A survey of characteristics of smokeless tobacco users in a treatment program

Mayo Clinic of Medicine, Rochester, MN 55905, USA.
American journal of health behavior (Impact Factor: 1.31). 01/2005; 29(1):25-35. DOI: 10.5993/AJHB.29.1.3
Source: PubMed


To determine the characteristics and outcomes of smokeless tobacco (ST) users receiving interventions in an outpatient tobacco-dependence treatment program.
Survey was mailed with telephone follow-up to ST users treated during a 2-year period.
Nicotine replacement therapy and family and social support were the most helpful intervention components in maintaining tobacco abstinence. Continuing ST users face significant barriers to abstinence such as high levels of nicotine dependence, lack of motivation, nicotine withdrawal symptoms, and stress.
Enhancing confidence in their ability to quit, managing stress, prescribing bupropion SR, offering nicotine replacement therapy to relieve withdrawal symptoms, and providing ongoing support may be important for ST users in tobacco- dependence treatment programs.

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    ABSTRACT: Few nicotine dependence measures have been developed for smokeless tobacco (ST) users. Existing measures are limited by the requirement to rate the nicotine content of ST brands for which data is scarce or non-existent. We modified the Fagerström Test for Nicotine Dependence (FTND) for ST users, referred to this scale as the FTND-ST, and evaluated its characteristics in a population of 42 ST users. The correlation between the FTND-ST total score and the serum cotinine concentrations was 0.53 (p<0.001). Internal consistency reliability assessed using the coefficient alpha was 0.47. Correlations and the coefficient alpha are similar to those reported for commonly used nicotine dependence measures. Development and refinement of nicotine dependence measures for ST users are essential steps in order to advance the field of ST research.
    Addictive Behaviors 09/2006; 31(9):1716-21. DOI:10.1016/j.addbeh.2005.12.015 · 2.76 Impact Factor
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    ABSTRACT: No pharmacotherapies have been shown to increase long-term (> or = 6 months) tobacco abstinence rates among smokeless tobacco (ST) users. Bupropion SR has demonstrated potential efficacy for ST users in pilot studies. We conducted a multicenter, randomized, double-blind, placebo-controlled, clinical trial to assess the efficacy and safety of bupropion SR for tobacco abstinence among ST users. Adult ST users were randomized to bupropion SR titrated to 150 mg twice daily (N=113) or placebo (N=112) for 12 weeks plus behavioral intervention. The primary endpoint was the 7-day point-prevalence tobacco abstinence rate at week 12. Secondary outcomes included prolonged and continuous tobacco abstinence rates, craving and nicotine withdrawal, and weight gain. The 7-day point-prevalence tobacco abstinence rates did not differ between bupropion SR and placebo at the end treatment (53.1% versus 46.4%; odds ratio (OR) 1.3; p=0.301). The 7-day point-prevalence abstinence did not differ at weeks 24 and 52. The prolonged and continuous tobacco abstinence rates did not differ at weeks 12, 24, and 52. A time-by-treatment interaction was observed in craving over time with greater decreases in the bupropion SR group. At 12 weeks, the mean (+/-S.D.) weight change from baseline among abstinent subjects was an increase of 1.7 (+/-2.9)kg for the bupropion SR group compared to 3.2 (+/-2.7)kg for placebo (p=0.005). Bupropion SR did not significantly increase tobacco abstinence rates among ST users, but it significantly decreased craving and weight gain over the treatment period.
    Drug and Alcohol Dependence 09/2007; 90(1):56-63. DOI:10.1016/j.drugalcdep.2007.02.008 · 3.42 Impact Factor
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    ABSTRACT: Smokeless tobacco (SLT) is used in a variety of forms throughout the world. Long-term SLT use is associated with adverse health consequences. Effective pharmacotherapies are needed to treat SLT users who want to achieve tobacco abstinence. In the current review, we discuss the pharmacological interventions identified in a recent meta-analysis of interventions for SLT users, with inclusion of additional articles identified by searching PubMed up to August 2011. Nicotine replacement therapy (NRT) has been demonstrated to increase short-term tobacco abstinence rates and to alleviate craving and withdrawal symptoms among SLT users trying to quit. Bupropion sustained release has been shown to decrease craving and attenuate post-cessation weight gain among SLT users trying to quit. Varenicline is the only available medication demonstrated to increase long-term (≥6 months) tobacco abstinence rates among SLT users. Overall, findings from studies investigating pharmacotherapies for SLT users have been relatively disappointing. SLT reduction interventions may hold some promise for increasing abstinence rates among SLT users not interested in quitting. Additional investigations of higher dose NRT and combination pharmacotherapy are needed to advance the treatment of SLT users.
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