Dual cigarette and smokeless tobacco use: behavior patterns and toxicant exposure

描述（由申请人提供）：吸烟者越来越多地使用替代烟草产品：雪茄、水烟和无烟烟草（烟草）。烟草消费的这一新趋势可能反映了吸烟者认为这些产品的致命性低于香烟的信念。特别地，新型的生物制品（例如，鼻烟）可以被吸烟者用于减少吸烟相关的危害和/或完全戒烟的目的。能够成功地用这些产品取代香烟的吸烟者可能会带来这些与健康有关的好处。然而，公共卫生官员担心，吸烟者可能会补充他们的香烟使用，特别是考虑到行业营销做法加上室内吸烟限制。例如，工业界已经为吸烟者在禁止吸烟的情况下使用而推广了新的戒烟产品。同样，一些吸烟者报告使用传统的戒烟产品（例如，湿鼻烟）出于同样的原因。为了更好地了解吸烟者的健康风险是如何由于伴随的滥用而受到影响的，需要描述其自然使用模式。在拟议的研究中，双胞胎用户将在自己的环境中连续14天使用电子日记。他们将记录每支香烟和吸烟事件，以及相关的上下文细节（例如，使用的位置/活动）以及情绪和渴望的评级。在每天结束时，参与者将提供唾液样本，用于随后的可替宁（尼古丁代谢物）分析。本研究的目的是确定a）吸烟和唾液可替宁水平在双重与单一使用日之间是否不同，以及B）吸烟者中的吸烟是否通过时间和背景（例如，室内与室外位置）因素。研究结果将揭示吸烟者使用烟草是否与产品补充或替代一致，从而这种行为是否会影响他们对烟草有毒物质的暴露。

DESCRIPTION (provided by applicant): Cigarette smokers are increasingly engaging in use of alternative tobacco products: cigars, waterpipe tobacco, and smokeless tobacco (SLT). This emerging trend in tobacco consumption may reflect smokers' beliefs that these products are less lethal than cigarettes. In particular, novel SLT products (e.g., snus) may be used by smokers for purposes of reducing smoking-related harms and/or ceasing cigarettes altogether. Smokers able to successfully replace their cigarettes with these products may incur such health-related benefits. Public health officials are concerned, however, that smokers may instead supplement their cigarette use, especially given industry marketing practices coupled with indoor smoking restrictions. For instance, novel SLT products have been promoted by the industry for smokers to use in situations where cigarettes are prohibited. Similarly, some smokers report use of traditional SLT products (e.g., moist snuff) for this same reason. To better understand how smokers' health risks are affected as a result of concomitant SLT use, their natural patterns of use need to be characterized. In the proposed study, dual cigarette-SLT users will use an electronic diary for 14 consecutive days in their own environment. They will record each cigarette and SLT use episode as it occurs, as well as related contextual details (e.g., location/activity of use) and ratings of mood and craving. At the end of each day, participants will provide a saliva sample for later analysis of cotinine (metabolite of nicotine). The goals of this study are to determine whether a) cigarette smoking and salivary cotinine levels differ between dual versus single use days, and b) SLT use is promoted among smokers by temporal and contextual (e.g., indoor versus outdoor locations) factors. Study results will shed light on whether cigarette smokers' use of SLT is consistent with product supplementation or replacement, and thus whether this behavior influences their exposure to tobacco toxicants.