November 5, 2018

Stanton A. Glantz, PhD

Why smokeless tobacco needs to be included in local and state laws prohibiting sale of flavored tobacco products

Alameda, CA is considering an ordinance to license tobacco retailers and prohibit the sale of flavored tobacco products.  Retailers are arguing that chewing tobacco should be exempted becuase theh claim the average age of those that chew is 40.   I asked my colleague Ben Chaffee about this and here is what he had to say:

While smokeless (dip and chew) has been traditionally been a product for older adults, the last several decades have seen a major shift toward use by younger consumers (and marketing to them).

Smokeless tobacco consumption in the United States overall has been on the rise. {Bhattacharyya N. Trends in the use of smokeless tobacco in United States, 2000-2010. Laryngoscope 2012;122(10):2175-8; Chang JT, Levy DT, Meza R. Trends and Factors Related to Smokeless Tobacco Use in the United States. Nicotine Tob Res 2016;18(8):1740-8; Lipari RN. Trends in Smokeless Tobacco Use and Initiation: 2002 to 2012.  The CBHSQ Report. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2013.}

Unlike cigarette smoking, which has been going down among adolescents for 20 years, use of smokeless tobacco has held steady at about the same level. {Agaku IT, Vardavas CI, Ayo-Yusuf OA, Alpert HR, Connolly GN. Temporal trends in smokeless tobacco use among US middle and high school students, 2000-2011. JAMA 2013;309(19):1992-4; Miech RA, Johnson LD, O'Malley PM, Bachman JG, Schulenberg JE. Monitoring the Future national survey results on drug use, 1975-2015: Overview, key findings on adolescent drug use: Volume I, Secondary school students.  2016.}

Among high school students (national data), boys are much more likely to use smokeless than girls, but among boys, the prevalence of smokeless use is about the same as cigarette smoking. {Kann L, McManus T, Harris WA, Shanklin SL, Flint KH, Hawkins J, Queen B, Lowry R, Olsen EO, Chyen D, Whittle L, Thornton J, Lim C, Yamakawa Y, Brener N, Zaza S. Youth Risk Behavior Surveillance - United States, 2015. MMWR Surveill Summ 2016;65(6):1-174 }

Adolescents who use smokeless tobacco are at increased risk of progressing to cigarette use. {Severson HH, Forrester KK, Biglan A. Use of smokeless tobacco is a risk factor for cigarette smoking. Nicotine Tob Res 2007;9(12):1331-7}

Previously secret, tobacco industry documents suggest that flavored, lower-priced, lower-nicotine ST "starter products" are used to target novice users who are then "graduated" to established use through a series of higher nicotine products.  {Connolly GN. The marketing of nicotine addiction by one oral snuff manufacturer. Tob Control 1995;4(1):73; Mejia AB, Ling PM. Tobacco industry consumer research on smokeless tobacco users and product development. Am J Public Health 2010;100(1):78-87}

This fact sheet from Campaign for Tobacco Free Kids that covers all this and more:

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