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Dual tobacco use bob anderson

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  • 1. Outline    Dual  User  Study     Background     Purpose     Methods     Results     Conclusions    Expert  Panel  
  • 2. Acknowledgement    West  Virginia  Bureau  for  Public  Health,  Division  of   Tobacco  Prevention  
  • 3. Background  –  West  Virginia    90%  of  WV  adults  know  that  SHS  is  a  health  hazard    72%  of  WV  adults  ban  smoking  in  their  home    24%  of  WV  adults  –  current  smokers       8%  of  WV  adults  –  current  ST  users    WV  Dual  Tobacco  Use     11.4%  of  smokers  use  ST     34.8%  of  ST  users  smoke  WV  2012  Adult  Tobacco  Survey  
  • 4. Background  -­‐  Industry    Aggressive  industry  promotion  of  snus  and  other   tobacco  products  (OTPs)  as  a  “solution”  for  smokers    Convenience  Stores     OTPs:  10%  of  tobacco  sales     OTPs:  31%  gross  profit  margin     Cigarettes:  14%  gross  profit  margin     25%  of  OTP  customers  also  buy  cigarettes  Convenience  Store  News:  http://www.csnews.com/top-­‐story-­‐tobacco-­‐otp_becoming_increasingly_important_for_c_stores-­‐62283.html  
  • 5. Background  -­‐  Industry    Swedish  Match     "Taking  care  of  your  OTP  shopper  can  go  a  long  way  to   taking  care  of  your  cigarette  shopper.”    Joe  Teller,  Director,  Category  Management  
  • 6. Background  -­‐  Industry    Reynolds  American     Camel  Snus  sales  8-­‐10%/year     Cigarette  sales    3%/year     $14  billion  “profit  pool”—85%  from  combustibles     Vuse—a  “digital  cigarette”   http://www.bizjournals.com/triad/news/2012/11/12/reynolds-­‐american-­‐touts-­‐ efforts-­‐to.html  
  • 7. Background  -­‐  Industry    Vuse—a  “digital  cigarette”—"Were  not  looking  to   make  a  little  splash  in  the  category,  were  looking  to   make  a  big  splash  in  the  category.”  Daan  [sic]  Delen,   President  and  CEO,  Reynolds  American  
  • 8. Non-­‐combustible  Tobacco    Snuff    Chew    Snus    Dissolvable  tobacco     Sticks,  Strips,  Orbs  (Camel)     Java  –  Stonewall     Ariva  (Star  Scientific)  
  • 9. But  Wait,  There’s  More!  
  • 10. Non-­‐combustible  Tobacco    Tobacco-­‐derived  Discs     Verve  (Altria)     Flex  (RJR)     Velo  (RJR)  
  • 11. “No  matter  how  cynical  you  get,  it’s  impossible  to  keep  up.”    Lily  Tomlin  
  • 12. 22 West Virginia HancockCounties With BrookeAll Workplace OhioProtection Marshall Wetzel Monongalia Morgan Tyler Marion Berkeley Pleasants Preston Mineral Jeff- Taylor erson Dodd- Harrison Hampshire Wood Ritchie ridge Barbour Tucker Grant Wirt Hardy Lewis Cal- Gilmer Upshur houn Mason Jackson Randolph Roane Braxton Pendleton Putnam Webster Cabell Kanawha Clay Nicholas Pocahontas Lincoln Wayne Boone Fayette Greenbrier BLUE : Smoking banned in all public and private places Mingo Logan and places of employment, including restaurants, bars, Raleigh gambling, and vehicles when used as place of employment. Sum- Wyoming mers Monroe McDowell Mercer
  • 13. Purpose    Explore  with  current  adult  dual  tobacco  users     Usage  patterns     Opinions     Nicotine     Health  risks     Rules  at  home  &  work     Experience  with  snus     Tobacco  cessation  history  
  • 14. Methods    Recruitment  with  Wellness  Council  of  WV    Interviews,  10-­‐20  minutes    Gift  cards  to  participants    Approved  by  WVU  IRB  as  exempt  research    Interviews  transcribed,  imported  into  NVivo  9   software    Coded  by  both  investigators    Congruence  between  the  investigators  
  • 15. Participants    16  men;  1  woman    Ages:  20-­‐58    16  Caucasian;  1  African  American  
