Predictors of Smokeless Tobacco and Dual Use in the US Military

说明(申请人提供)：本申请是对RFA-CA-08-024号文件的回应，标题为“无烟烟草使用、预防和戒烟的措施和决定因素”(R01)。这是田纳西大学健康科学中心、美国空军和梅奥临床医学院的联合申请。无烟烟草(ST)是指口头消费而非燃烧的烟草。从2004年到2006年，12岁的美国人中使用ST的流行率显著增加(3.0%比3.3%)。据估计，ST的使用是人类接触致癌亚硝胺的最大外源来源，并与口腔和口外癌症以及心脑血管疾病有关。现有证据表明，报告同时吸食ST和香烟的烟草使用者(即“双重吸烟者”)与只吸食香烟的人相比，患心血管事件的风险可能更高。世界上最大的两家卷烟制造商菲利普·莫里斯美国公司和R.J.雷诺兹公司已经进入ST市场。菲利普·莫里斯美国公司开发了“万宝路鼻烟”，雷诺兹公司推出了“骆驼鼻烟”。这两种产品的设计都是为了吸引吸烟者，并可能破坏受清洁室内空气政策和增加香烟消费税推动的戒烟尝试。与此同时，ST也越来越多地被提出为吸烟者的一种减少危害的策略。因此，预计未来ST的患病率将会增加。采用和使用ST的最高风险群体之一是美国军方。正如RFA所指出的，“1994-95年对美国军事人员的一项调查发现，大约24%的现役白人男性使用无烟烟草。”更新的结果表明，14.5%的军事人员经常使用ST，18-24岁的白人男性中有21.6%是吸毒者，空军与军队的长期趋势背道而驰，因为ST的使用正在上升。此外，我们合作的研究表明，ST的绝大多数使用者是“双重使用者”，即ST和其他烟草产品的常规使用者(见以前的工作)。我们怀疑，军民两用现象盛行的部分原因是大多数军事基地对吸烟实行了限制。由于双重吸烟者的尼古丁暴露估计较高，与只使用香烟或ST的人相比，戒烟的可能性较小，因此获得这些人在军队中的起效和戒烟数据是非常优先的。基于这一背景，我们提出了以下具体目标： (1)从德克萨斯州圣安东尼奥莱克兰空军基地的基本军事训练(BMT)招收约30,000名空军新兵。 (2)在BMT结束时，即所有新兵戒烟8周后进行基线评估。 (3)在1年和2年的随访中评价ST和双重吸烟(ST+香烟)开始和停止的情况。

DESCRIPTION (provided by applicant): The application is in response to RFA-CA-08-024, entitled "Measures and Determinants of Smokeless Tobacco Use, Prevention, and Cessation" (R01). This is a joint application between the University of Tennessee Health Science Center, the United States Air Force, and Mayo Clinic College of Medicine. Smokeless tobacco (ST) is tobacco consumed orally and not burned. The prevalence of ST use among Americans aged =12 years has increased significantly from 2004 to 2006 (3.0% vs. 3.3%). ST use is estimated to be the greatest exogenous source of human exposure to carcinogenic nitrosamines and has been associated with oral and extra-oral cancer as well as cardiovascular and cerebrovascular disease. Evidence exists suggesting the tobacco users who report using both ST and cigarettes (i.e., "dual users") may be at increased risk for cardiovascular events compared to those who smoke only cigarettes. Phillip Morris USA and R.J. Reynolds, two of the world's largest cigarette manufacturers, have entered the ST market. Phillip Morris USA has developed "Marlboro Snus" and R.J. Reynolds has launched "Camel Snus." Both products have been designed to appeal to smokers and potentially undermine cigarette smoking cessation attempts motivated by clean indoor air policies and increased cigarette excise taxes. At the same time, ST is also increasingly being proposed as a harm reduction strategy for cigarette smokers. As such, it is anticipated that the prevalence of ST will increase in the future. One of the highest risk groups for adoption and use of ST is the U.S. military. As indicated in the RFA, "A survey of U.S. military personnel in 1994-95 found that approximately 24% of white men on active duty used smokeless tobacco." More updated results indicate that 14.5% of all military personnel regularly use ST, 21.6% of white males aged 18-24 are users, and the Air Force is going against secular trends in the military in that ST use is on the rise. Moreover, research from our collaboration is showing that the overwhelming percentage of ST users are "dual users," regular users of ST and other tobacco products (see Previous Work). We suspect that the high prevalence of dual use is partially due to the restrictions placed on smoking at most military bases. Since dual users have a higher estimated nicotine exposure and are less likely to quit smoking relative to those who use cigarettes or ST exclusively, obtaining onset and cessation data on these individuals in the military is a very high priority. Based on this background, we propose the following Specific Aims: (1) To enroll approximately 30,000 Air Force recruits from Basic Military Training (BMT) at Lackland Air Force Base in San Antonio, TX. (2) To conduct a baseline assessment at the end of BMT, a time when all recruits have been tobacco free for eight weeks. (3) To evaluate ST and dual tobacco use (ST + cigarette smoking) initiation and cessation at a one and two-year follow-up.