Tobacco.org

CV Risk Seen With Smokeless Tobacco  

Action Points

* Explain to interested patients that smokeless products such as snuff and chewing tobacco may carry risks for fatal heart attacks and strokes.

* Explain that a study showed that the risks were small but the public health implications may be significant.

The use of smokeless tobacco products was associated with an increased risk for fatal myocardial infarction (MI) and stroke, a meta-analysis found.

For fatal MI, the relative risk associated with ever having used these products was 1.13 (95% CI 1.06 to 1.21), according to Paolo Boffetta, MD, and Kurt Straif, MD, PhD, of the International Agency for Research on Cancer in Lyon, France. . . .

Primary source: BMJ Source reference: Boffetta P, Straif K "Use of smokeless tobacco and risk of myocardial infarction and stroke: systematic review with meta-analysis"

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Smokeless Tobacco Increases Risk Of Heart Attack And Stroke, Research Finds 

People who use smokeless tobacco products like snus have a slightly higher risk of having a fatal heart attack or stroke, according to research published on bmj.com.

In the past few decades there has been an increase in the number of people in Europe and North America using smokeless tobacco, particularly among people younger than 40. Given that these products are being promoted as 'safer' alternatives to smoking cigarettes, the number of individuals using them is set to increase, says the study.

The research team, led by Dr Paolo Boffetta at International Agency for Research on Cancer in France, analysed the results of 11 studies carried out in Sweden and North America on the use of smokeless tobacco products and the risk of developing or dying from a heart attack or stroke.

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Use of smokeless tobacco and risk of myocardial infarction and stroke: systematic review with meta-analysis 

Design

Meta-analysis of observational studies from Sweden and the United States. . . .

Conclusion

An association was detected between use of smokeless tobacco products and risk of fatal myocardial infarction and stroke, which does not seem to be explained by chance.

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• Increased Risk Of Heart Attack And Stroke With The Use Of Smokeless Tobacco Products 

Research just published on bmj.com reports that people who use smokeless tobacco products like snus (a moist powder tobacco product) have a slightly higher risk of having a fatal heart attack or stroke.

Over the last couple of decades, there has been an increase in the number of people in Europe and North America using smokeless tobacco. Most new users are aged under 40. According to the study, since these products are being promoted as 'safer' alternatives to smoking cigarettes, the number of individuals using them is expected to increase.

Dr Paolo Boffetta at International Agency for Research on Cancer in France led the research team. They examined the results of 11 studies carried out in Sweden and North America on the use of smokeless tobacco products and the risk of developing or dying from a heart attack or stroke.

In order to reduce partiality, variations in study plan and features were considered.

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Smoking in relation to ST-segment elevation acute myocardial infarction: findings from the Register of Information and Knowledge about Swedish Heart Intensive Care Admissions  

Objectives: In the past few decades, clinical presentation in AMI has been reported to be changing, with milder cases and less ST-elevation myocardial infarction, the most serious form of AMI. The better outcome may be due to improved medical and interventional management, as well as more sensitive methods for detecting AMI. However, changes in risk factors have also been documented, especially lower tobacco-smoking rates. Therefore, the relation between smoking and ST-elevation AMI in a large observational cohort was analysed. . . .

Results: Tobacco smoking was more prevalent in younger patients (ie, <65 years). More than 50% of younger patients presenting with STEMI were smokers at the time of hospitalisation. After multiple adjustments, smoking was found to be an independent determinant for presenting with STEMI compared with non-STEMI. The adjusted odds ratio (OR) associated with smoking was 2.01 (99% CI 1.75 to 2.30) in younger women and 1.33 (99% CI 1.22 to 1.43) in younger men, with a significant interaction between smoking and gender. In older women and men (65 years), the corresponding ORs were 1.33 (99% CI 1.20 to 1.48) and 1.14 (99% CI 1.04 to 1.25), respectively.

Conclusion: Tobacco smoking is a major determinant for presenting with STEMI compared with non-STEMI, particularly among younger patients and among women. These results indicate that smoking is one of the major risk factors for presenting with more severe AMIs.

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• Patterns and behaviors of snus consumption in Sweden (FREE Full Text) 

Results: The majority of respondents (96%) used either pouched or loose snus alone. A minority (12.6%) reported dual use of smokeless and combustible tobacco products. Average daily consumption was 11–12 g for pouched snus and 29–32 g for loose snus. The typical duration of use of each pouch/portion was 60–70 min.

Discussion: This survey has provided new insights into contemporary snus use in Sweden, such as the marked differences in daily consumption between loose and pouched snus, length of time that snus users typically keep pouches in the mouth, differential patterns of use in males and females, and the simultaneous use of multiple pouches in a small proportion of users.

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Most Swedes support ban on outdoor smoking 

A new survey by Synovate that was commissioned by the Swedish Network of Tobacco Prevention reveals that 73 percent of Swedes support a ban on smoking in the outdoor dining sections of restaurants. This would suggest that Swedes are getting tired of second hand smoke, even within the well-ventilated realm of the great outdoors.

The Local newspaper reports that the Hotel and Restaurant Workers Union (HRF) is demanding the government extend its existing 2005 ban on smoking in all licensed premises. The original ban proved very popular with Swedes, leading the Parliament to establish a goal of expanding this notion against exposure to passive smoking in public by 2014.

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EDITORIAL: Can Sweden Sell the EU on Snus? 

Snus will, if allowed to market, only gain prominence as a safer alternative to cigarettes that will help ween people off combustible goods. There remains no good reason that snus should remain prohibited in the EU, aside from assuaging the tobacco-phobia that exists in much of the western world. It will be interesting to see if Ms. Bjorling's charge can open up a massive new field of play for the industry's great snus experiment.

