title: Characteristics of "American Snus" and Swedish Snus Products for Sale in Massachusetts, USA.
abstract: Snus may present lower health risks than cigarettes, but its harm reduction potential may be undermined if used dually with cigarettes. The likelihood of exclusive snus use compared with dual use may depend in part on the capacity of snus to deliver nicotine in doses that are satisfactory to smokers. We examined characteristics of "American snus" products, including nicotine levels, and compared to snus products that are more typical of Sweden.
  
  
  
  Tobacco industry reports for snus products submitted to the Massachusetts Department of Public Health for the year 2014 were used to assess moisture (%), pH, total nicotine, and unionized (free) nicotine (both mg/g and percent of total). A total of 14 ("American") snus products made by American manufacturers Philip Morris USA (n = 6), R.J. Reynolds Tobacco Company (n = 6), and US Smokeless Tobacco Company (n = 2), were compared with Swedish-style ("Swedish") snus products (n = 10) made by Swedish Match North America.
  
  
  
  Compared with Swedish snus, American snus brands contained significantly lower concentrations of unionized nicotine (median: 0.52 mg/g vs. 6.52 mg/g; p < .001) and proportion of unionized nicotine (median: 3.17% vs. 81.8%; p < .001). American snus brands also had significantly lower pH (median: 6.54 vs. 8.68; p < .001) and moisture (median: 30.3% vs. 53.4%; p < .001).
  
  
  
  Swedish-made snus has higher unionized nicotine, measured by concentration and proportion of total nicotine, compared with snus products made by American manufacturers. These findings suggest that American snus products have lower addiction potential than Swedish snus, and may be more likely to be used dually with cigarettes than as a sole source of nicotine.
  
  
  
  American snus products contain significantly lower unionized nicotine, lower pH, and lower moisture, compared with Swedish snus products. Snus addiction potential and patterns of usage, including co-use with cigarettes, may differ between American and Swedish snus products due to differences in snus product characteristics.
authors.affiliation: Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Seidenberg
authors.affiliation: Office of the Director, School of Oral Health Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa.|Center for Global Tobacco Control, Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA.
authors.forename: Olalekan A
authors.initials: OA
authors.lastname: Ayo-Yusuf
authors.affiliation: Center for Global Tobacco Control, Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA.
authors.forename: Vaughan W
authors.initials: VW
authors.lastname: Rees
mesh_terms: D003132:Commerce; D006801:Humans; D008404:Massachusetts; D009538:Nicotine / Q000032:analysis*; D013548:Sweden; D019460:Tobacco Industry / Q000706:statistics & numerical data*; D014029:Tobacco Use Disorder / Q000453:epidemiology*; D014030:Tobacco, Smokeless / Q000145:classification / Q000191:economics / Q000706:statistics & numerical data* / Q000600:supply & distribution*
chemical_list: D009538:Nicotine