Project 3: Smokeless Tobacco Use among Rural High School Males and p231-301

与吸烟不同，美国高中生中传统无烟烟草（ST）使用（湿鼻烟，称为蘸烟和嚼烟）的男性（13%）比女性（2%）高得多，在农村地区尤其高。在农村高中男运动员和吸烟者中，无烟烟草的使用率为18%至42%。2005年，ST制造商在市场营销上花费了超过2.5亿美元，包括“新”ST产品， 作为可溶解膜、压缩烟草（例如片剂和牙签状棒），和鼻烟产品， 瑞典鼻烟是一种相对低的烟草致癌物和高尼古丁含量的湿鼻烟。 2006年至2008年间，雷诺兹美国公司和菲利普莫里斯/奥驰亚公司收购了ST公司， 积极推广其旗舰品牌骆驼和万宝路卷烟品牌的新ST产品线（例如， 骆驼鼻烟，骆驼球和骆驼棒，和万宝路鼻烟）。扩大推广传统的， 新的和新兴的ST产品可能会鼓励增加ST的使用和与香烟的双重使用， 青春期的男性没有数据显示，在吸烟者中， 青少年单独使用新的ST产品或与香烟双重使用。我们提出了一个集群 青少年男性运动员的纵向观察研究，以更好地了解认知和社会 传统和新型ST产品使用的决定因素，其与香烟的双重使用，以及 暴露于ST营销和反烟草信息（例如图形警告标签）的风险和益处 感知、ST使用状态的变化（实验、开始、复发、转换和停止），以及 农村高中男生长期实际接触尼古丁和致癌物的情况。具体来说，我们建议 1)衡量传统和新型ST产品使用以及与香烟双重使用的模式和决定因素 2）测量烟草营销和反烟草信息的暴露及其与ST的关联 使用、使用的感知风险和受益以及传统和新型ST产品使用的未来预期 以及随着时间的推移与香烟双重使用; 3）评估尼古丁和致癌物暴露及其相关性 传统和新型ST产品使用者以及多种形式的使用者的尼古丁代谢率 4）确定除了产品类型和品牌之外的因素，预测尼古丁和致癌物 暴露（例如风险和获益感知以及尼古丁代谢率的测量）。

Unlike smoking, conventional smokeless tobacco (ST) use (moist snuff, known as dip and chewing tobacco) among US high school students is much higher among males (13%) than females (2%) and is especially high in rural areas. Among rural high school male athletes and smokers, smokeless tobacco use ranges from 18% to 42%. In 2005, ST manufacturers spent over $250M on marketing, including "new" ST products such as dissolvable films, compressed tobacco (e.g. tablets and toothpick-like sticks), and snus products, modeled after Swedish snus, a relatively low-tobacco carcinogen and high-nicotine-content moist snuff. Between 2006 and 2008, Reynolds American and Philip Morris/Altria bought ST companies and started aggressively promoting new ST line extensions of their flagship Camel and Marlboro cigarette brands (e.g. Camel Snus, Camel Orbs and Camel Sticks, and Marlboro Snus). Expanded promotion of conventional, new, and emerging ST products may encourage increased ST use and dual use with cigarettes among adolescent males. No data exist on the addictive potential or nicotine and carcinogen exposure in adolescents using new ST products alone, or in dual use with cigarettes. We propose a clustered longitudinal observational study of adolescent male athletes to better understand cognitive and social determinants of conventional and new ST product use, their dual use with cigarettes, and the impact of exposure to ST marketing and anti-tobacco messages (e.g. graphic warning labels) on risk and benefit perceptions, change in ST use status (experimentation, initiation, relapse, switching, and cessation) and actual exposure to nicotine and carcinogens over time in rural high school males. Specifically, we propose to 1) measure patterns and determinants of conventional and new ST product use and dual use with cigarettes over time; 2) measure tobacco marketing and anti-tobacco message exposure and their association with ST use, perceived risks and benefits of use, and future expectations of conventional and new ST product use and dual use with cigarettes over time; 3) evaluate nicotine and carcinogen exposure and their association with the rate of nicotine metabolism in conventional and new ST product users, and users of multiple forms of tobacco; and 4) identify factors in addition to product type and brand that predict nicotine and carcinogen exposure (e.g. measures of risk and benefit perception and nicotine metabolism rate).