Tobacco Harm Reduction: Evidence from the U.S
Tobacco Harm Reduction: Evidence from the U.S.
Brad Rodu Professor, Department of Medicine Endowed Chair, Tobacco Harm Reduction Research University of Louisville
Smokeless Tobacco For Smoking g Cessation in the U.S. 2000 National Health Interview Survey Cancer Control Supplement- Funded by the National Cancer Institute • • • • •
12 methods used in last quit attempt Former Smoker – method successful Current Smoker – method not successful Not a clinical trial, but real-world experience among smokers Our study – men only Nationally representative
B Rodu and CV Phillips, Harm Reduction Journal 5: 18, 2008
Smokeless Tobacco for Smoking Cessation Men in the U.S., 2000 Method All
Attempted* 39.3
% Former 61
% Current 39
Nicotine Patch Nicotine Gum Bupropion Nicotine Inhaler Nicotine Spray
2.9 1.0 1.1 0 0.098 098 0.014
35 34 29 28 0
65 66 71 72 100
Switch to ST
0 36 0.36
73
27
*Numbers in millions Rodu and Phillips, Harm Reduction Journal 5: 18, 2008
Smokeless Tobacco For Smoking g Cessation in the U.S. 2005 National Health Interview Survey Cancer Control Supplement- Funded by the National Cancer Institute •
Smokeless Tobacco Option removed from survey
2000-2005, Growing awareness of smokeless as a substitute • •
2002 00 Royal oya Co College ege o of Physicians ys c a s Report epo t 2003 Congressional hearing
Smokeless Tobacco Use Among g Men in the U.S., NHIS 2000 and 2005 Tobacco Use
Prevalence (%) 2000 2005
Current ST – Never Smoke
2.0
1.7
Current ST – Former Smoke
1.2
1.2
Current ST – Current Smoke
1.2
1.4
Former ST – Current Smoke
29 2.9
31 3.1
B Rodu & P Cole. J Oral Pathol Med, 2009. Also seen in 1998 NHIS: SL Tomar. Am J Prev Med, 2002.
Smokeless Tobacco as a Smoking g Cessation Method in the U.S. A large majority of Americans incorrectly believe that smokeless tobacco is just as dangerous as smoking1,2 U of L Health Science Faculty Survey, 20073
General Health Heart Attack, Stroke Cancer Oral Cancer
ST Risks > Cigarettes 45% 28% 56% 81%
1. O’Connor et al. Am J Prev Med 2005. 2. Cummings et al. NCToH Conference, 2001. 3. Peiper et al. Drug Alc Review 2010
Smokeless Tobacco for Smoking Cessation Clinical Trials Tilashalski, Rodu, Cole
Am J Med, 1998 Skoal Bandits J Psych Drugs, 2005
Mendoza-Baumgart et al. NTR, 2007 Tønnesen et al. NTR, 2008
Exalt, NRT, Ariva Oliver Twist
Carpenter and Gray Caldwell et al.
NTR, 2010 NTR NTR, 2010
Ariva, Stonewall Ariva Snus, Zonnic, NRT
Joksic et al al.
Harm Red J, J 2011 Snus
Fagerström et al.
NTR, 2012
Snus
Smoking Cessation Trial With Smokeless Tobacco •
Pilot, Open Label, Non-randomized
•
Inclusion Adults Smoking Daily, Desire to Quit Exclusion Pregnant Women, Nicotine Medications
•
•
63 Participants
K. Tilashalski, B. Rodu and P. Cole. Am J Med 104: 456-458, 1998.
Smoking Cessation Trial: Results- One Year Outcome (n) Quit Smoking- SLT* (16) Men (10) 31% Women (6) 19% g 50% (4) ( ) Reduced Smoking Quit Smoking– Other* (6) Continued Smoking (37)
Percent 25
7 10 58
*Verification CO Exp Air (< 10 ppm) K. Tilashalski, B. Rodu and P. Cole. Am J Med 104: 456-458, 1998.
