quitting cigarettes completely or switching to … · quitting cigarettes completely or switching...
TRANSCRIPT
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Quitting Cigarettes Completely or Switching to Smokeless Tobacco:
Do U.S. Data Replicate the Swedish Results?
Shu-Hong ZhuUniversity of California, San Diego
TUS-CPS Users WorkshopPhoenix, June 9, 2009
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Shu-Hong Zhu Julie B. WangAnne Hartman Yuerong ZhuangAnthony Gamst James T. GibsonHans Gilljam* M. Rosaria Galanti
University of California, San DiegoNational Cancer Institute
Information Management Services, RockvilleKarolinska Institutet, Stockholm, Sweden
Funded by NCI Grant 5 P30 CA 23100-22S4
-
Disclaimer
Grants/contracts from agencies that fund tobacco control research.
No interest in entering emotional debate on harm reduction.
-
Should We Encourage Smokers to Switching to Smokeless?
Pro: Many smokers cant or will not quit
Con: Dilute the overall anti-tobacco message
-
Key Swedish Results
Male smoking prevalence < females Men have a high prevalence of snus use Many male smokers reported using snus to
quit smoking Male lung cancer rate drops faster than
expected
Foulds et al. 2003 Tobacco Control 349-359
-
Reservations on Applicability of Swedish Results to Other Countries
Country/Culture-specific Effects on smoking uptake vs. cessation Price Unrelated to perception of reduced harm No such thing as Swedish results Mostly logical exercises, little data when it
comes to applications to other countries
-
Need Data
Data from countries other than Sweden U.S. is the other western country with a long
history of smokeless tobacco use
Longitudinal population-based data Recall of ever use of smokeless tobacco has serious
problems here TUS-CPS 2002-2003 longitudinal data set
-
Our Task
Focus on smoking cessation effects One survey cannot solve all problems
Summarize the relevant Swedish results Repeat the analysis
-
How to Test for a Snus Effect on Smoking Cessation in Sweden
Men uses snus far more than women Need of nicotine is cause of relapse The test should be two-prolonged
Sex difference in smoking cessation No sex difference in tobacco cessation
(cigarettes and snus)
-
Annual Quit Rate for Smoking or for Smoking and Snus in MONICA Project (5-13 years), Sweden
02468 Male Female
Quit Smoking Quit Smoking and Snus
% Q
uit
Based on results reported in Tables 3-5 in Rodu et al. (2003),
-
Annual Quit Rate for Smoking or for Smoking and Snus in MONICA Project (5-13 years), Sweden
02468 Male Female
Quit Smoking Quit Smoking and Snus
% Q
uit
Based on results reported in Tables 3-5 in Rodu et al. (2003),
-
TUS-CPS 2002-2003 Define tobacco use status
Smoking only Smokeless only Both Neither
Data reduction Ignore cigars and pipe (after finding them unimportant) Remove inconsistency
-
0
4
8
12
16 Male Female
Figure 1B. Percent of 2002 Smokers Who Quit Smoking or Quit Both Smoking and Smokeless In 2003, U.S.
Quit Smoking Quit Smoking and SmokelessBased on US 2002-2003 TUS-CPS longitudinal sample
% Q
uit
Figure 1A. Annual Quit Rate for Smoking or for Smoking and Snus in MONICA Project (5-13 years), Sweden
012345678 Male Female
Quit Smoking Quit Smoking and Snus
% Q
uit
Based on the multi-year followed up results reported in Tables 3-5 in Rodu et al. (2003),
-
0
4
8
12
16 Male Female
Quit Smoking Quit Smoking and Smokeless
% Q
uit
Figure 1B. Percent of 2002 Smokers Who Quit Smoking or Quit Both Smoking and Smokeless In 2003, U.S.
Based on US 2002-2003 TUS-CPS longitudinal sample
Figure 1A. Annual Quit Rate for Smoking or for Smoking and Snus in MONICA Project (5-13 years), Sweden
012345678 Male Female
Quit Smoking Quit Smoking and Snus
% Q
uit
Based on the multi-year followed up results reported in Tables 3-5 in Rodu et al. (2003),
-
Other Key Results (for Male)
Switching is infrequent 0.3% from cigarettes to smokeless 3.9% from smokeless to cigarettes
Recent former smokers turn to smokeless 1.7% turn to smokeless 24.4% relapse to cigarettes
-
Quitting Among Exclusive Users (Cigarettes or Smokeless)
0
10
20
30
40
50
%Q
uit
Quit Smoking
Quit Smokeless
-
Quitting Among Dual Users (Cigarettes or Smokeless)
0
10
20
30
40
50
60%
Qui
t
Quit Smoking
Quit Smokeless
-
0
4
8
12
16 Male Female
Quit Smoking Quit Smoking and Smokeless
% Q
uit
Figure 1B. Percent of 2002 Smokers Who Quit Smoking or Quit Both Smoking and Smokeless In 2003, U.S.