  • 16. Patterns  of  Use    Initial  use    ST:  snuff  or  snus;  no  chew    Principal  reasons  for  dual  use     Rules  at  work  (safety;  secondhand  smoke)     Secondhand  smoke  concerns  at  home     Social  situations  
  • 17. Why  a  Dual  User?  For  the  simple  reason  where  I  have  a  daughter  I  don’t   want  to  smoke  around  her,  but  still  when  I’m  [at   work]  here  I  just…don’t  want  to  give  them  up.  Oh  God,  I  smoke  when  I  wake  up  and  the  whole  time   from  traveling  from  work  to  the  mine  I  smoke  and   then  as  soon  as  I  get  on  the  mine  site,  I  work  12  hours  a   day  on  the  mine  site,  and  as  soon  as  I  get  up  there  I   start  chewing,  and  then  when  I’m  off  the  property  I   start  smoking  again.    Well  if  I’m  in  a  building  I’ll  use  the  snus  because  you  don’t   have  to  spit  with  it,  but  you  still  get  the  nicotine.  Now   if  I’m  working  in  the  basement  on  the  boiler  .  .  .  I’ll  put   a  rub  in.  
  • 18. Health  Risks    More  than  half  believe  risks  are  equal    Others  believe  smoking  is  riskier    None  believe  that  ST  is  riskier  
  • 19. Weighing  the  Risks  If  you  chew  you’re  not  going  to  have  to  worry  about  lung   cancer,  and  if  you  smoke  you’re  going  to  have  to  worry   about  throat  cancer  and  lung  cancer,  but  if  you  chew   you  just  got  to  worry  about  your  mouth  cancer  .  .  .  I   think  chewing’s  a  safer  way  but  I’d  rather  keep  my   face,  that’s  why  I  smoke  more  than  I  chew.    
  • 20. Nicotine    Cigarettes  vs.  ST—cigarettes  are  stronger    Several  found  ST  to  be  stronger  
  • 21. Nicotine  Cigarettes  are  a  lot  more  potent  as  far  as  the  nicotine.   Snuff  is  more  of  a  relaxed,  it  doesn’t  hit  you  right  off   the  bat  .  .  .  If  you  dip  snuff  .  .  .  you  get  the  nicotine,  and  it  kind  of   curbs  you  away  from  smoking.  Yea  the  snuff  just  kills  the  craving  more  than  the   cigarette  does  because  if  I  smoke  one  cigarette  I  want   another  one,  and  then  when  I  dip  I  can  dip  and  you  can   keep  that  dip  in  longer  and  it  gives  you  the  nicotine   longer.    
  • 22. Rules    Work—tobacco  use  banned  by     most  employers     Most  were  compliant    Home—most  do  not  smoke     at  home,  nor  permit  others     to  smoke  
  • 23. Rules  You  can’t  smoke  unless  you’re  in  a  designated  smoking  area.     You’re  not  supposed  to  chew  unless  it’s  a  designated  area   too.    They  don’t  pay  too  much  attention  to  the  chewing   though.  No  when  [at  work]  I  don’t  chew.    I  mean  it’s  because  I’ve  got   my  access  to  cigarettes.    I  don’t  have  to  worry  about  my   daughter,  and  I’d  rather  smoke  than  chew  because  I’m   worried  about  my  mouth,  but  at  the  same  time  it’s   nicotine.    So  I  mean  it’s  keeping  me  calm  at  home.    
  • 24. Snus    10  tried  snus     8  not  impressed     2  are  regular  users  
  • 25. Snus  I  didn’t  like  it.    Snus  you  can  swallow  the  spit.    With   chewing  tobacco  you  can’t.    I  don’t  think  the  snus  is  as   strong  as  what  chewing  tobacco  is.  You  can  spit  or  you  can  swallow  it,  so  it  doesn’t  really   matter  .  .  .  I  do  spit  when  I  smoke  more,  but  it’s  more   or  less  .  .  .  the  sensation  of  the  menthol  and  the   tingling.    [My  partner  and  I]  both  smoke  the  same  cigarettes  and   we  both  use  the  same  Camel  Snus,  and  we  get   coupons  .  .  .  you  buy  a  Camel  product,  you  get  snus  for   free.  If  it’s  free  why  not  use  it?  
