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Enough Snuff

Program Title Enough Snuff
Purpose Self-help cessation manual specialized for smokeless tobacco users. (2000)
Program Focus Smoking Cessation
Population Focus Current Tobacco Users
Topic Tobacco Control
Age Adolescents (11-18 years), Adults (40-65 years), Older Adults (65+ years), Young Adults (19-39 years)
Gender Female, Male
Race/Ethnicity American Indian, White, not of Hispanic or Latino origin
Setting Home-based
Origination United States
Funded by NCI (Grant number(s): CA60586)
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The Need

Although cigarette smoking has long been called the number one preventable cause of cardiovascular disease and cancer, the hazards of smokeless tobacco (SLT) have more recently come to light. SLT is not a safe substitute for cigarettes. As with smoking, SLT leads to nicotine dependence. Nicotine levels for SLT users are similar and in some cases higher than for smokers of a pack or more per day. Most daily smokeless tobacco users (73%) have non-cancerous and pre-cancerous oral lesions. Use of moist snuff is linked with oral cancer.

The Program

Enough Snuff is a 60-page self-help cessation manual specialized for smokeless tobacco users. The self-help manual is most effective when used in conjunction with phone counseling and a supplemental video.

Community Preventive Services Task Force Finding
Guide to Community Preventive Services This program uses an intervention approach recommended by the Community Preventive Services Task Force: quitline interventions (Tobacco Control).
Time Required

The 60-page manual can be referred to as often as necessary. The video is 20 minutes in length, and counselor phone calls are approximately 10 -- 14 minutes long.

Intended Audience

Participants were self-identified SLT users in Oregon, Washington, Idaho, Montana, and Alaska, 15 years and older, users of smokeless tobacco daily for at least 1 year, willing to quit all tobacco products, and not involved in another cessation program or using nicotine replacement therapy.   They were predominantly White, though also included people who were Alaskan Native and American Indian origin.

Suitable Settings

The program can be implemented in the participant's home.

Required Resources

The 60-page quitting guide Enough Snuff: A Guide for Quitting Smokeless Tobacco, a 20-min Enough Snuff video designed to accompany the manual, and two supportive phone calls from tobacco cessation counselors.  Costs associated with the program's implementation are not provided.

About the Study

The study evaluated the use of a self-help intervention provided by mail and telephone to interested SLT users who responded to an offer for a free cessation program. SLT users in five Northwest states were invited to participate through news stories and announcements in print and broadcast media. Of the 1,069 people randomized to either the manual only group (MAN) or the manual, plus video, plus two counseling phone calls (ASH), 97% were male and 95% were Caucasian. Participants in the MAN group were mailed a copy of Enough Snuff. ASH Participants received the Enough Snuff guide as well as the 20 minute accompanying video, and two supportive phone calls from tobacco cessation counselors. During the first phone call, which averaged 14 minutes, counselors encouraged participants to articulate reasons for quitting, choose a quit method, and select a quit date. During the second call, which averaged 10 minutes, the counselors focused on dealing with withdrawal and relapse.

The results of the study are encouraging:

  • Using the intent to treat model, 6-month follow up data showed that participants in the ASH group, when compared to those in the MAN group, had higher quit rates for both smokeless (23.4% vs. 18.4%) and all tobacco use (21.1% vs. 16.5%).
    Graph of Study Results
  • More SLT users in the ASH condition (81%) made a serious attempt to quit than SLT users in the MAN condition (69%).
    Graph of Study Results
  • Participants in the ASH condition were more likely than MAN participants to set a quit date, write down reasons for quitting, tell family and friends, plan for tough situations, and use an alternative product as a cessation aid.
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Updated: 06/16/2020