Department of Psychiatry, Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas Street, P.O. Box 250955, Charleston, SC 29425, USA.
Nicotine Tob Res. 2010 Feb;12(2):136-43. doi: 10.1093/ntr/ntp186. Epub 2010 Jan 6.
Several prior studies suggest that smokeless tobacco use results in less carcinogenic risk than does cigarette smoking. Whether smokers will use smokeless tobacco is unclear, as is the impact of such use on long-term smoking behavior and cessation. It is equally plausible that smokeless tobacco use among smokers could either (a) increase total tobacco exposure and undermine motivation to quit or (b) decrease overall tobacco exposure, motivate smokers to quit, and enhance cessation. Either outcome is of major public health significance.
In this small (N = 31), short-term (2 week) pilot study, smokers uninterested in quitting were randomized to (a) receive Ariva or Stonewall (both spitless and smokeless tobacco lozenges) or (b) continue smoking conventional cigarettes.
Ariva/Stonewall use led to a significant reduction (40%, 95% CI: 24%-55%) in cigarettes per day, no significant increases in total tobacco use (cigarettes + Ariva/Stonewall; p > .05), and significant increases in two measures of readiness to quit, either in the next month (p < .001) or within the next 6 months (p = .04), as well as significant increases in self-efficacy to quit smoking (p < .001). No such changes were found among smokers maintained on conventional cigarettes.
These results suggest no deleterious effect on short-term smoking and quitting behavior among smokers who use smokeless tobacco. More broadly, this study suggests a strong need for a large prospective randomized clinical trial to more accurately assess the long-term viability of smokeless tobacco use as a method for cessation induction among unmotivated smokers.
多项先前的研究表明，使用无烟烟草导致的致癌风险低于吸烟。目前尚不清楚吸烟者是否会使用无烟烟草，也不清楚这种使用对长期吸烟行为和戒烟的影响。同样合理的是，吸烟者使用无烟烟草可能会导致：（a）增加总的烟草暴露量，并破坏戒烟动机；或（b）减少总体烟草暴露量，促使吸烟者戒烟，并增强戒烟效果。这两种结果都具有重要的公共卫生意义。
在这项小型（N=31）、短期（2 周）的试点研究中，对没有戒烟意愿的吸烟者进行随机分组，分别接受（a）Ariva 或 Stonewall（两种均为无唾液、无烟草味的口含烟）或（b）继续吸食传统香烟。
Ariva/Stonewall 的使用导致每日吸烟量显著减少（40%，95%CI：24%-55%），总烟草使用量（香烟+Ariva/Stonewall）无显著增加（p＞.05），且两个衡量戒烟准备程度的指标均显著增加，无论是在接下来的一个月（p＜.001）还是在接下来的 6 个月内（p=0.04），以及戒烟自我效能感显著增加（p＜.001）。而继续吸食传统香烟的吸烟者则没有发现这些变化。
这些结果表明，对于使用无烟烟草的吸烟者，在短期吸烟和戒烟行为方面没有不良影响。更广泛地说，这项研究表明，强烈需要进行一项大型前瞻性随机临床试验，以更准确地评估使用无烟烟草作为诱导不吸烟者戒烟的方法的长期可行性。
