American journal of preventive medicine
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Review Comparative Study
Epidemiologic perspectives on smokeless tobacco marketing and population harm.
Moist snuff is the most popular form of orally-used smokeless tobacco in North America and parts of Europe. Because moist snuff use conveys lower risks for morbidity or mortality than does cigarette smoking, its use has been proposed as a tobacco harm-reduction strategy. This article critically reviews new and published epidemiologic evidence on health effects of moist snuff and its patterns of use relative to smoking in the United States, Sweden, and Norway. ⋯ S. and an inconsistent role in Sweden, (6) U. S. states with the lowest smoking prevalence also tend to have the lowest prevalence of snuff use, (7) there are no data on the efficacy of snuff as a smoking-cessation method, (8) the prevalence of cigarette smoking is relatively high among people who use snuff, and (9) snuff use is more consistently associated with partial substitution for smoking than with complete substitution. The evidence base for promotion of snuff use as a public health strategy is weak and inconsistent.
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More adults in the United States have quit smoking than remain current smokers. But 45 million adults (20.9%) continue to smoke, with highest rates among low socioeconomic status (SES), blue-collar, and Native American populations. More than two thirds (70%) of adult smokers want to quit, and approximately 40% make a serious quit attempt each year, but only 20%-30% of quitters use an effective behavioral counseling or pharmacologic treatment. ⋯ This paper uses the "push-pull capacity" model as a framework for illustrating strategies to achieve this goal. This model recommends: (1) improving and communicating effective treatments for wide population use; (2) building the capacity of healthcare and other systems to deliver effective treatments; and (3) boosting consumer, health plan, and insurer demand for them through policy interventions shown to motivate and support quitting (e.g., clean indoor-air laws, tobacco tax increases, expanded insurance coverage/reimbursement) and efforts to improve treatment access and appeal, especially for smokers who use them least. Innovations recommended by the National Consumer Demand Roundtable for achieving "breakthrough" improvements in cessation treatment demand and use are described.
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Quitlines in the United States have grown dramatically over the past 15 years, from one state and a handful of health plans to all 50 states and over 200 health plans and employers. Over half a million tobacco users received help from state quitlines alone in 2005. ⋯ Quitlines have the capacity to serve a larger fraction of the population than they currently serve. Accomplishing this is dependent on creating ambitious, multi-institution funding and delivery mechanisms, as well as further research and development to improve reach, effectiveness, and efficiency.
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The purpose of the current study was to assess whether men who have sex with men (MSM) who limit their unprotected anal sexual partners to those who are of the same HIV status (serosort) differ in their risk for HIV transmission than MSM who do not serosort. ⋯ Men who identify as HIV-negative and serosort are no more likely to know their HIV status than men who do not serosort and are at higher risk for exposure to HIV. Interventions targeting MSM must address the limitations of serosorting.