Perceived Flavored Smokeless Tobacco Ease-of-use and Youth Susceptibility

Abstract

Objectives Beliefs that flavored smokeless tobacco (ST) is more pleasant, less potent, or otherwise easier to use could contribute to youth initiation. We evaluated associations between perceived ease-of-use of flavored ST (moist snuff and chewing tobacco) and ST initiation susceptibility in a representative sample of US youth. Methods Among 7,718 tobacco never-users in the Population Assessment of Tobacco and Health study (age: 12–17; collected: 2013–2014), we compared 4 ST susceptibility items (curiosity, expectation, willingness to try, and a composite) according to whether participants reported flavored ST to be “easier to use” than unflavored ST. We calculated marginal prevalences of ST susceptibility and odds ratios adjusted for socio-demographic characteristics, tobacco advertisement receptivity, warning label exposure, and sensation seeking. Results ST susceptibility was greatest among tobacco never-users who perceived flavored ST as easier to use. Adjusted odds of potential ST susceptibility (≥1 item) were 1.5-fold higher (95% confidence interval: 1.2, 1.8) among adolescents who perceived flavored ST as easier to use than unflavored ST. Conclusions ST flavors could contribute to perceptions that facilitate youth initiation. Alternatively, youth susceptible to ST use may perceive flavored varieties differently. Prospective studies are warranted to strengthen causal evidence and measure ST initiation according to perceived ease-of-use.

Electronic cigarette and moist snuff product characteristics independently associated with youth tobacco product perceptions

“…Tobacco product curiosity correlates with product susceptibility and use among youth 14,28 . Youth who perceived flavored smokeless tobacco and flavored e-cigarettes as easier to use than unflavored options were more likely to be susceptible to smokeless tobacco use 17 and to initiate future e-cigarette use 16 , respectively. The present discrete choice findings demonstrate that multiple independent product-related factors are associated with constructs shown to predict future tobacco use.…”

“…In each experiment, for each pair of product composites, participants were asked which product 'are you more curious about', which 'is more dangerous to health', which 'would be easier to use', and which 'would give a bigger 'buzz' or 'head rush''. These outcomes were chosen because of previous work showing associations between tobacco use and/or susceptibility with youth-reported curiosity 14 , perceived danger 15 , and perceived ease-of-use 16,17 . The outcome 'buzz' was introduced to measure perceived physiological effects or potency.…”

Smokeless Tobacco Use and Prevalence of Cardiovascular Disease Among Males in the Population Assessment of Tobacco and Health (PATH) Study, Waves 1–4

“…Five CVD risk factors were assessed by asking respondents in the Wave 4 PATH Study interview to self-report having a history of: ( Food and Administration, 2018 ) high blood pressure, ( Chang et al, 2016 ) high cholesterol, ( Cornelius et al, 2020 ) diabetes, ( Levy et al, 2018 ) family history of premature cardiac disease, and ( Chaffee et al, 2017 ) obesity (body mass index [BMI] ≥ 35). Adult participants were asked, ‘Has a doctor or other health professional ever told you that you had any of the following conditions?’ Responses included high blood pressure, high cholesterol, and diabetes (including sugar diabetes, high blood sugar, or borderline diabetes).…”

“…By contrast, cigarette smoking prevalence has been falling since the mid-1960s although the prevalence of current cigarette smoking is still 4-fold greater compared to SLT ( Cornelius et al, 2020 ). Some public health researchers have attributed the differential trends in SLT and cigarette prevalence to increasing restrictions on indoor smoking, increased availability of snus products in the U.S., and the marketing of appealing flavored SLT products ( Levy et al, 2018 , Chaffee et al, 2017 ).…”

The greater use of flavoured snus among ever-smokers versus never-smokers in Norway

“…Proponents claim that flavoured products mask unpleasant taste and make products more palatable. They refer to literature suggesting that flavoured smokeless tobacco (ST) products appeal to youth [16][17][18][19][20][21][22] and may increase curiosity and willingness to try snus [23].…”