Exposure and response to current text-only smokeless tobacco health warnings among smokeless tobacco users aged ≥18years, United States, 2012-2013

Prev Med. 2016 Jun;87:200-206. doi: 10.1016/j.ypmed.2016.02.014. Epub 2016 Feb 15.


Introduction: We assessed US adult smokeless tobacco (SLT) users' exposure and response to SLT health warnings, which are currently in text-only format, covering 30% of the two primary surfaces of SLT containers and 20% of advertisements.

Methods: Data were from the 2012-2013 National Adult Tobacco Survey. Past 30-day exposure to SLT health warnings among past 30-day SLT users (n=1626) was a self-report of seeing warnings on SLT packages: "Very often," "Often," or "Sometimes" (versus "Rarely" or "Never"). We measured the association between SLT health warning exposure and perceptions of SLT harmfulness and addictiveness using logistic regression.

Results: Of past 30-day SLT users, 77.5% reported exposure to SLT health warnings, with lower prevalence reported among females and users of novel SLT products (snus/dissolvable tobacco). Furthermore, exposure reduced linearly with reducing education and annual household income (p<0.01). Among exposed past 30-day SLT users, 73.9% reported thinking about the health risks of SLT, while 17.1% reported stopping SLT use on ≥1 occasion within the past 30days. Exposure to SLT warnings was associated with perceived SLT harmfulness (AOR=2.16; 95% CI=1.15-4.04), but not with perceived SLT addictiveness.

Conclusion: Socioeconomic disparities found in exposure and response to SLT health warnings can be addressed through implementation of large pictorial warnings.

Keywords: Chewing tobacco; Health policy; Smokeless tobacco; Snuff; Snus; Tobacco control; Warning labels.

MeSH terms

  • Adult
  • Aged
  • Behavior, Addictive / psychology*
  • Female
  • Harm Reduction
  • Humans
  • Male
  • Middle Aged
  • Product Labeling / legislation & jurisprudence*
  • Risk Factors
  • Self Report
  • Surveys and Questionnaires
  • Tobacco Use Disorder / epidemiology*
  • Tobacco, Smokeless* / statistics & numerical data