CORRESPONDENCE Smoker and smokeless tobacco user athletes: dual users? T. Zandonai 1 ,2 and C. Chiamulera 3 1 Department of Clinical Pharmacology, Paediatrics and Organic Chemistry, Miguel Herna ´ ndez University of Elche, Elche 03550, Spain, 2 Department of Sport Sciences, Sports Research Centre, Miguel Herna ´ ndez University of Elche, Elche 03202, Spain and 3 Neuropsychopharmacology Laboratory, Department of Diagnostic and Public Health, University of Verona, Verona 37134, Italy Address correspondence to Dr T. Zandonai, Department of Clinical Pharmacology, Paediatrics and Organic Chemistry, Miguel Herna ´ ndez University of Elche, Crta. Nacional, N-332. s/n, 03550 Sant Joan (Alicante), Elche, Spain. email: tzandonai@umh.es Dear Editor, We read with great interest the article by Sullivan et al. 1 entitled ‘A study to assess smoking habits and smoking ex- posure in sportspeople’. The authors reported about the prevalence of smoking among different sport disciplines across Ireland showing an high-smoking rate especially in rugby. The authors also reported a significant number of participants who were exposed to second-hand smoke. In this correspondence letter, we would like to provide add- itional data and insights about nicotine intake in sports es- pecially through smokeless tobacco (ST). First, we are aware of that the aim of the survey was focused on smokers, however, we emphasize that it is well known an increase of this stimulant drug use among ath- letes. 2 Indeed, survey data and anti-doping urine analyses in- dicate a prevalence of nicotine use at 25–50% amongst athletes and already previously showed in rugby (28% 2 and 34% 3 ). Even more, nicotine data from biological samples are not able to distinguish between intake sources; however, it is likely that a majority of use stems from ST products. In Ireland, according a recent report prevalence study, 4 the use of ST products is around of 1.3%, higher than Italy (0.6%) where a recent investigation found that 74% of the athletes who practice winter sports have tried ST at least once, with 50% of them as regular users. 5 Therefore, here, we would like to introduce an important issue of smoker and ST user ath- letes: the dual users. Indeed, many smokers report use of ST in places where they cannot smoke and (i) believe that ST products are less harmful than are cigarettes and (ii) they use ST as a method for quitting to smoke. 6 Regarding sport environment, in a survey about 49 current ST users (80.3% of the total, n ¼ 61) 32 of them were cur- rent smokers. Authors showed that nicotine could induce greater satisfaction and psychological reward than occasional use. In this survey emerged, therefore, that ST use induced effects similar to smoking tobacco, and that some of these effects—those associated with reward and satisfaction—were positively related to ST daily intake. 5 Moreover, the addicted properties of nicotine may be considered a potential health risk and its use could be possible gateway toward doping despite nicotine is not considered a doping agent but this topic should be monitored in depth. 5 Athletes use drugs for various reasons and could be prone to develop substance use disorders in contexts other than sport. As the authors have pointed out, only 2% use E-cigarettes des- pite an widespread use among general population, therefore, more studies in this field are needed to monitoring in order to prevent drug misuse and chronic licit substance use in athletes, independently of the sport disciplines. Conflict of interest. None declared. References 1. O’Sullivan B, Scully P, Curtin RJ, Plant BJ. A study to assess smoking habits and smoking exposure in sportspeople. QJM 2020; hcaa189. doi:10.1093/qjmed/hcaa189 2. Mundel T. Nicotine: sporting friend or foe? A review of athlete use, performance consequences and other considerations. Sport Med 2017; 47:2497–506. 3. Pacifici R, Pichini S, Palmi I, de la Torre X, Botre ` F, Casciello M, et al. Smoking habits of Italian athletes undergoing anti- doping control. Drug Test Anal 2016; 8:134–6. 4. Leon ME, Lugo A, Boffetta P, Gilmore A, Ross H, Schu ¨ z J, et al. Smokeless tobacco use in Sweden and other 17 European countries. Eur J Public Health 2016; 26:817–21. V C The Author(s) 2020. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For permissions, please email: journals.permissions@oup.com 1 QJM: An International Journal of Medicine, 2020, 1–3 doi: 10.1093/qjmed/hcaa222 Advance Access Publication Date: 10 July 2020 Correspondence Downloaded from https://academic.oup.com/qjmed/advance-article/doi/10.1093/qjmed/hcaa222/5869811 by guest on 15 February 2023