A pilot randomized study of smokeless tobacco use among smokers not interested in quitting: changes in smoking behavior and readiness to quit

Abstract

Introduction: Several prior studies suggest that smokeless tobacco use results in less carcinogenic risk than does cigarette smoking. Whether smokers will use smokeless tobacco is unclear, as is the impact of such use on long-term smoking behavior and cessation. It is equally plausible that smokeless tobacco use among smokers could either (a) increase total tobacco exposure and undermine motivation to quit or (b) decrease overall tobacco exposure, motivate smokers to quit, and enhance cessation. Either outcome is of major public health significance.

Methods: In this small (N = 31), short-term (2 week) pilot study, smokers uninterested in quitting were randomized to (a) receive Ariva or Stonewall (both spitless and smokeless tobacco lozenges) or (b) continue smoking conventional cigarettes.

Results: Ariva/Stonewall use led to a significant reduction (40%, 95% CI: 24%-55%) in cigarettes per day, no significant increases in total tobacco use (cigarettes + Ariva/Stonewall; p > .05), and significant increases in two measures of readiness to quit, either in the next month (p < .001) or within the next 6 months (p = .04), as well as significant increases in self-efficacy to quit smoking (p < .001). No such changes were found among smokers maintained on conventional cigarettes.

Discussion: These results suggest no deleterious effect on short-term smoking and quitting behavior among smokers who use smokeless tobacco. More broadly, this study suggests a strong need for a large prospective randomized clinical trial to more accurately assess the long-term viability of smokeless tobacco use as a method for cessation induction among unmotivated smokers.

Figure 1.

(A) Changes in cigarettes per day. Significant Group × Time interaction (p < .001) (*significantly different from Visit 1, p = .002; **significantly different from Visit 1, p < .001). (B) Changes in carbon monoxide and (C) changes in tobacco units per day.

Figure 2.

(A) Changes in readiness to quit (0–10 scale). Significant Group × Time interaction for readiness to quit both in the next month (p < .001) and within the next 6 months (p = .04) (*significantly different from Visit 1, p < .01; **significantly different from Visit 1, p = .03). (B) Changes in self-efficacy to quit (9–45). Significant Group × Time interaction (p < .001) (*significantly different from Visit 1, p < .05; **significantly different from Visit 1, p < .001).