Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI.
Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Washington D.C.
Nicotine Tob Res. 2018 Sep 25;20(11):1412-1416. doi: 10.1093/ntr/ntx251.
Smokeless tobacco (SLT) use in the United States has remained constant or even increased slightly in recent years, whereas smoking has continuously decreased. Characterization of transitions between tobacco products is critical to understand the reasons behind the continuing use of smokeless tobacco.
Two longitudinal cohorts of Tobacco Use Supplement of the Current Population Survey (TUS-CPS), 2002-2003 (n = 14996) and 2010-2011 (n = 18226), were used to examine transitions between cigarette and SLT use over 1-year periods. Weighted population percentages of four use categories (exclusive cigarette use, exclusive SLT use, dual use, and neither) were calculated for different demographic groups. Transition between use categories and quit rates by product were calculated for each cohort.
Relative to 2002-2003, smoking quit rates of male exclusive smokers significantly increased in 2010-2011 (11.6% vs. 24.4%, p < .0001), but the corresponding SLT use quit rates remained stable (41.3% vs. 40.0%, p = .87). Similar patterns were found in females with smoking quit rates increasing considerably (12.3% vs. 24.2%, p < .0001). Smoking quit rates increased in most sociodemographic groups analyzed. Male SLT use quit rates were significantly lower in SLT exclusive users than in dual users in the 2010-2011 cohort (40.0% vs. 62.2%; p = .04), but smoking quit rates in exclusive smokers and in dual users were roughly equivalent (24.4% vs. 29.5%, p = .68).
Although smoking quit rates doubled overall and increased in most sociodemographic groups, SLT quit rates remained constant with little transition between products. Longer-term prospective data examining polytobacco use are needed to better understand transitions between tobacco products.
This study uses two longitudinal surveys to investigate changes in switching behaviors between tobacco products. We found that quit rates of self-reported smoking doubled between 2002-2003 and 2010-2011 in most sociodemographic groups in the United States, whereas in contrast quit rates of self-reported Smokeless Tobacco (SLT) use remained roughly constant. This explains in part the opposing trends of tobacco use by product in the United States, with smoking continuing its decrease, whereas SLT use remains constant. Moreover, smokers were unlikely to switch to other forms of tobacco compared to SLT users. Lastly, smoking cessation for dual users was not significantly different from that of exclusive smokers. Understanding transitions between smoking and SLT use is critical to assess the potential long-term impact of SLT use, and potentially that of other alternative tobacco products, on tobacco-related health outcomes.
近年来，美国无烟烟草（SLT）的使用保持不变，甚至略有增加，而吸烟则持续减少。对烟草产品之间的转换进行特征描述对于理解继续使用无烟烟草的原因至关重要。
使用 2002-2003 年（n=14996）和 2010-2011 年（n=18226）的两次烟草使用补充当前人口调查（TUS-CPS）的纵向队列，来检查一年内香烟和 SLT 使用之间的转换。为不同的人口统计学群体计算了四个使用类别的加权人口百分比（独家香烟使用、独家 SLT 使用、双重使用和均不使用）。为每个队列计算了不同产品之间的使用类别的转换和戒烟率。
与 2002-2003 年相比，2010-2011 年男性独家吸烟者的吸烟戒烟率显著增加（11.6%比 24.4%，p<0.0001），但相应的 SLT 使用戒烟率保持稳定（41.3%比 40.0%，p=0.87）。女性也有类似的模式，吸烟戒烟率大幅增加（12.3%比 24.2%，p<0.0001）。在分析的大多数社会人口统计学群体中，吸烟戒烟率都有所增加。2010-2011 年，SLT 独家使用者的男性 SLT 使用戒烟率明显低于双重使用者（40.0%比 62.2%；p=0.04），但独家吸烟者和双重使用者的吸烟戒烟率大致相同（24.4%比 29.5%，p=0.68）。
尽管吸烟戒烟率总体上翻了一番，而且在大多数社会人口统计学群体中都有所增加，但 SLT 的戒烟率保持不变，产品之间的转换很少。需要进行更长期的前瞻性多烟草使用研究，以更好地理解烟草产品之间的转换。
本研究使用两项纵向调查来调查烟草产品之间转换行为的变化。我们发现，2002-2003 年至 2010-2011 年期间，美国大多数社会人口统计学群体中自我报告的吸烟戒烟率翻了一番，而自我报告的无烟烟草（SLT）使用戒烟率却大致保持不变。这部分解释了美国不同产品烟草使用的相反趋势，即吸烟继续减少，而 SLT 使用保持不变。此外，与 SLT 用户相比，吸烟者不太可能转而使用其他形式的烟草。最后，双重使用者的戒烟率与独家吸烟者没有显著差异。了解吸烟和 SLT 使用之间的转换对于评估 SLT 使用对烟草相关健康结果的潜在长期影响，以及其他替代烟草产品的潜在影响至关重要。