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Teenagers do listen to their parents when it comes to smoking 

Parents can help their teenagers to never start smoking. A Swedish study published in the open access journal BMC Public Health has found that adolescents respond positively to their parents' attitudes towards smoking.

The research, carried out by a team led by Maria Nilsson of Ume� University, Sweden, utilized statistics obtained from three national surveys conducted by The National Board for Health and Welfare and The Swedish National Institute of Public Health in 1987, 1994 and 2003. The surveys explored the attitudes, beliefs and tobacco use of teenagers across Sweden. Responses were obtained from young people aged 13, 15 and 17 years old, with 1500 adolescents in each age group. A total of 13500 adolescents were surveyed. The aim of the study was to determine adolescent attitudes towards parental intervention on tobacco use in Sweden and to see if these have changed over time.

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Genes And Smoking Play Role In Rheumatoid Arthritis 

Recent genetic studies have revealed several new sites of genes that are risk factors for developing rheumatoid arthritis (RA). The strongest association with anti-citrullinated protein antibody (ACPA)-positive RA (ACPAs are autoantibodies detected in RA that are used as a major diagnostic tool) has been found for the HLA-DRB1 gene, and this site seems to play a central role in susceptibility to the disease in Caucasian populations.

Previous studies have shown a high increase in the risk of ACPA-positive RA associated with smoking in those who have certain variations of the HLA-DRB1 gene. There are several types of such alleles related to a particular amino acid sequence known as shared epitope (SE). ACPAs occur in about 60 percent of RA patients and are closely linked to the presence of SE alleles. In fact, SE alleles are the strongest genetic risk factor for ACPA-positive RA.

Of several environmental factors that predispose people toward developing RA, smoking has been found to be the main risk factor and a strong gene-environment interaction between smoking and SE alleles for ACPA-positive patients has been shown in previous studies in Europe.

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Improving education may cut smoking in youth 

Although low socio-economic status is associated with an increased liability to smoke, performing well at school can mitigate this effect. A new study, published in BioMed Central's open access International Journal for Equity in Health, has shown that high-achieving schoolchildren, even those from poor backgrounds, are less likely to smoke.

Christina Schnohr led a team of researchers from the University of Copenhagen's Institute of Public Health who surveyed 20,399 schoolchildren from the UK, Denmark, Sweden, Norway and Finland. She said, "Above average academic achievement was associated with lower risk of smoking. Teachers and politicians may find this information useful, and allocate resources to give higher priority to a supportive environment in schools especially for children and adolescents in lower social groups. This might contribute to reducing smoking in this group".

The researchers' study confirmed that children from less well-off families are more likely to smoke, and are less likely to perform well at school - although this latter effect was least pronounced in the UK. However, those poorer children who did perform well in class were also less likely to be smokers. Schnohr said, "This mediating role of academic achievement emphasizes the role of teachers in supporting students from deprived families. If they can focus on students from lower socio-economic positions, it might help reduce the social inequality in smoking prevalence".

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Improving education may cut smoking in youth 

Although low socio-economic status is associated with an increased liability to smoke, performing well at school can mitigate this effect. A new study, published in BioMed Central's open access International Journal for Equity in Health, has shown that high-achieving schoolchildren, even those from poor backgrounds, are less likely to smoke.

Christina Schnohr led a team of researchers from the University of Copenhagen's Institute of Public Health who surveyed 20,399 schoolchildren from the UK, Denmark, Sweden, Norway and Finland. She said, "Above average academic achievement was associated with lower risk of smoking. Teachers and politicians may find this information useful, and allocate resources to give higher priority to a supportive environment in schools especially for children and adolescents in lower social groups. This might contribute to reducing smoking in this group".

The researchers' study confirmed that children from less well-off families are more likely to smoke, and are less likely to perform well at school

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School-related mediators in social inequalities in smoking: a comparative cross-sectional study of 20,399 adolescents. 

The aim of this study was to examine the associations between social inequalities and daily smoking among 13 and 15 year olds, and to determine the role of students' academic achievement and school satisfaction in these associations.

Conclusions

The study found social inequality in daily smoking in Denmark, Sweden, Norway, Finland and United Kingdom, as well as inequalities in students' academic achievement and school satisfaction. The analyses also showed that above average academic achievement was associated with lower OR of smoking. Teachers and politicians may find this information useful, and allocate resources to give higher priority to a supportive environment in schools especially for children and adolescents in lower social groups. Subsequently this prioritisation might contribute to reducing smoking in this group.

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Adults important in reducing tobacco use among young people 

A clear commitment from adults against the use of tobacco is expected by their children as they grow up, and it can prevent teenagers from starting to smoke or use snuff. This is shown in current research from Umeå University in Sweden.

In 1993 a program called Tobacco-Free Duo was started in collaboration between the Country Council of Västerbotten County and the schools in the county's municipalities. The target group was young people between 13 and 15 years of age, and the program is still going on. A central component of the program was to include adults in the task of supporting adolescents in saying no to tobacco.

In her dissertation, Maria Nilsson evaluates the effects of the program and studies the attitudes of young people to how adults, and especially parents, should approach the use of tobacco among their children.

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• Adults Important In Reducing Tobacco Use Among Young People 

A clear commitment from adults against the use of tobacco is expected by their children as they grow up, and it can prevent teenagers from starting to smoke or use snuff. This is shown in current research from Umeå University in Sweden.

In 1993 a program called Tobacco-Free Duo was started in collaboration between the Country Council of Västerbotten County and the schools in the county’s municipalities. The target group was young people between 13 and 15 years of age, and the program is still going on. A central component of the program was to include adults in the task of supporting adolescents in saying no to tobacco.

In her dissertation, Maria Nilsson evaluates the effects of the program and studies the attitudes of young people to how adults, and especially parents, should approach the use of tobacco among their children.

Jump to full article »