New data shows spike in smokeless tobacco sales

The number of smokeless tobacco products sold in Massachusetts is soaring, as are the levels of nicotine packed into many of them, according to a new analysis from UMass Medical School and the Massachusetts Department of Public Health (DPH).

"Nationwide, cigarette smoking control has been very successful and we have experienced a steady decline, but that success is being offset by the increased use of smokeless tobacco products, especially by youth," said UMMS statistical scientist Wenjun Li, PhD. Dr. Li, associate professor of medicine in the Division of Preventive and Behavioral Medicine, co-authored the paper with colleagues from the DPH.

Published in the journal Tobacco Control, the study examines ten years of product data (from 2003 to 2012) that Massachusetts law requires tobacco manufacturers provide to the DPH. Notable findings include a nearly 30 percent increase in the number of moist snuff products and a nearly sixfold increase in the number of snus products (see sidebar) sold in Massachusetts; these increases correlate with rising use among high school students.

Nationwide, more than one in eight males in the 12th grade uses smokeless tobacco. In Massachusetts, use among high school students has more than doubled since 2001. A wide variety of smokeless tobacco products on the market include newer inventions like dissolvable lozenges, snus and moist snuff, many of them flavored and colorfully packaged to appeal to youth, along with more traditional forms used by adults including chewing tobacco and dry snuff.

Researchers were particularly interested in unionized, or free nicotine, the form that is most easily absorbed in the mouth. The amount of free nicotine and how it is delivered in both smokable and smokeless tobacco products is associated with a product's addictive potential—and is determined by modifiable design features as well as the amount of nicotine contained naturally in the tobacco leaf.

They found that while nicotine levels varied, free nicotine increased for several manufacturers. Li and DPH lead author and research analyst Doris Cullen,MA, believe that these as-yet inexplicable variations in nicotine content support the argument that free nicotine levels are controlled in the manufacturing process, and suggests that manufacturers are manipulating products' addictive potential.

"The current success in tobacco control is very likely undermined without government surveillance, regulation and widespread public disclosure of nicotine levels in these products," said Cullen.

"Smokeless products are easier for youth to access and use than cigarettes, and harder for parents to monitor," said Li. "Even though they have less nicotine than cigarettes, more of that nicotine is readily absorbed, making snus and moist snuff a gateway to nicotine addiction and, possibly, future smoking."

While the study did not focus on smokeless tobacco marketing, he noted that packaging products to look like candy also suggests that the tobacco industry is specifically targeting youth.

"This study supports that the tobacco industry's manipulation of product design extends to smokeless products," said corresponding author Lois Keithly, PhD, director of the DPH's Massachusetts Tobacco Cessation and Prevention Program. "Considering the potential risk for nicotine addiction associated with the use of smokeless tobacco products, and the aggressive marketing of these products, it is critical to continue and expand surveillance of smokeless products at the state and national levels."

What is smokeless tobacco and how does it affect health?

Smokeless tobacco is tobacco that is not burned. It comes in many forms, all containing addictive nicotine:

• Chewing tobacco is placed between the cheek and gums
• Dried snuff can be sniffed
• Moist snuff is used like chewing tobacco
• Snus is a small pouch of moist snuff
• Dissolvable products include lozenges, orbs, sticks and strips

Known health hazards of smokeless tobacco products include:

• Tooth decay and gum disease
• Leathery white patches and red sores in the mouth that can turn into oral cancer
• At least 28 cancer-causing chemicals related to esophageal, oral and pancreatic cancers

Scientists are studying whether smokeless tobacco use contributes to heart disease and stroke.

Source: NIH factsheet on smokeless tobacco and Fact sheet at BeTobaccoFree.gov