title: A longitudinal, naturalistic study of U.S. smokers' trial and adoption of snus.
abstract: To refine public health policy amidst a changing landscape of tobacco products in the United States, it is first necessary to describe fully the nature of smokers' alternative product use. Little research addresses smokers' snus use, and most studies are limited by small samples, cross-sectional designs, and crude outcome measurement. This study sample includes 626 adult US smokers who denied intention to quit in the next month and were randomized to receive free snus during a 6-week sampling period, after which no snus was provided. Participants were then followed for one year. Outcome data were collected via phone. Participants (mean age: 48.7years) were predominately female, White non-Hispanic. Eighty-four percent reported trial of snus. Eleven percent reported purchase (i.e., adoption). Current use declined from 47.1% at the end of the sampling period to 6.5% at the end of follow-up. Frequency and quantity of snus use among current users was low. Among snus users, 79.3% said it functioned as an alternative to smoking and 58.4% said it provided a means of coping with smoking restrictions; options not mutually exclusive. In logistic regressions, men were more likely to report trial (odds ratio [OR]=2.33, p<0.01) and adoption (OR=1.84, p<0.05) than women. Baseline expectations about the nature of snus use also predicted snus outcomes (OR=1.28-1.78, p<0.05). Smokers showed willingness to try snus, but product interest waned over time. Snus as currently marketed is unlikely to play a prominent role in US tobacco control efforts.
authors.affiliation: University of Kentucky, Department of Psychology and Markey Cancer Center, 206 Combs Cancer Research Building, Lexington, KY 40536, USA. Electronic address: burris.jessica@gmail.com.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Burris
authors.affiliation: Medical University of South Carolina, Department of Public Health Sciences and Hollings Cancer Center, 135 Cannon St., Room 302E, Charleston, SC 29425, USA. Electronic address: herrin@musc.edu.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Wahlquist
authors.affiliation: Medical University of South Carolina, Department of Public Health Sciences and Hollings Cancer Center, 86 Jonathan Lucas St., MSC 955, Charleston, SC 29425, USA. Electronic address: alberg@musc.edu.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Alberg
authors.affiliation: Medical University of South Carolina, Department of Public Health Sciences and Hollings Cancer Center, 86 Jonathan Lucas St., MSC 955, Charleston, SC 29425, USA; Medical University of South Carolina, Department of Psychiatry and Behavioral Science and Hollings Cancer Center, 86 Jonathan Lucas St., MSC 955, Charleston, SC 29425, USA. Electronic address: cummingk@musc.edu.
authors.forename: K Michael
authors.initials: KM
authors.lastname: Cummings
authors.affiliation: Medical University of South Carolina, Department of Psychiatry and Behavioral Science, 125 Doughty St., Charleston, SC 29425, USA. Electronic address: graykm@musc.edu.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Gray
authors.affiliation: Medical University of South Carolina, Department of Public Health Sciences and Hollings Cancer Center, 86 Jonathan Lucas St., MSC 955, Charleston, SC 29425, USA. Electronic address: garrettm@musc.edu.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Garrett-Mayer
authors.affiliation: Medical University of South Carolina, Department of Psychiatry and Behavioral Science and Hollings Cancer Center, 86 Jonathan Lucas St., MSC 955, Charleston, SC 29425, USA. Electronic address: carpente@musc.edu.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Carpenter
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017678:Sex Distribution; D000074285:Smokers / Q000706:statistics & numerical data*; D014030:Tobacco, Smokeless / Q000706:statistics & numerical data*; D014481:United States
keywords: Harm reduction; Non-cigarette tobacco product; Smokeless tobacco; Smoking; Snus; Tobacco industry