Two large prospective studies of mortality among men who use snuff or chewing tobacco (United States) Article Received: 22 October 2004 Accepted: 27 October 2004 DOI:
Cite this article as: Henley, S.J., Thun, M.J., Connell, C. et al. Cancer Causes Control (2005) 16: 347. doi:10.1007/s10552-004-5519-6 Abstract Background: Few prospective studies have examined the health risks associated with use of snuff and chewing tobacco. Methods: We studied the association between the use of spit tobacco (snuff or chewing tobacco) and mortality among men enrolled in Cancer Prevention Study I (CPS-I) in 1959 or Cancer Prevention Study II (CPS-II) in 1982. Analyses were based on men who reported exclusive use of snuff or chewing tobacco (7745 in CPS-I, 3327 in CPS-II) or no previous use of any tobacco product (69,662 in CPS-I, 111,482 in CPS-II) at baseline. Twelve-year follow-up of CPS-I, and 18-year follow-up of CPS-II identified 11,871 and 19,588 deaths, respectively. Cox proportional hazards models were used to control for age and other covariates. Results: Men who currently used snuff or chewing tobacco at baseline had higher death rates from all causes than men who did not in both CPS-I (hazard ratio [HR]=1.17, 95% CI=1.11–1.23) and CPS-II (HR=1.18, 95% CI=1.08–1.29). In CPS-I, current use of spit tobacco was statistically significantly associated with death from coronary heart disease (CHD), stroke, and diseases of the respiratory, digestive, and genitourinary systems, but not with death from cancer. In CPS-II, use of these products was significantly associated with death from CHD, stroke, all cancers combined, lung cancer, and cirrhosis. The associations with cardiovascular and other non-malignant endpoints were attenuated, but not eliminated, by controlling for measured covariates. Former use of spit tobacco was not associated with any endpoint in CPS-II. No clear dose response was observed with either the frequency or duration of usage for any endpoint. Conclusions: These two prospective studies provide limited evidence that current use of chewing tobacco or snuff may increase mortality from heart disease and stroke. Keywords mortality tobacco References
Substance Abuse and Mental Health Services Administration (2004) Results from the 2003 National Survey on Drug Use and Health: National Findings. Rockville, MD: Office of Applied Studies, NSDUH Series H-25, DHHS Publication No. SMA 04–3964.
U.S. Department of Health and Human Services (1986) The Health Consequences of Using Smokeless Tobacco: A Report of the Advisory Committee to the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services,National Institutes of Health, National Cancer Institute.
Tomar, SL 2003 Trends and patterns of tobacco use in the United States Am J Med Sci 326 248 254 PubMed Google Scholar
Bell, RA, Spangler, JG, Quandt, SA 2000 Smokeless tobacco use among adults in the Southeast South Med J 93 456 462 PubMed Google Scholar
U.S. Department of Health and Human Services (2002) 10′th Report on Carcinogens: U.S. Department of Health and Human Services, Public Health Service, National Toxicology Program.
Critchley, JA, Unal, B 2003 Health effects associated with smokeless tobacco: a systematic review Thorax 58 435 443 PubMed Google Scholar
Huhtasaari, F, Asplund, K, Lundberg, V, Stegmayr, B, Wester, PO 1992 Tobacco and myocardial infarction: is snuff less dangerous than cigarettes? BMJ Med J 305 1252 1256 Google Scholar
Bolinder, G, Alfredsson, L, Englund, A, Faire, U 1994 Smokeless tobacco use and increased cardiovascular mortality among Swedish construction workers Am J Public Health 84 399 404 PubMed Google Scholar
Huhtasaari, F, Lundberg, V, Eliasson, M, Janlert, U, Asplund, K 1999 Smokeless tobacco as a possible risk factor for myocardial infarction: a population-based study in middle-aged men J Am Coll Cardiol 34 1784 1790 PubMed Google Scholar
Asplund, K, Nasic, S, Janlert, U, Stegmayr, B 2003 Smokeless tobacco as a possible risk factor for stroke in men: a nested case-control study Stroke 34 1754 1759 PubMed Google Scholar
Wallenfeldt, K, Hulthe, J, Bokemark, L, Wikstrand, J, Fagerberg, B 2001 Carotid and femoral atherosclerosis, cardiovascular risk factors and C-reactive protein in relation to smokeless tobacco use or smoking in 58-year-old men J Int Med 250 492 501 Google Scholar
Ahlbom, A, Olsson, UA, Pershagen, G 1997Halsorisker med snus (Health risks by snuff). Position paper Swedish National Board of Health and Welfare Stockholm Google Scholar
Accortt, NA, Waterbor, JW, Beall, C, Howard, G 2002 Chronic disease mortality in a cohort of smokeless tobacco users Am J Epidemiol 156 730 737 PubMed Google Scholar
Thun M, Day-Lally C, Meyers D,
et al. (1992) Trends in tobacco smoking and mortality from cigarette use in Cancer Prevention Studies I (1959 through 1965) and II (1982 through 1988). In: Shopland D, Burns D, Garfinkel L, Samet J, eds. National Cancer Institute. Changes in Cigarette-related Disease Risks and Their Implication for Prevention and Control. Smoking and Tobacco Control Monograph No. 8. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute, NIH Pub No. 97-4213, pp. 305–382.
