Promotion of low-nitrosamine smokeless tobacco (LN-SLT) as a cigarette substitute is one of the most divisive issues in tobacco control. Proponents cite the large number of former male smokers from Sweden who transitioned to the alternate form of tobacco, purportedly reducing the country's tobacco-related morbidity. But, critics have raised a number of valid concerns about the promotion of a 'safer'alternative. The primary concern is the motive of the tobacco industry, whose interest in tobacco substitution conflicts with its dual investments in cigarettes and smokeless tobacco (SLT). Using data from the 1993-1999 Teen Longitudinal California Tobacco Survey, the effects of marketing on the initiation of SLT use will be examined among adolescents (n~2200) who were followed for six years into young adulthood. Longitudinal analyses will assess the main effects of two measures, 1) enumeration of the most advertised SLT brand, and 2) receipt of a promotional item. Exposure to the marketing of the SLT brands is expected to have a modest, but significant effect on the uptake of SLT. A comprehensive review of internal tobacco documents suggests that cigarette manufacturers were concerned about the future of anti-smoking ordinances as early as 1984. Consequently, these manufacturers have expressed great interest in smokeless products, evidenced by R.J. Reynolds Tobacco Company's recent acquisition of Conwood. Using digital images of magazine advertisements of Camel Snus (2008-2010), a content analysis will assess marketing to three groups: 1) non-smoking adolescents, 2) smokers receptive to a situational substitute, 3) smokers receptive to a permanent substitute. The content analysis will utilize either a sample of the magazine advertisements of Camel Snus or the entire population, depending on the size of the population. Size of the population will also determine whether a descriptive or multivariate analysis is employed for the statistical methods. It is hypothesized that the non-smoking adolescents and smokers concerned about indoor restrictions are the intended audience. The marketing of a complementary tobacco product, rather than tobacco replacement, could exacerbate dependence on nicotine and subsequent attempts to abstain from smoking. Using longitudinal data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a latent transition analysis will be conducted among past-year tobacco users (n=12,238). Past-year use of tobacco will include cigarette smoking, cigar smoking and use of smokeless tobacco;nicotine dependence will be assessed by symptoms from a DSM-IV diagnosis. The poly-tobacco users in the NESARC sample are expected to transition to a latent stage characterized by greater nicotine dependence and continued use of multiple forms of tobacco over the course of three years.
The specific aims of this proposal are relevant to public health for two reasons. First, the U.S. Food and Drug Administration will need baseline data in evaluating marketing practices of the tobacco companies, as specified in the Family Smoking Prevention and Tobacco Control Act. Second, leading cigarette manufacturers have recently acquired the major producers of smokeless tobacco, a move which may lead to an influx of resources for marketing the smokeless products.