Larger text size Large text size Regular text size. What Is Smokeless Tobacco? Smokeless tobacco comes as either snuff or chewing tobacco: Snuff is finer-grain tobacco that sometimes comes in pouches that look like teabags. Chewing tobacco is larger-grain tobacco leaves that are twisted or shredded and come loose in paper packets or small cans.
Why Is Smokeless Tobacco Dangerous? If you use smokeless tobacco, these tips can help you quit: Use nicotine gum or a nicotine patch, but only after talking to your doctor about which would work best for you. Distract yourself with healthier activities. Try lifting weights, shooting baskets, swimming, biking, and other sports.
Talk to friends and family for support. This study examined the prevalence, patterns and underlying risk factors for smokeless tobacco use among non-institutionalised Nigerian adults. The findings show a relatively low prevalence. The commonest form of use was snuff by nose, with a majority as daily users. Proper perception of risk of use was low and some of the determinants of use included low risk perception, male sex, increasing age, rural residence, no formal education and residence in the north- and south-eastern regions of the country.
The overall prevalence of SLT use in the study population appeared low in comparison to recent global and African averages [ 8 ], and a previous study in a city in the north-east of Nigeria [ 7 ], similar to figures from a secondary analysis of data from the Nigeria Demographic and Health Survey NDHS [ 2 ], and higher than figures from the NDHS [ 18 ]. Analysis of large population-based surveys across Africa have also shown a low prevalence of SLT use among men and women in West Africa as compared to other regions [ 26 ], findings probably accounted for by varying cultural and social norms.
The north-eastern region of Nigeria has consistently shown a higher level of SLT use as revealed in the index study as well, this due to a high level of social acceptance of SLT [ 7 ].
The NDHS findings in combination with ours, seem to suggest a downward trend, but the differing methodologies, and just 2 time points preclude the validity of this conclusion.
Most of the SLT users in our study were daily users. This is similar to findings in Pakistan [ 13 ], as well as in Bangladesh, India and Myanmar [ 9 ]. This relative preponderance of daily users is likely due to the well-established addiction initiating and perpetuating effects of nicotine, a notable challenge to tobacco cessation interventions. SLT users are known to crave and continue to use it even when harmful to their health, they sometimes switch to products with higher nicotine levels, and are not able to sustain attempts at cessation of use [ 27 ].
In an earlier study among an elderly Nigerian population half of the respondents were dependent on snuff [ 28 ]. A much lower proportion of the aggregate Nigerian population were dual smoked and smokeless tobacco users relative to figures from India [ 14 ], Bangladesh [ 9 ] and north-east Nigeria [ 7 ]. This difference is reflective of the already documented higher prevalence of the individual products in these other populations. Dual-use is an important public health metric as dual users when compared with single users, are at a greater risk for morbidity and mortality [ 29 ].
Snuff by nose was the predominant SLT type, followed by snuff by mouth. A negligible proportion used other forms such as chewing and drinking tobacco. Other local studies have shown similar patterns [ 2 , 7 ]. There are two main types of smokeless tobacco: snuff moist and dry and chewing tobacco [ 30 ], the specific types, formulations and names vary significantly by country and region [ 9 ]. The moist snuff predominates in Africa generally [ 31 ], but the dry snuff most commonly inhaled through the nose, is historically and culturally local to Nigeria, Cameroon, Senegal and Chad [ 9 ].
A significant percentage of the population was unaware of the risk of serious illness due to SLT use. This was much higher than what was found in Uganda amongst a similar population [ 10 ] as well as for cigarette use in our study population [ 1 ].
Some of the reasons behind this comparative lower levels of awareness include social acceptance [ 7 ], regular use of SLT products in social and traditional gatherings such as marriages [ 9 , 31 ], perceived medicinal properties [ 7 , 9 ], marketing of SLT as a convenient and harm reducing alternative to cigarette smoking, and less emphasis on SLT use control as compared to cigarette smoking [ 9 ].
These factors independently and through the mediating effect of lower levels of awareness of harm may serve as critical drivers of increased SLT use in response to intensified marketing efforts, while also impinging on efforts at getting users to quit. Well-designed, sustained, comprehensive health education efforts and enlightenment campaigns will serve to attenuate the effect of the interplay of these factors. There were significantly higher odds of current SLT use associated with increasing age, male gender, rural location, having no formal education, having no perception of risk of SLT use and living in all other regions of the country as compared to the north-west.
