PROJECT ABSTRACT
For decades, the tobacco industry has manipulated moist snuff (i.e., dip) to become as appealing and addictive
as possible. These manipulations have resulted in moist snuff accounting for 90% of the smokeless tobacco
(SLT) market share in the United States and have slowed progress in reducing the prevalence of SLT use. The
public health burden of the tobacco industry’s actions has not been equitable; males living in Appalachian regions
of the United States continue to use SLT at high rates, leading to regional inequities in cardiovascular disease,
cancer, and poor oral health. The goal of this research is to identify local, state, and/or federal regulations for
moist snuff that reduce its addiction potential. This research will evaluate two features of moist snuff that are key
targets of manipulation from the tobacco industry and drivers of its addiction potential: length of tobacco cut (long
vs. fine) and nicotine form (low vs. high levels of nicotine in the free-base form). Finer tobacco cuts and higher
levels of free-base nicotine (FBN) result in faster, greater nicotine delivery. Building on the PI’s areas of expertise
and providing crucially-needed training, evaluations of tobacco cut and nicotine form will be done
epidemiologically, using analytical chemistry, and using experimental human laboratory methods. For the
epidemiological evaluation, we will complete a secondary data analysis of recent population-based cohorts to
evaluate associations between level of SLT dependence and product characteristics (i.e., cut, flavor, brand) of
moist snuff used by adolescents and adults in Appalachian Ohio. For the analytical chemistry evaluation, we will
quantitate the levels of total nicotine and FBN present in moist snuff products used by adolescent and adult
participants in our Appalachian Ohio cohorts; these characteristics of products will be compared according to
level of SLT dependence of the user as well as other product features (e.g., tobacco cut and flavor). For the
human laboratory evaluation, we will use a 2x2 within-subjects cross-over design to test how moist snuff use
(amount and duration), nicotine delivery, and appeal differ according to variations in cut (long vs. fine) and level
of FBN (low vs. high). We will also evaluate whether the association between style of moist snuff and outcomes
varies according to level of SLT dependence. Participants will be adults who live in Appalachian Ohio and are
daily moist snuff users. Altogether, this research will provide a foundation for understanding the characteristics
of moist snuff used in Appalachia—where the burden of SLT use remains stubbornly high—and the effects that
regulations on tobacco cut and nicotine form could have on reducing health inequities in this region. The conduct
of this research and implementation of the proposed training plan will also provide the PI, a promising scientist
with strong foundations in epidemiology and biostatistics, Appalachian health disparities research, and other
areas of tobacco regulatory science with needed training in addiction research, tobacco product evaluation, and
human laboratory experimental designs.