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MRTP claim authorisation and General Snus sales in the USA: evidence from a difference-in-differences model
  1. Alex C Liber1,
  2. Andrew B Seidenberg2,
  3. Michael F Pesko3
  1. 1Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
  2. 2Schroeder Institute, Truth Initiative, Washington, DC, USA
  3. 3Public Health, Georgia State University Andrew Young School of Policy Studies, Atlanta, GA, USA
  1. Correspondence to Dr Alex C Liber, Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA; alex.liber{at}


Background The 2009 Tobacco Control Act granted the US Food and Drug Administration (FDA) regulatory authority over tobacco products, including the ability to authorise modified-risk tobacco product (MRTP) claims. In October 2019, the FDA authorised the first-ever MRTP claim for General Snus, which allowed the product to be marketed as reduced risk (relative to cigarettes). MRTP authorisation may increase otherwise low rates of snus use in the USA (<0.5% for children and adults).

Methods Using 2017–2021 Nielsen sales data from 19 US states, we conducted a difference-in-differences analysis to determine whether logged unit sales of General Snus were affected by the MRTP authorisation, compared with (1) sales of other snus brands and (2) sales of non-snus smokeless products; we also examined (3) if sales of non-General Snus brands were affected by General Snus’s MRTP authorisation, compared with sales of non-snus smokeless tobacco products.

Results Although sales declined in absolute terms, sales of General Snus relative to other snus brands were unchanged after MRTP authorisation (−9.0%, 95% CI −19.6% to 1.60%, p=0.098). However, compared with non-snus smokeless brand sales, sales of General Snus (+14.7%, 95% CI 5.23% to 24.2%, p=0.002) rose after MRTP authorisation. Compared with non-snus smokeless products, sales of non-General Snus brands also rose after MRTP authorisation (+23.7%, 95% CI 9.5% to 38.0%, p=0.001).

Conclusions Although only General Snus received MRTP authorisation, this designation appears to have slowed declines for the entire snus category. This suggests consumers may make determinations regarding product risk to a product class rather than individual products.

  • Non-cigarette tobacco products
  • Public policy
  • Harm Reduction
  • Advertising and Promotion

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  • Contributors ACL performed the analysis, wrote the first draft and critically revised the manuscript; ABS conceptualised the study, helped write the first draft and revised the manuscript; MFP assisted with modelling and critically revised the manuscript.

  • Funding Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health (under award number R01DA045016) and by a pilot project award from the Center for the Assessment of Tobacco Regulations, which is funded by the US National Cancer Institute (NCI) and the US Food and Drug Administration (FDA) (grant U54CA229974). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.The content of this article does not necessarily reflect the official opinion or policy of the NCI, the National Institutes of Health, the FDA or the Truth Initiative.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.