CHICAGO--New insights about the scope of the tobacco epidemic and the most effective tools for combating this problem were presented at the 11th World Conference on Tobacco OR Health, which was recently held in Chicago.

TOBACCO USE COMMON AMONG COLLEGE STUDENTS

Nearly half of 14,138 college students surveyed in a recent study reported using tobacco products within the past year, according to data presented by Nancy A. Rigotti, MD, of the Massachusetts General Hospital in Boston, and colleagues. The findings also were published in the August 9 JAMA.

Overall, 61% of respondents had ever tried a tobacco product, 45.7% had used a tobacco product in the past year, and 32.9% reported current use of tobacco products. In terms of cigarette use, 38.1% of respondents had smoked in the past year and 28.5% had smoked in the past 30 days. Among current smokers, 32% smoked less than one cigarette per day, 43.6% smoked one to 10 cigarettes a day, and 12.8% smoked one or more packs per day.

After cigarettes, cigars were the most commonly used tobacco products. More than one third of respondents (37.1%) had ever smoked a cigar, 23% had smoked a cigar within the past year, and 8.5% had smoked a cigar within the past 30 days.

Tobacco use was more prevalent among men than among women, owing to a higher prevalence of cigar and smokeless tobacco use among men. Furthermore, the findings indicate that "tobacco use is more common among whites, other substance users, and students whose priorities are social rather than educational or athletic," according to the study investigators.

HEALTH CONSEQUENCES OF CIGAR SMOKING

Cigars are not a safe alternative to cigarettes, reported David M. Burns, MD, of the University of California, San Diego, School of Medicine. Dr. Burns and colleagues have found that the risk of death related to cigar smoking approaches that due to cigarette smoking. Their data, also published in the August 9 JAMA, were derived from a conference convened by the American Cancer Society in June 1998.

Smoking cigars instead of cigarettes does not reduce the risk of nicotine addiction. Cigar smoke has a more alkaline pH, which allows nicotine to be absorbed through oral mucosa. Thus, cigar smoking can lead to nicotine dependence even if the smoke is not inhaled. The nicotine in the smoke of a single cigar can vary from an amount comparable to that in the smoke of a single cigarette to the amount generated by smoking a pack or more of cigarettes.

Rates of oral and esophageal cancer are similar among cigar and cigarette smokers. Rates of laryngeal cancer among cigar smokers are intermediate between those of cigarette smokers and never smokers. Rates of cardiovascular disease, chronic obstructive pulmonary disease, and lung cancer are slightly higher among heavy cigar smokers than among never smokers, but the risk among cigar smokers increases dramatically if they inhale. "What makes the pattern of disease different for cigarette and cigar smokers is the different locations in the body exposed to the smoke with the different forms of tobacco use," according to Dr. Burns and colleagues.

GENDER DIFFERENCES IN QUIT ATTEMPTS

Men prefer to quit smoking cold turkey, while women prefer to use smoking cessation products. Reasons for failed smoking cessation attempts also vary by sex, according to a recent survey of more than 1,000 smokers.

In the summer of 1999, Linda Hyder Ferry, MD, MPH, and colleagues from the Foundation for Innovations in Nicotine Dependence in Loma Linda, California, administered a 36-item telephone survey to randomly selected smokers. Of this group, 47% had tried to stop smoking during the past year.

The most commonly reported reason male subjects tried to stop smoking was to improve their sex life. The second most frequent reason was to reduce shortness of breath. Among female subjects, the most commonly reported motivating factors were a desire to improve their health, to improve the health of their family, and to improve their appearance.

In terms of the reasons for unsuccessful quit attempts, women were more likely than men to report stress, irritability, moodiness, weight gain, depression, and anxiety. Women were also more likely to continue to smoke if weight control was a concern.

The men had made more attempts to quit (7.3 vs 5.6) and were more likely to quit without pharmacologic aids (42% vs 30%) than were the women. In contrast, women were more likely than men to consult a doctor (58% vs 45%) and to use smoking cessation products (Table 1).

LIGHT CIGARETTES ARE NOT LESS HAZARDOUS

Different levels of tar do not alter the risk of lung cancer among smokers, according to new findings. Dr. Burns examined data from the American Cancer Society's Cancer Prevention Study I to explore the possibility that low tar/nicotine cigarettes reduce the risk of lung cancer--as was suggested in epidemiologic studies from the 1960s and 1970s.

Initially, the results showed a lower risk among people who smoked low-yield as opposed to high-yield cigarettes. However, after Dr. Burns took into account the number of cigarettes smoked per day, the reduced risk among smokers of low-yield cigarettes disappeared. Furthermore, when Dr. Burns examined only the outcomes among participants who had not changed the number of cigarettes they smoked during the 12-year study, the risk was not affected by the type of cigarette.

"These analyses suggest that the difference in lung cancer risks demonstrated to exist for smokers of low-yield cigarettes in epidemiological studies may be due to differences in the populations of individuals who select these cigarettes rather than differences in the lung cancer risks produced by smoking low-yield cigarettes," Dr. Burns concluded.

NRT SALES DOUBLE WITH OTC SWITCH

The change of nicotine replacement therapy (NRT) from prescription to over-the-counter (OTC) status doubled the sale of these products in the first two months after the switch was made in France. The findings are based on a survey of the sale of nicotine replacement products sold before and after December 1999, when the prescription-to-OTC switch occurred. The results were presented by Professor Bertrand Dautzenberg, of the Office Français de Prévention du Tabagisme (in Paris) and Paris Sans Tabac, and colleagues.

--Kristin Della Volpe