{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T03:36:38Z","timestamp":1752550598269,"version":"3.37.3"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2018,7,6]],"date-time":"2018-07-06T00:00:00Z","timestamp":1530835200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["R01DA030276"],"award-info":[{"award-number":["R01DA030276"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,7,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>A higher proportion of people living with HIV (PLWH) smoke compared to the general population, but little information exists about the prevalence and correlates of smokeless tobacco use among PLWH. In South Africa, dry powdered tobacco is inhaled nasally as snuff.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A cross-sectional survey among PLWH attending three HIV clinics was conducted. Snuff use was assessed via self-report and urine cotinine.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Given the low (3%) prevalence of snuff use among men, analysis was restricted to n = 606 nonsmoking women living with HIV. Half (n = 298, 49%) were snuff users, the majority of whom (n = 244, 84%) had a positive urine cotinine test. In adjusted analysis, snuff use was negatively associated with higher education (relative risk [RR] 0.55; 95% confidence interval [CI]: 0.39, 0.77) and mobile phone ownership (RR 0.83; 95% CI: 0.71, 0.98), and positively associated with ever having tuberculosis (TB) (RR 1.22; 95% CI: 1.03, 1.45). In adjusted analysis, with current TB as the outcome, snuff use was marginally statistically significantly associated with a twofold increase in odds of a current TB diagnosis (odds ratio [OR] 1.99; 95% CI: 0.98, 4.15).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>A high proportion of nonsmoking South African women living with HIV use snuff, which was a risk factor for TB. Additional research is needed to understand the relationship between snuff, TB, and other potential health risks.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Implications<\/jats:title>\n                  <jats:p>PLWH have a higher prevalence of smoking than their seronegative peers, but there is a paucity of research on smokeless tobacco use in this population, especially in low-resource settings. TB is the leading cause of death among PLWH, and with improvements to HIV treatment and care, PLWH are at greater risk of tobacco-related diseases. We report an extremely high prevalence of snuff use among women living with HIV in South Africa. Further, in this population snuff use is positively associated with ever having a TB diagnosis, as well as currently having TB.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ntr\/nty137","type":"journal-article","created":{"date-parts":[[2018,7,4]],"date-time":"2018-07-04T00:16:24Z","timestamp":1530663384000},"page":"1087-1092","source":"Crossref","is-referenced-by-count":8,"title":["Prevalence and Correlates of Snuff Use, and its Association With Tuberculosis, Among Women Living With HIV in South Africa"],"prefix":"10.1093","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4298-6395","authenticated-orcid":false,"given":"Jessica L","family":"Elf","sequence":"first","affiliation":[{"name":"Center for TB Research, Johns Hopkins School of Medicine, Baltimore, MD"},{"name":"The Schroeder Institute for Tobacco Research and Polity Studies at Truth Initiative, Washington, DC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ebrahim","family":"Variava","sequence":"additional","affiliation":[{"name":"Perinatal HIV Research Unit (PHRU), SAMRC Soweto Matlosana Collaborating Centre for HIV\/AIDS and TB, University of the Witwatersrand, Soweto, South Africa"},{"name":"Department of Internal Medicine and Department of Health, Klerksdorp Tshepong Hospital Complex, Matlosana, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandy","family":"Chon","sequence":"additional","affiliation":[{"name":"Center for TB Research, Johns Hopkins School of Medicine, Baltimore, MD"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Limakatso","family":"Lebina","sequence":"additional","affiliation":[{"name":"Perinatal HIV Research Unit (PHRU), SAMRC Soweto Matlosana Collaborating Centre for HIV\/AIDS and TB, University of the Witwatersrand, Soweto, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katlego","family":"Motlhaoleng","sequence":"additional","affiliation":[{"name":"Perinatal HIV Research Unit (PHRU), SAMRC Soweto Matlosana Collaborating Centre for HIV\/AIDS and TB, University of the Witwatersrand, Soweto, South Africa"},{"name":"Department of Internal Medicine and Department of Health, Klerksdorp Tshepong Hospital Complex, Matlosana, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikhil","family":"Gupte","sequence":"additional","affiliation":[{"name":"Center