Based on US 2002-2003 TUS-CPS longitudinal sample
Figure 1A. Annual Quit Rate for Smoking or for Smoking and Snus in MONICA Project (5-13 years), Sweden
012345678 Male Female
Quit Smoking Quit Smoking and Snus
% Q
uit
Based on the multi-year followed up results reported in Tables 3-5 in Rodu et al. (2003),
-
Possible Explanations
It was not promoted as safer products Price differential is not big enough Product difference Not enough of them using it
-
Conclusions U.S. Data do not replicate the Swedish results U.S. male smokers seem to quit smoking at a high rate,
without using smokeless U.S. female smokers quit on the same level as males Promoting smokeless tobacco as less harmful
alternative may not lead to an increase of population smoking cessation rate in places like the U.S.
Price differential may have a greater effect in increasing switching to smokeless
-
Thank [email protected]
Quitting Cigarettes Completely or Switching to Smokeless Tobacco: Do US Data Replicate the Swedish Results?Should We Encourage Smokers to Switching to Smokeless?Key Swedish ResultsOur TaskHow to Test for a Snus Effect on Smoking Cessation in SwedenTUS-CPS 2002-2003Other Key Results (for Male)Quitting Among Exclusive Users (Cigarettes or Smokeless)Quitting Among Dual Users (Cigarettes or Smokeless)Possible ExplanationsConclusions
Quitting Cigarettes Completely or Switching to Smokeless Tobacco:
Do U.S. Data Replicate
the Swedish Results?
Shu-Hong Zhu
University of California, San Diego
TUS-CPS Users Workshop
Phoenix, June 9, 2009
Shu-Hong ZhuJulie B. Wang
Anne Hartman Yuerong Zhuang
Anthony GamstJames T. Gibson
Hans Gilljam*M. Rosaria Galanti
University of California, San Diego
National Cancer Institute
Information Management Services, Rockville
Karolinska Institutet, Stockholm, Sweden
Funded by NCI Grant 5 P30 CA 23100-22S4
Disclaimer
Grants/contracts from agencies that fund tobacco control research.
No interest in entering emotional debate on harm reduction.
*
Should We Encourage Smokers to Switching to Smokeless?
Pro: Many smokers cant or will not quit
Con: Dilute the overall anti-tobacco message
*
Key Swedish Results
Male smoking prevalence < females
Men have a high prevalence of snus use
Many male smokers reported using snus to quit smoking
Male lung cancer rate drops faster than expected
Foulds et al. 2003 Tobacco Control 349-359
*
Reservations on Applicability of Swedish Results to Other Countries
Country/Culture-specific
Effects on smoking uptake vs. cessation
Price
Unrelated to perception of reduced harm
No such thing as Swedish results
Mostly logical exercises, little data when it comes to applications to other countries
*
Need Data
Data from countries other than Sweden
U.S. is the other western country with a long history of smokeless tobacco use
Longitudinal population-based data
Recall of ever use of smokeless tobacco has serious problems here
TUS-CPS 2002-2003 longitudinal data set
*
Our Task
Focus on smoking cessation effects
One survey cannot solve all problems
Summarize the relevant Swedish results
Repeat the analysis
*
How to Test for a Snus Effect on Smoking Cessation in Sweden
Men uses snus far more than women
Need of nicotine is cause of relapse
The test should be two-prolonged
Sex difference in smoking cessation
No sex difference in tobacco cessation (cigarettes and snus)
*
Annual Quit Rate for Smoking or for Smoking and Snus in MONICA Project (5-13 years), Sweden
Quit Smoking
Quit Smoking and Snus
Based on results reported in Tables 3-5 in Rodu et al. (2003),
% Quit
Chart1
64.11.210.80.7
3.83.60.90.80.70.6
Male
Female
Sheet1
Male63.8
1.20.9
10.8
Female4.13.6
0.80.7
0.70.6
Sheet1
00
00
Male
Female
Quit %
Sheet2
Sheet3
Annual Quit Rate for Smoking or for Smoking and Snus in MONICA Project (5-13 years), Sweden
Quit Smoking
Quit Smoking and Snus
Based on results reported in Tables 3-5 in Rodu et al. (2003),
% Quit
Chart1
64.11.210.80.7
3.83.60.90.80.70.6
Male
Female
Sheet1
Male63.8
1.20.9
10.8
Female4.13.6
0.80.7
0.70.6
Sheet1
00
00
Male
Female
Quit %
Sheet2
Sheet3
TUS-CPS 2002-2003
Define tobacco use status
Smoking only
Smokeless only
Both
Neither
Data reduction
Ignore cigars and pipe (after finding them unimportant)
Remove inconsistency
*
Figure 1B. Percent of 2002 Smokers Who Quit Smoking or Quit Both Smoking and Smokeless In 2003, U.S.