Smoking Cessation Trial: Seven-Year Follow-Up • 63 Successful follow-up 62/63 (Included 4 deaths, Info/surrogate) • Duration of Follow-up
6.8 years
K. Tiashalski, B. Rodu and P. Cole. J Psychoactive Drugs, 2005
Seven-Year Follow-Up Tobacco Status of Participants 1-Year Status
7-Year Status Smoking
Not Smoking
Smoking (n=41)
71% (29)
29% (12*)
Smokeless Tobacco (n 16) (n=16)
25%
75% (12)
(4)
*3 used SLT K. Tiashalski, B. Rodu and P. Cole. J Psychoactive Drugs, 2005
Tobacco Harm Reduction Clinical Trial, 2011-2016 PI
Matthew Carpenter Medical University of South Carolina
Target
Smokers unmotivated to quit
Design
Population based, nationwide Population-based, Randomized clinical trial (n = 1,250) Phone-based cessation induction
Intervention
Provision of Camel Snus, or not
Sponsor
National Cancer Institute
Tobacco Harm Reduction Th Owensboro, The O b KY Campaign C i
For More Information
www.smokersonly.org Rodutobaccotruth blogspot com Rodutobaccotruth.blogspot.com www.SwitchandQuitOwensboro.org
Brad Rodu Professor, Department of Medicine Endowed Chair, Tobacco Harm Reduction Research University of Louisville
Smokeless Tobacco For Smoking g Cessation in the U.S. 2000 National Health Interview Survey Cancer Control Supplement- Funded by the National Cancer Institute • • • • •
12 methods used in last quit attempt Former Smoker – method successful Current Smoker – method not successful Not a clinical trial, but real-world experience among smokers Our study – men only Nationally representative
B Rodu and CV Phillips, Harm Reduction Journal 5: 18, 2008
Smokeless Tobacco for Smoking Cessation Men in the U.S., 2000 Method All
Attempted* 39.3
% Former 61
% Current 39
Nicotine Patch Nicotine Gum Bupropion Nicotine Inhaler Nicotine Spray
2.9 1.0 1.1 0 0.098 098 0.014
35 34 29 28 0
65 66 71 72 100
Switch to ST
0 36 0.36
73
27
*Numbers in millions Rodu and Phillips, Harm Reduction Journal 5: 18, 2008
Smokeless Tobacco For Smoking g Cessation in the U.S. 2005 National Health Interview Survey Cancer Control Supplement- Funded by the National Cancer Institute •
Smokeless Tobacco Option removed from survey
2000-2005, Growing awareness of smokeless as a substitute • •
2002 00 Royal oya Co College ege o of Physicians ys c a s Report epo t 2003 Congressional hearing
Smokeless Tobacco Use Among g Men in the U.S., NHIS 2000 and 2005 Tobacco Use
Prevalence (%) 2000 2005
Current ST – Never Smoke
2.0
1.7
Current ST – Former Smoke
1.2
1.2
Current ST – Current Smoke
1.2
1.4
Former ST – Current Smoke
29 2.9
31 3.1
B Rodu & P Cole. J Oral Pathol Med, 2009. Also seen in 1998 NHIS: SL Tomar. Am J Prev Med, 2002.
Smokeless Tobacco as a Smoking g Cessation Method in the U.S. A large majority of Americans incorrectly believe that smokeless tobacco is just as dangerous as smoking1,2 U of L Health Science Faculty Survey, 20073
General Health Heart Attack, Stroke Cancer Oral Cancer
ST Risks > Cigarettes 45% 28% 56% 81%
1. O’Connor et al. Am J Prev Med 2005. 2. Cummings et al. NCToH Conference, 2001. 3. Peiper et al. Drug Alc Review 2010
Smokeless Tobacco for Smoking Cessation Clinical Trials Tilashalski, Rodu, Cole
Am J Med, 1998 Skoal Bandits J Psych Drugs, 2005
Mendoza-Baumgart et al. NTR, 2007 Tønnesen et al. NTR, 2008
Exalt, NRT, Ariva Oliver Twist
Carpenter and Gray Caldwell et al.
NTR, 2010 NTR NTR, 2010
Ariva, Stonewall Ariva Snus, Zonnic, NRT
Joksic et al al.
Harm Red J, J 2011 Snus
Fagerström et al.
NTR, 2012
Snus
Smoking Cessation Trial With Smokeless Tobacco •
Pilot, Open Label, Non-randomized
•
Inclusion Adults Smoking Daily, Desire to Quit Exclusion Pregnant Women, Nicotine Medications
•
•
63 Participants
K. Tilashalski, B. Rodu and P. Cole. Am J Med 104: 456-458, 1998.
Smoking Cessation Trial: Results- One Year Outcome (n) Quit Smoking- SLT* (16) Men (10) 31% Women (6) 19% g 50% (4) ( ) Reduced Smoking Quit Smoking– Other* (6) Continued Smoking (37)
Percent 25
7 10 58
*Verification CO Exp Air (< 10 ppm) K. Tilashalski, B. Rodu and P. Cole. Am J Med 104: 456-458, 1998.
Smoking Cessation Trial: Seven-Year Follow-Up • 63 Successful follow-up 62/63 (Included 4 deaths, Info/surrogate) • Duration of Follow-up
6.8 years
K. Tiashalski, B. Rodu and P. Cole. J Psychoactive Drugs, 2005
Seven-Year Follow-Up Tobacco Status of Participants 1-Year Status
7-Year Status Smoking
Not Smoking
Smoking (n=41)
71% (29)
29% (12*)
Smokeless Tobacco (n 16) (n=16)
25%
75% (12)
(4)
*3 used SLT K. Tiashalski, B. Rodu and P. Cole. J Psychoactive Drugs, 2005
Tobacco Harm Reduction Clinical Trial, 2011-2016 PI
Matthew Carpenter Medical University of South Carolina
Target
Smokers unmotivated to quit
Design
Population based, nationwide Population-based, Randomized clinical trial (n = 1,250) Phone-based cessation induction
Intervention
Provision of Camel Snus, or not
Sponsor
National Cancer Institute
Tobacco Harm Reduction Th Owensboro, The O b KY Campaign C i
For More Information
www.smokersonly.org Rodutobaccotruth blogspot com Rodutobaccotruth.blogspot.com www.SwitchandQuitOwensboro.org