for TB Research, Johns Hopkins School of Medicine, Baltimore, MD"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raymond","family":"Niaura","sequence":"additional","affiliation":[{"name":"The Schroeder Institute for Tobacco Research and Polity Studies at Truth Initiative, Washington, DC"},{"name":"Department of Health, Behavior and Society, Johns Hopkins School of Public Health, Balitimore, MD"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Abrams","sequence":"additional","affiliation":[{"name":"The Schroeder Institute for Tobacco Research and Polity Studies at Truth Initiative, Washington, DC"},{"name":"Department of Health, Behavior and Society, Johns Hopkins School of Public Health, Balitimore, MD"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neil","family":"Martinson","sequence":"additional","affiliation":[{"name":"Perinatal HIV Research Unit (PHRU), SAMRC Soweto Matlosana Collaborating Centre for HIV\/AIDS and TB, University of the Witwatersrand, Soweto, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan E","family":"Golub","sequence":"additional","affiliation":[{"name":"Center for TB Research, Johns Hopkins School of Medicine, Baltimore, MD"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2018,7,6]]},"reference":[{"issue":"6","key":"2019071707061988300_CIT0001","doi-asserted-by":"crossref","first-page":"e578","DOI":"10.1016\/S2214-109X(17)30170-5","article-title":"Tobacco use among people living with HIV: analysis of data from Demographic and Health Surveys from 28 low-income and middle-income countries","volume":"5","author":"Mdege","year":"2017","journal-title":"Lancet Glob Health"},{"volume-title":"The Health Consequences of Smoking - 50 Years of Progress: A Report of the Surgeon General","author":"U.S. Department of Health and Human Services","key":"2019071707061988300_CIT0002"},{"volume-title":"Fact Sheet - World AIDS Day 2017","year":"2017","author":"UNAIDS","key":"2019071707061988300_CIT0003"},{"issue":"3","key":"2019071707061988300_CIT0004","doi-asserted-by":"crossref","first-page":"e2","DOI":"10.1136\/tc.2010.037465","article-title":"Global surveillance of oral tobacco products: total nicotine, unionised nicotine and tobacco-specific N-nitrosamines","volume":"20","author":"Stanfill","year":"2011","journal-title":"Tob Control"},{"key":"2019071707061988300_CIT0005","first-page":"1017","volume-title":"IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Volume 89. Smokeless Tobacco and Some Tobacco-Specific N-nitrosamines","author":"World Health Organization International Agency for Research on Cancer","year":"2007"},{"issue":"10","key":"2019071707061988300_CIT0006","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1093\/aje\/kww075","article-title":"Smokeless tobacco use and the risk of head and neck cancer: pooled analysis of US Studies in the INHANCE Consortium","volume":"184","author":"Wyss","year":"2016","journal-title":"Am J Epidemiol"},{"issue":"7","key":"2019071707061988300_CIT0007","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1016\/S1470-2045(08)70173-6","article-title":"Smokeless tobacco and cancer","volume":"9","author":"Boffetta","year":"2008","journal-title":"Lancet Oncol"},{"issue":"9578","key":"2019071707061988300_CIT0008","doi-asserted-by":"crossref","first-page":"2015","DOI":"10.1016\/S0140-6736(07)60678-3","article-title":"Oral use of Swedish moist snuff (snus) and risk for cancer of the mouth, lung, and pancreas in male construction workers: a retrospective cohort study","volume":"369","author":"Luo","year":"2007","journal-title":"Lancet"},{"issue":"6","key":"2019071707061988300_CIT0009","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1002\/ijc.20811","article-title":"Smokeless tobacco use and risk of cancer of the pancreas and other organs","volume":"114","author":"Boffetta","year":"2005","journal-title":"Int J Cancer"},{"issue":"9536","key":"2019071707061988300_CIT0010","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1016\/S0140-6736(06)69249-0","article-title":"Tobacco use and risk of myocardial infarction in 52 countries in the INTERHEART study: a case-control study","volume":"368","author":"Teo","year":"2006","journal-title":"Lancet"},{"key":"2019071707061988300_CIT0011","doi-asserted-by":"crossref","first-page":"b3060","DOI":"10.1136\/bmj.b3060","article-title":"Use of smokeless tobacco and risk of myocardial infarction and stroke: systematic review with meta-analysis","volume":"339","author":"Boffetta","year":"2009","journal-title":"BMJ"},{"issue":"2","key":"2019071707061988300_CIT0012","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1097\/01.hjr.0000114971.39211.d7","article-title":"Is smokeless tobacco a risk factor for coronary heart disease? A systematic review of epidemiological studies","volume":"11","author":"Critchley","year":"2004","journal-title":"Eur