Susceptibility to snus and dissolvable tobacco products among u.s. adolescents

Background: Declining cigarette use and increasing smoke-free laws have led tobacco companies to promote new smokeless products such as snus and dissolvable tobacco. Marketing these products with top-selling cigarette brands may increase their popularity with youth and promote dual use of products that share the same brand name. This longitudinal study examined susceptibility, product awareness, use, and risk perceptions among adolescents. Methods: Adolescents ages 13-16 (n=1,488) were surveyed at baseline (summer/fall 2011) and at follow-up (mean=10.4 months, SD=1.4). Respondents were part of a nationally representative web panel managed by Knowledge Networks. Susceptibility, the primary outcome, was defined as the lack of a firm commitment to avoid product use. Logistic regressions modeled susceptibility as a function of baseline receptivity to cigarette marketing, susceptibility to smoking and sensation seeking, and both individual and household demographics. Results: Among all respondents (n=1,488), awareness was 31% for snus and 9% for dissolvables. Among never users (n=1,461), susceptibility to use was 15% for snus and 15% for dissolvables. Approximately 10% of adolescents believed these products were less harmful or addictive than cigarettes. For both products, risk factors for susceptibility were marketing receptivity, sensation seeking, poor school achievement, susceptibility to smoking, ever smoking, and being male. In both models, being African American was protective. Conclusion: Adolescents are susceptible to using new smokeless tobacco products, which may facilitate or maintain smoking. Steps should be taken to reduce the visibility of marketing for all tobacco products and to educate adolescents about industry marketing tactics and product harms.