title: Snus use and rejection in the USA.
abstract: To determine whether snus might become a strategy for reducing the harm associated with cigarette smoking in the USA as appears to be the case in Sweden, we examined receptivity to snus use in two cities with the greatest exposure to the major brands.
  
  
  
  A dual frame, telephone survey and a brief mail survey were conducted in 2011 and 2012 in Indianapolis, Indiana and Dallas/Fort Worth Texas. Over 5000 adults completed surveys. Trial, ever use, current use and reasons for using or quitting snus after trial were measured.
  
  
  
  Among male smokers, 29.9% had ever tried snus (CI 22.7 to 38.1) and 4.2% were current users (CI 1.6 to 10.7). Among female smokers, 8.5% ever tried snus (CI 4.4 to 15.7) and current use was unknown. Current use was virtually absent among former smokers and never smokers. A major predictor of any level of snus use was current use of conventional smokeless tobacco. Those who tried and gave up snus cited curiosity (41.3%) and the fact that it was available at low or no cost (30%) as reasons for trial; reasons for not continuing included preferring another form of tobacco (75.1%) and disliking the mouth feel (34.6%). Almost all current snus users indicated that they were trying to cut down on cigarettes, but few (3.9%) were using it to quit smoking entirely.
  
  
  
  The low rate of adoption of snus suggests that neither the hopes nor the fears surrounding this new product are likely to be realised in the USA with the current marketing patterns.
authors.affiliation: Center for Survey Research, University of Massachusetts Boston, Boston, Massachusetts, USA.
authors.forename: Lois
authors.initials: L
authors.lastname: Biener
authors.affiliation: Center for Survey Research, University of Massachusetts Boston, Boston, Massachusetts, USA.
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Roman
authors.affiliation: Center for Survey Research, University of Massachusetts Boston, Boston, Massachusetts, USA.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Mc Inerney
authors.affiliation: Center for Survey Research, University of Massachusetts Boston, Boston, Massachusetts, USA.
authors.forename: Dragana
authors.initials: D
authors.lastname: Bolcic-Jankovic
authors.affiliation: Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Dororthy K
authors.initials: DK
authors.lastname: Hatsukami
authors.affiliation: Department of Kinesiology & Health Education, University of Texas at Austin, Austin, Texas, USA.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Loukas
authors.affiliation: Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: O'Connor
authors.affiliation: Department of Oral Biology, Indiana University School of Dentistry, Indianapolis, Indiana, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Romito
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000073865:Cigarette Smoking / Q000453:epidemiology*; D005260:Female; D040261:Harm Reduction; D006801:Humans; D007196:Indiana / Q000453:epidemiology; D008297:Male; D040541:Marketing / Q000379:methods; D008875:Middle Aged; D016540:Smoking Cessation / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013781:Texas / Q000453:epidemiology; D062789:Tobacco Products; D064424:Tobacco Use / Q000453:epidemiology*; D014030:Tobacco, Smokeless / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Harm Reduction; Non-cigarette tobacco products; Public policy