Rules at work (safety; secondhand smoke)   Secondhand smoke concerns at home   Social situations

Why a Dual User? For the simple reason where I have a daughter I don’t

want to smoke around her, but still when I’m [at work] here I just…don’t want to give them up.

Oh God, I smoke when I wake up and the whole time from traveling from work to the mine I smoke and then as soon as I get on the mine site, I work 12 hours a day on the mine site, and as soon as I get up there I start chewing, and then when I’m off the property I start smoking again.

Well if I’m in a building I’ll use the snus because you don’t have to spit with it, but you still get the nicotine. Now if I’m working in the basement on the boiler . . . I’ll put a rub in.

Health Risks

  More than half believe risks are equal

  Others believe smoking is riskier

  None believe that ST is riskier

Weighing the Risks

If you chew you’re not going to have to worry about lung cancer, and if you smoke you’re going to have to worry about throat cancer and lung cancer, but if you chew you just got to worry about your mouth cancer . . . I think chewing’s a safer way but I’d rather keep my face, that’s why I smoke more than I chew.

Nicotine

  Cigarettes vs. ST—cigarettes are stronger

  Several found ST to be stronger

Nicotine Cigarettes are a lot more potent as far as the nicotine.

Snuff is more of a relaxed, it doesn’t hit you right off the bat . . .

If you dip snuff . . . you get the nicotine, and it kind of curbs you away from smoking.

Yea the snuff just kills the craving more than the cigarette does because if I smoke one cigarette I want another one, and then when I dip I can dip and you can keep that dip in longer and it gives you the nicotine longer.

Rules

  Work—tobacco use banned by most employers   Most were compliant

  Home—most do not smoke at home, nor permit others to smoke

Rules

You can’t smoke unless you’re in a designated smoking area. You’re not supposed to chew unless it’s a designated area too. They don’t pay too much attention to the chewing though.

No when [at work] I don’t chew. I mean it’s because I’ve got my access to cigarettes. I don’t have to worry about my daughter, and I’d rather smoke than chew because I’m worried about my mouth, but at the same time it’s nicotine. So I mean it’s keeping me calm at home.

Snus

  10 tried snus   8 not impressed   2 are regular users

Snus I didn’t like it. Snus you can swallow the spit. With

chewing tobacco you can’t. I don’t think the snus is as strong as what chewing tobacco is.

You can spit or you can swallow it, so it doesn’t really matter . . . I do spit when I smoke more, but it’s more or less . . . the sensation of the menthol and the tingling.

[My partner and I] both smoke the same cigarettes and we both use the same Camel Snus, and we get coupons . . . you buy a Camel product, you get snus for free. If it’s free why not use it?

Cost   Little brand loyalty   Some buy whatever cigarette brand is cheapest   One used RYO tobacco   Some vary ST brand, always going with whatever was

cheapest

  One estimate for Monthly cost of tobacco for the participant and his girlfriend: $400.

Tobacco Cessation

  All tried to quit   3 cold turkey   3 with meds

  15/17 want to quit   Most expect to quit both

simultaneously   Several expect to quit smoking first

Tobacco Cessation

Well if I tried to quit smoking I’d probably dip a whole lot more, and then I’d want to dip all the time, and after the dip wasn’t doing nothing for me I’d have to buy me cigarettes. So I’d have to try doing both at the same time because there’s no way I could just quit.

I’d probably hold on to the snuff to transition out of the cigarettes, because I can put the snuff down. I know I can quit that anytime.

Thinking About Quitting?

Yes. It’s getting too expensive. I mean when you’ve got to buy diapers and formula and liners and you work at Wal-‐mart and your wife only works three days a week and goes to school full time, yea.

I don’t want to be under the stereotype of people saying oh you’re a smoker and you smell bad, and I don’t want to put that negativity around my clients and patients, you know what I mean? I just don’t want that bad persona.

Profiles

  5 Distinct Types of Dual Tobacco Users   Smokers

  “When I have to”   “When I want to”   “When I need to”

  ST Users   “Social smokers”

  Hard Core Users   Use both types daily and love them

Limitations

  17 interviews

  Convenience sample

  Not generalizable

Conclusions

  Variability   When products are used   Where products are used   Why products are used

  Messages need to be tailored

Conclusions

  The Law of Unintended Consequences   Smoking bans at work   Recognition of secondhand smoke dangers

  Result -‐ the initiation of ST use

Conclusions

  User version of “tobacco harm reduction”—smoke less, dip more

  Strong recognition of SHS smoke hazards

Addressing Dual Tobacco Use in West

Virginia

Recommendations of the Expert Panel

Goals

  Explore the prevalence of dual tobacco use in WV.

  Identify successes and challenges.

  Identify cessation practices and models.

  Develop targeted recommendations for addressing dual tobacco use for dissemination to . . .

Policy Makers Local Health Depts Clinicians

Health Care Providers Researchers NGOs

Process

  Break Free Alliance – lead agency

  Experts (in state and out of state) planned

  Participants recruited

  Panel met: December 13, 2011

Recommendations

  Increase support to $28,000,000

  Maintain the Quitline, able to counsel dual users

  Maintain/expand partnerships to address dual use

  Develop a statewide research group on dual use

  Maintain/expand regional tobacco networks

  Continue/expand provider education efforts on dual use

Recommendations

  Maintain and add clean indoor (and outdoor) smoking regulations; advocate for a statewide comprehensive, non-‐preemptive law

  Increase taxes   $2/pack tax on cigarettes   Parity tax on smokeless tobacco

dual tobacco use bob anderson

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