Hammond, E 1966 Smoking in relation to the death rates of one million men and women Haenszel, W eds. Epidemiologic Approaches to the Study of Cancer and Other Chronic Diseases. Natl Cancer Inst Monogr 19. US Department of health, Education, and Welfare Rockville, MD 127 204 Google Scholar
Garfinkel, L 1985 Selection, follow-up and analysis in the American Cancer Society prospective studies Monogr Natl Cancer Inst 67 49 52 Google Scholar
Stellman, SD, Garfinkel, L 1986 Smoking habits and tar levels in a new American Cancer Society prospective study of 1.2 million men and women J Natl Cancer Inst 76 1057 1063 PubMed Google Scholar
Thun, M, Calle, E, Rodriguez, C, Wingo, P 2000 Epidemiological research at the American Cancer Society Cancer Epidemiol Biomark Prev 9 861 868 Google Scholar
Calle, E, Terrell, D 1993 Utility of the National Death Index for ascertainment of mortality among Cancer Prevention Study II particpants Am J Epidemiol 137 235 241 PubMed Google Scholar
World Health Organization. International Classification of Diseases (1957)
Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death. 7th rev. Vol. 1. Geneva: World Health Organization.
World Health Organization (1977).
International Classification of Diseases, Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death. 9th rev. Vol. 1. Geneva: World Health Organization.
IARC 2004Tobacco Smoke and Involuntary Smoking International Agency for Research on Cancer Lyon Google Scholar
U.S. Department of Health and Human Services (2004)
The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.
Cox, D 1972 Regression models and life tables J R Stat Soc 34 187 220 Google Scholar
Breslow, N, Day, N 1980Statistical Methods in Cancer Research. The Analysis of Case-Control Studies International Agency for Research on Cancer Lyon, France Google Scholar
Stockwell, H, Lyman, G 1986 Impact of smoking and smokeless tobacco on the risk of cancer of the head and neck Head Neck Surg 9 104 110 PubMed Google Scholar
Winn, DM, Blot, WJ, Shy, CM, Pickle, LW, Toledo, A, Fraumeni, JF, Jr 1981 Snuff dipping and oral cancer among women in the southern United States New Engl J Med 304 745 749 PubMed Google Scholar
Sankaranarayanan, R, Duffy, S, Day, N, Nair, M, Padmakumary, G 1989 A case-control investigation of cancer of the oral tongue and the floor of the mouth in southern india Int J Cancer 60 617 621 Google Scholar
Sankaranarayanan, R, Duffy, S, Padmakumary, G, Day, N, Padmanabhan, T 1969 Tobacco chewing, alcohol and nasal snuff in cancer of the gingiva in Kerala, India Brit J Cancer 60 638 643 Google Scholar
Sankaranarayanan, R, Duffy, SW, Day, NE, Nair, MK, Padmakumary, G 1989 A case-control investigation of cancer of the oral tongue and the floor of the mouth in southern India Int. J. Cancer 44 617 621 PubMed Google Scholar
Sankaranarayanan, R, Duffy, S, Padmakumary, G, Day, N, Nair, M 1990 Risk factors for cancer of the buccal and labial mucosa in Kerala, southern India J Epidemiol Commun Health 44 286 292 Google Scholar
Dikshit, RK, Buch, JG, Mansuri, SM 1987 Effect of tobacco consumption on semen quality of a population of hypofertile males Fertil Steril 48 334 336 PubMed Google Scholar
Rao, DN, Ganesh, B, Rao, RS, Desai, PB 1994 Risk assessment of tobacco, alcohol and diet in oral cancer–a case-control study Int J Cancer 58 469 473 PubMed Google Scholar
Gupta, PC, Mehta, FS, Irani, RR 1980 Comparison of mortality rates among bidi smokers and tobacco chewers Indian J Cancer 17 149 151 PubMed Google Scholar
Gupta, PC, Mehta, FS, Daftary, DK, et al. 1980 Incidence rates of oral cancer and natural history of oral precancerous lesions in a 10-year follow-up study of Indian villagers Commun Dent Oral Epidemiol 8 283 333 Google Scholar
Idris, AM, Ahmed, HM, Malik, MO 1995 Toombak dipping and cancer of the oral cavity in the Sudan: a case-control study Int J Cancer 63 477 480 PubMed Google Scholar
Lewin, F, Norell, SE, Johansson, H, et al. 1998 Smoking tobacco, oral snuff, and alcohol in the etiology of squamous cell carcinoma of the head and neck: a population-based case-referent study in Sweden Cancer 82 1367 1375 PubMed Google Scholar
Schildt, EB, Eriksson, M, Hardell, L, Magnuson, A 1998 Oral snuff, smoking habits and alcohol consumption in relation to oral cancer in a Swedish case-control study Int J Cancer 77 341 346 PubMed Google Scholar
IARC 1985Tobacco Habits Other than Smoking; Betel-Quid and Areca Nut Chewing; and Some Related Nitrosamines International Agency for Reseach on Cancer Lyon Google Scholar
National Cancer Institute 2004SEER Cancer Statistics Review, 1975–2001 US Department of Health and Human Services, Public Health Service Bethesda, MD Google Scholar
Rodu, B, Cole, P 2002 Smokeless tobacco use and cancer of the upper respiratory tract Oral Surg Oral Med Oral Pathol Oral Radiol Endod 93 511 515 PubMed Google Scholar
Foulds, J, Ramstrom, L, Burke, M, Fagerstrom, K 2003 Effect of smokeless tobacco (snus) on smoking and public health in Sweden Tob Control 12 349 359 PubMed Google Scholar
U.S. Smokeless Tobacco Company Request for Advisory Opinion (2002) http://www.ftc.gov/os/comments/smokelesscomments/ reqadvisoryop.pdf http://www.ftc.gov/os/comments/smokelesscomments/reqadvisoryop.pdf (accessed September 13, 2002).