title: The Effect of Tobacco Control Policies on US Smokeless Tobacco Use: A Structured Review.
abstract: BACKGROUND
  Tobacco use has shifted increasingly from cigarettes to other products. While the focus has been mostly on cigarette-oriented policies, it is important to gauge the effects of policies targeting other products. We review and critique the literature on how policies affect smokeless tobacco (ST).
  
  
  METHODS
  We conducted a search of the literature on tobacco control policies as they relate to ST use, focusing on tobacco taxes, smoke-free air laws, media campaigns, advertising restrictions, health warnings, cessation treatment policies, and youth access policies. Findings from 78 total studies are summarized.
  
  
  RESULTS
  ST taxes, media campaigns, health warnings, and cessation treatment policies were found to be effective tools in reducing ST use. Evidence on the effects of current youth access policies is less strong. Studies have not yet been conducted on marketing or product content restrictions, but the literature indicates that product marketing, through advertising, packaging, flavorings, and extension of cigarette brands, plays an important role in ST use.
  
  
  CONCLUSIONS
  Although the evidence base is less established for ST policies than for cigarette policies, the existing literature indicates ST use responds to tobacco control policies. Policies should be structured in a way that aims to reduce all tobacco use while at the same time increasing the likelihood that continuing tobacco users use the least risky products.
  
  
  CONCLUSIONS
  Studies find that policies targeting smoking and policies targeting smokeless products affect smokeless use, but studies are needed to examine the effect of policies on the transitions between cigarette and smokeless use.
authors: Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC.
authors: David T
authors: DT
authors: Levy
authors: Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC.
authors: Darren
authors: D
authors: Mays
authors: Research Programs Department, ClearWay Minnesota, Minneapolis, MN.
authors: Raymond G
authors: RG
authors: Boyle
authors: Department of Health Management and Policy, University of Michigan, Ann Arbor, MI.
authors: Jamie
authors: J
authors: Tam
authors: Department of Economics, University of Illinois at Chicago, Chicago, IL.
authors: Frank J
authors: FJ
authors: Chaloupka
mesh_terms: D006801:Humans; D011640:Public Policy; D000073869:Tobacco Smoking / Q000331:legislation & jurisprudence*; D064424:Tobacco Use / Q000331:legislation & jurisprudence*; D014030:Tobacco, Smokeless / Q000706:statistics & numerical data*