  • 26. Cost    Little  brand  loyalty     Some  buy  whatever  cigarette  brand  is  cheapest     One  used  RYO  tobacco     Some  vary  ST  brand,  always  going  with  whatever  was   cheapest    One  estimate  for  Monthly  cost  of  tobacco  for  the   participant  and  his  girlfriend:  $400.  
  • 27. Tobacco  Cessation    All  tried  to  quit     3  cold  turkey     3  with  meds    15/17  want  to  quit     Most  expect  to  quit  both     simultaneously     Several  expect  to  quit  smoking  first  
  • 28. Tobacco  Cessation  Well  if  I  tried  to  quit  smoking  I’d  probably  dip  a  whole  lot   more,  and  then  I’d  want  to  dip  all  the  time,  and  after   the  dip  wasn’t  doing  nothing  for  me  I’d  have  to  buy   me  cigarettes.    So  I’d  have  to  try  doing  both  at  the   same  time  because  there’s  no  way  I  could  just  quit.  I’d  probably  hold  on  to  the  snuff  to  transition  out  of  the   cigarettes,  because  I  can  put  the  snuff  down.    I  know  I   can  quit  that  anytime.    
  • 29. Thinking  About  Quitting?  Yes.  It’s  getting  too  expensive.    I  mean  when  you’ve  got   to  buy  diapers  and  formula  and  liners  and  you  work  at   Wal-­‐mart  and  your  wife  only  works  three  days  a  week   and  goes  to  school  full  time,  yea.  I  don’t  want  to  be  under  the  stereotype  of  people  saying   oh  you’re  a  smoker  and  you  smell  bad,  and  I  don’t   want  to  put  that  negativity  around  my  clients  and   patients,  you  know  what  I  mean?    I  just  don’t  want   that  bad  persona.  
  • 30. Profiles    5  Distinct  Types  of  Dual  Tobacco  Users     Smokers     “When  I  have  to”     “When  I  want  to”     “When  I  need  to”     ST  Users     “Social  smokers”     Hard  Core  Users     Use  both  types  daily  and  love  them  
  • 31. Limitations    17  interviews    Convenience  sample    Not  generalizable  
  • 32. Conclusions    Variability     When  products  are  used     Where  products  are  used     Why  products  are  used    Messages  need  to  be  tailored  
  • 33. Conclusions    The  Law  of  Unintended  Consequences     Smoking  bans  at  work     Recognition  of  secondhand  smoke  dangers    Result  -­‐  the  initiation  of  ST  use  
  • 34. Conclusions    User  version  of  “tobacco  harm  reduction”—smoke   less,  dip  more    Strong  recognition  of  SHS  smoke  hazards  
  • 35. Addressing  Dual   Tobacco  Use  in  West   Virginia  Recommendations  of  the  Expert  Panel  
  • 36. Goals    Explore  the  prevalence  of  dual  tobacco  use  in  WV.    Identify  successes  and  challenges.    Identify  cessation  practices  and  models.    Develop  targeted  recommendations  for  addressing   dual  tobacco  use  for  dissemination  to  .  .  .   Policy  Makers   Local  Health  Depts   Clinicians   Health  Care  Providers   Researchers   NGOs  
  • 37. Process    Break  Free  Alliance  –  lead  agency    Experts  (in  state  and  out  of  state)  planned    Participants  recruited    Panel  met:  December  13,  2011  
  • 38. Recommendations    Increase  support  to  $28,000,000    Maintain  the  Quitline,  able  to  counsel  dual  users    Maintain/expand  partnerships  to  address  dual  use    Develop  a  statewide  research  group  on  dual  use    Maintain/expand  regional  tobacco  networks    Continue/expand  provider  education  efforts  on  dual   use  
  • 39. Recommendations    Maintain  and  add  clean  indoor  (and  outdoor)   smoking  regulations;  advocate  for  a  statewide   comprehensive,  non-­‐preemptive  law    Increase  taxes     $2/pack  tax  on  cigarettes     Parity  tax  on  smokeless  tobacco    

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