J Cardiovasc Prev Rehabil"},{"issue":"2","key":"2019071707061988300_CIT0013","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1136\/tc.2007.022608","article-title":"Association of snuff use with chronic bronchitis among South African women: implications for tobacco harm reduction","volume":"17","author":"Ayo-Yusuf","year":"2008","journal-title":"Tob Control"},{"year":"2016","author":"UNAIDS","key":"2019071707061988300_CIT0014"},{"key":"2019071707061988300_CIT0015","article-title":"Prevalence and correlates of smoking among people living with HIV in South Africa","author":"Elf","year":"2017","journal-title":"Nicotine Tob Res"},{"volume-title":"Global Tuberculosis Report 2016","year":"2016","author":"World Health Organization","key":"2019071707061988300_CIT0016"},{"volume-title":"WHO report on the Global Tobacco Epidemic, 2017. Monitoring Tobacco Use and Prevention Policies. Country Profile: South Africa","year":"2017","author":"World Health Organization","key":"2019071707061988300_CIT0017"},{"issue":"9","key":"2019071707061988300_CIT0018","doi-asserted-by":"crossref","first-page":"e45913","DOI":"10.1371\/journal.pone.0045913","article-title":"Point-of-care urine tests for smoking status and isoniazid treatment monitoring in adult patients","volume":"7","author":"Nicolau","year":"2012","journal-title":"PLoS One"},{"article-title":"R Core Team","volume-title":"R: A Language and Environment for Statistical Computing [Computer Program]","year":"2013","key":"2019071707061988300_CIT0019"},{"key":"2019071707061988300_CIT0020","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1186\/1471-2458-13-1031","article-title":"Tobacco use patterns in tuberculosis patients with high rates of human immunodeficiency virus co-infection in South Africa","volume":"13","author":"Louwagie","year":"2013","journal-title":"BMC Public Health"},{"issue":"7","key":"2019071707061988300_CIT0021","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1177\/0956462416632428","article-title":"Prevalence and distribution of non-AIDS causes of death among HIV-infected individuals receiving antiretroviral therapy: a systematic review and meta-analysis","volume":"28","author":"Farahani","year":"2017","journal-title":"Int J STD AIDS"},{"issue":"3","key":"2019071707061988300_CIT0022","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1007\/s11904-016-0313-0","article-title":"Non-infectious pulmonary diseases and HIV","volume":"13","author":"Triplette","year":"2016","journal-title":"Curr HIV\/AIDS Rep"},{"issue":"4","key":"2019071707061988300_CIT0023","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1007\/s11904-015-0284-6","article-title":"Risk of cardiovascular disease in an aging HIV population: where are we now","volume":"12","author":"Martin-Iguacel","year":"2015","journal-title":"Curr HIV\/AIDS Rep"},{"issue":"1","key":"2019071707061988300_CIT0024","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1017\/S0022215100122030","article-title":"Nasal muco-ciliary clearance in snuff users","volume":"107","author":"Chetan","year":"1993","journal-title":"J Laryngol Otol"},{"issue":"1","key":"2019071707061988300_CIT0025","doi-asserted-by":"crossref","first-page":"e0146939","DOI":"10.1371\/journal.pone.0146939","article-title":"Characterization of bacterial communities in selected smokeless tobacco products using 16S rDNA analysis","volume":"11","author":"Tyx","year":"2016","journal-title":"PLoS One"},{"volume-title":"Preventing a Tobacco Epidemic in Africa: a Call for Effective Action to Support Health, Social, and Economic Development","year":"2014","author":"Network of African Science Academies","key":"2019071707061988300_CIT0026"},{"key":"2019071707061988300_CIT0027","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1186\/s12916-015-0424-2","article-title":"Global burden of disease due to smokeless tobacco consumption in adults: analysis of data from 113 countries","volume":"13","author":"Siddiqi","year":"2015","journal-title":"BMC Med"}],"container-title":["Nicotine &amp; Tobacco Research"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ntr\/article-pdf\/21\/8\/1087\/28941680\/nty137.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,9,21]],"date-time":"2019-09-21T09:41:09Z","timestamp":1569058869000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ntr\/article\/21\/8\/1087\/5050185"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,7,6]]},"references-count":27,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2018,7,6]]},"published-print":{"date-parts":[[2019,7,17]]}},"URL":"https:\/\/doi.org\/10.1093\/ntr\/nty137","relation":{},"ISSN":["1469-994X"],"issn-type":[{"type":"electronic","value":"1469-994X"}],"subject":[],"published-other":{"date-parts":[[2019,8]]},"published":{"date-parts":[[2018,7,6]]}}}