Quit Smoking
Quit Smoking and Smokeless
Based on US 2002-2003 TUS-CPS longitudinal sample
Figure 1A. Annual Quit Rate for Smoking or for Smoking and Snus in MONICA Project (5-13 years), Sweden
Quit Smoking
Quit Smoking and Snus
Based on the multi-year followed up results reported in Tables 3-5 in Rodu et al. (2003),
% Quit
% Quit
Chart1
11.712.42.62.22.42
11.312.32.72.22.42.1
Male
Female
Sheet1
Male11.711.3
UB2.62.7
LB2.22.2
Female12.412.3
UB2.42.4
LB22.1
Sheet1
11.712.42.62.22.42
11.312.32.72.22.42.1
Male
Female
Quit %
Sheet2
Sheet3
Chart1
64.11.210.80.7
3.83.60.90.80.70.6
Male
Female
Sheet1
Male63.8
1.20.9
10.8
Female4.13.6
0.80.7
0.70.6
Sheet1
00
00
Male
Female
Quit %
Sheet2
Sheet3
Figure 1B. Percent of 2002 Smokers Who Quit Smoking or Quit Both Smoking and Smokeless In 2003, U.S.
Quit Smoking
Quit Smoking and Smokeless
Based on US 2002-2003 TUS-CPS longitudinal sample
Figure 1A. Annual Quit Rate for Smoking or for Smoking and Snus in MONICA Project (5-13 years), Sweden
Quit Smoking
Quit Smoking and Snus
Based on the multi-year followed up results reported in Tables 3-5 in Rodu et al. (2003),
% Quit
% Quit
Chart1
11.712.42.62.22.42
11.312.32.72.22.42.1
Male
Female
Sheet1
Male11.711.3
UB2.62.7
LB2.22.2
Female12.412.3
UB2.42.4
LB22.1
Sheet1
11.712.42.62.22.42
11.312.32.72.22.42.1
Male
Female
Quit %
Sheet2
Sheet3
Chart1
64.11.210.80.7
3.83.60.90.80.70.6
Male
Female
Sheet1
Male63.8
1.20.9
10.8
Female4.13.6
0.80.7
0.70.6
Sheet1
00
00
Male
Female
Quit %
Sheet2
Sheet3
Other Key Results (for Male)
Switching is infrequent
0.3% from cigarettes to smokeless
3.9% from smokeless to cigarettes
Recent former smokers turn to smokeless
1.7% turn to smokeless
24.4% relapse to cigarettes
*
Quitting Among Exclusive Users (Cigarettes or Smokeless)
%Quit
Quit Smoking
Quit Smokeless
*
Quitting Among Dual Users (Cigarettes or Smokeless)
%Quit
Quit Smoking
Quit Smokeless
*
Figure 1B. Percent of 2002 Smokers Who Quit Smoking or Quit Both Smoking and Smokeless In 2003, U.S.
Quit Smoking
Quit Smoking and Smokeless
Based on US 2002-2003 TUS-CPS longitudinal sample
Figure 1A. Annual Quit Rate for Smoking or for Smoking and Snus in MONICA Project (5-13 years), Sweden
Quit Smoking
Quit Smoking and Snus
Based on the multi-year followed up results reported in Tables 3-5 in Rodu et al. (2003),
% Quit
% Quit
Chart1
11.712.42.62.22.42
11.312.32.72.22.42.1
Male
Female
Sheet1
Male11.711.3
UB2.62.7
LB2.22.2
Female12.412.3
UB2.42.4
LB22.1
Sheet1
11.712.42.62.22.42
11.312.32.72.22.42.1
Male
Female
Quit %
Sheet2
Sheet3
Chart1
64.11.210.80.7
3.83.60.90.80.70.6
Male
Female
Sheet1
Male63.8
1.20.9
10.8
Female4.13.6
0.80.7
0.70.6
Sheet1
00
00
Male
Female
Quit %
Sheet2
Sheet3
Possible Explanations
It was not promoted as safer products
Price differential is not big enough
Product difference
Not enough of them using it
*
Conclusions
U.S. Data do not replicate the Swedish results
U.S. male smokers seem to quit smoking at a high rate, without using smokeless
U.S. female smokers quit on the same level as males
Promoting smokeless tobacco as less harmful alternative may not lead to an increase of population smoking cessation rate in places like the U.S.
Price differential may have a greater effect in increasing switching to smokeless
*
Thank You!
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