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Smokeless tobacco products sold in Massachusetts from 2003 to 2012: trends and variations in brand availability, nicotine contents and design features
  1. Doris Cullen1,
  2. Lois Keithly1,
  3. Kevin Kane2,
  4. Thomas Land1,
  5. Mark Paskowsky1,
  6. Lili Chen2,
  7. Rashelle Hayes2,
  8. Wenjun Li2
  1. 1Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, Massachusetts, USA
  2. 2Health Statistics and Geography Lab, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  1. Correspondence to Dr Lois Keithly, Bureau of Community Health and Prevention, Massachusetts Department of Public Health, 250 Washington Street, 4th Floor, Boston, MA 02108, USA; Lois.Keithly{at}


Background Sales of smokeless tobacco products have increased in the USA. More than one in eight males in the 12th grade are current users of smokeless tobacco. Surveillance data examining nicotine levels of smokeless tobacco subsequent to 2006 have not been reported in the literature.

Methods Data on nicotine levels and design features (eg, pH, moisture content, leaf cut and flavour) of smokeless tobacco products sold in Massachusetts were obtained from manufacturers between 2003 and 2012. Design features, levels and temporal trends in unionised (free) nicotine and nicotine content of smokeless tobacco products were analysed overall and by manufacturer and product type.

Results The annual total number of moist snuff products increased from 99 in 2003 to 127 in 2012. The annual total number of reported snus products increased from 4 in 2003 to the highest level of 62 in 2011, before decreasing to 26 in 2012. Overall, mean unionised (free) nicotine remained relatively stable (β=0.018 (95% CI −0.014 to 0.050) mg/g dry weight/year) from 2003 to 2012. However, both levels and temporal trends of mean free nicotine varied significantly among manufacturers (p<0.001). Since 2003, the free nicotine content of snus has increased at an overall rate of 0.192 (95% CI 0.138 to 0.246) mg/g dry weight/year, but varied by manufacturer (p<0.001).

Conclusions The number of smokeless tobacco products increased in the Massachusetts market. Further, mean unionised (free) nicotine levels in smokeless tobacco products of several manufacturers continued to rise despite decreasing levels from other manufacturers. The current success in tobacco control is very likely undermined without government surveillance, regulation and widespread public disclosure of nicotine levels in these products.

  • Nicotine
  • Surveillance and monitoring
  • Public policy
  • Non-cigarette tobacco products

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