A longitudinal, naturalistic study of U.S. smokers' trial and adoption of snus

Jessica L. Burris, Amy E. Wahlquist, Anthony J. Alberg, K. Michael Cummings, Kevin M. Gray, Elizabeth Garrett-Mayer, Matthew J. Carpenter

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


To refine public health policy amidst a changing landscape of tobacco products in the United States, it is first necessary to describe fully the nature of smokers' alternative product use. Little research addresses smokers' snus use, and most studies are limited by small samples, cross-sectional designs, and crude outcome measurement. This study sample includes 626 adult US smokers who denied intention to quit in the next month and were randomized to receive free snus during a 6-week sampling period, after which no snus was provided. Participants were then followed for one year. Outcome data were collected via phone. Participants (mean age: 48.7 years) were predominately female, White non-Hispanic. Eighty-four percent reported trial of snus. Eleven percent reported purchase (i.e., adoption). Current use declined from 47.1% at the end of the sampling period to 6.5% at the end of follow-up. Frequency and quantity of snus use among current users was low. Among snus users, 79.3% said it functioned as an alternative to smoking and 58.4% said it provided a means of coping with smoking restrictions; options not mutually exclusive. In logistic regressions, men were more likely to report trial (odds ratio [OR] = 2.33, p < 0.01) and adoption (OR = 1.84, p < 0.05) than women. Baseline expectations about the nature of snus use also predicted snus outcomes (OR = 1.28–1.78, p < 0.05). Smokers showed willingness to try snus, but product interest waned over time. Snus as currently marketed is unlikely to play a prominent role in US tobacco control efforts.

Original languageEnglish
Pages (from-to)82-88
Number of pages7
JournalAddictive Behaviors
StatePublished - Dec 1 2016

Bibliographical note

Funding Information:
This work was supported the National Cancer Institute at the National Institutes of Health (grant numbers R01 CA154992 to M.J.C., K07 CA181351 to J.L.B, and P30 CA138313 to A.J.A.); and the National Center for Advancing Translational Science at the National Institutes of Health (grant number UL1 TR000062 ). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies. The funding agencies had no role in study design, data collection, analysis, or interpretation, manuscript preparation, or the decision to submit this manuscript for publication.

Funding Information:
Alberg, Burris, Carpenter, Garrett-Mayer, Gray, and Wahlquist have no conflict of interest to declare. Cummings has received grant funding from Pfizer, Inc. to study the impact of hospital-based tobacco cessation treatment. Cummings also receives funding as an expert witness in litigation filed against the tobacco industry.

Publisher Copyright:
© 2016 Elsevier Ltd


  • Harm reduction
  • Non-cigarette tobacco product
  • Smokeless tobacco
  • Smoking
  • Snus
  • Tobacco industry

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Clinical Psychology
  • Toxicology
  • Psychiatry and Mental health


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