Increasing age has been severally found to be associated with SLT use [ 7 , 13 , 16 , 17 ]. With the difficulty of cessation for earlier onset users, newer users are cumulatively added to older cohorts thus increasing the likelihood in older age. It is also thought that there might be a switch from smoked to smokeless tobacco in the later stages of the lifespan in a bid to minimise perceived health risks while retaining the nicotine addiction [ 32 ].
The higher rural burdens similarly reported previously seem to stem from the fact that SLTs are integral to many social gatherings [ 31 ] such as traditional marriages which are domiciled in the rural areas.
And even though SLT products available in Africa range from manufactured to home-made, most are home-made and these are more likely to be used by rural dwellers [ 31 ].
Our findings are also consistent with a widely documented [ 7 , 14 , 15 ] inverse relationship between educational attainment and SLT use. Those unaware of these risks were significantly more likely to use SLT, similar to a Ugandan study [ 10 ].
Regional differences have been shown in other countries [ 16 , 33 ], but since this is the first detailed national-level study of SLT use in Nigeria, there are no similar study results to compare it to. These differences are likely due to long-standing cultural differences and social norms. The current study had some strengths and limitations. With regards to the strengths, the sample size was large enough to ensure the validity of the various analyses and sub-group analyses.
Secondly, these respondents were selected using systematic and rigorous methods that ensured a good representation of the sub-groups represented within the larger Nigerian population.
Therefore, these findings are generalisable to the population. The first limitation derives from the cross-sectional study design so that a temporal sequence is not demonstrable between independent variables and the outcome variable. Interpretations of associations should therefore, be cautiously made.
Secondly, all the information especially the history of SLT use as obtained during the survey, is self-reported with no measured bio-markers for verification. In the relatively conservative Nigerian context, there could have been under-reporting due to the desire for conformity to social norms.
Thirdly, there were missing data for certain key variables, but the proportions in all cases were likely not high enough to introduce any form of bias.
Also, samples were restricted to persons living in non-institutionalized households, thus excluding residents of military barracks and dormitories. The generalisability of our findings to these excluded settings may therefore not be valid. Finally, the time lag between data collection and documentation of these findings is significant with the possibility that current realities may be different. Despite these limitations, this study is strong enough to provide useful information about the use of SLT products in Nigeria and would be important to guide future research on SLT consumption.
It would also help health policy-makers in planning tobacco control measures in Nigeria. Our study provides information about prevalence and patterns of SLT use among non-institutionalised adults in Nigeria and confirms that SLT use was higher among those with low-risk perception of SLT use, men, the older adults, rural residents, those with no formal education and residents of the north- and south-eastern regions of the country.
A significant and comparatively high proportion of the population was not aware of the harmful effects of SLT use. Policymakers should consider the social distribution of use to provide context-specific SLT prevention and control strategies.
There should be an emphasis on intense educational and enlightenment campaigns on the risks involved in SLT use so as to reduce the proportion of those unaware of use risk.
Policymakers need to consider SLT use separately in tobacco control efforts since the risk factors and health effects of SLT use are different from that of smoking. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Abstract Introduction The global tobacco epidemic contributes to more than 8 million deaths annually. Results The prevalence of current SLT use was 1. Conclusion The prevalence of SLT use among Nigerian adults was low with clearly identified predictors.
Funding: The author s received no specific funding for this work. Introduction The association between tobacco use and the risk of development of several health effects are well documented in literature. Data sources This study used data from the GATS conducted in Nigeria [ 1 ], the only one done in the country till date. Variables Outcome variable. Independent variables. Ethical considerations This study was a secondary analysis of an open source dataset which was downloaded from the Global Tobacco Surveillance System Data GTSS Data [ 25 ], a web-based application domiciled within the CDC website, that houses and displays data from four tobacco-related surveys conducted around the world.
Results Participation rates and socio-demographic characteristics A total of respondents were studied. Download: PPT. Table 1. Socio-demographic characteristics of Nigerian adults. Prevalence and patterns of current smokeless tobacco use The prevalence of smokeless tobacco use among Nigerians aged 15 years and above was 1.
Fig 1. Determinants of current smokeless tobacco use Table 2 shows the bivariate associations between selected independent factors and current smokeless tobacco use in Nigerian adults 15 years and above. Visit Lung. Centers for Disease Control and Prevention.
Factsheet: Smokeless Tobacco: Health Effects. December National Cancer Institute. Smokeless Tobacco and Cancer: Questions and Answers. October, Factsheet: Smokeless Tobacco: Products and Marketing.
July Federal Trade Commission. Smokeless Tobacco Report for ; Issued March National Center for Health Statistics. National Health Interview Survey, National Youth Tobacco Survey, This November your donation goes even further to improve lung health and defeat lung cancer.
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