Flavored and nonflavored smokeless tobacco products: Rate, pattern of use, and effects

Introduction: The initiation and maintenance of tobacco use are influenced by several factors, but of equal and often overlooked importance, until recently, is the palatability of the product. Because of the role that flavor may play in the initiation and maintenance of tobacco use, the Food andDrug Administration has decided to ban the use of flavorings, other than menthol, from cigarettes. To date, little attention has been paid to the impact of flavoring in smokeless tobacco (ST) products. Methods: This study combined the data from 5 previously completed treatment or switching studies to examine the choice of brand flavor in the course of ST use, from initiation to regular use. Results: The analyses revealed that a majority of subjects 'first and current choice of product was flavored, specifically mint or wintergreen, and that a significant number of ST users switched to a flavored brand after already initiating ST use with a regular nonflavored product. In this population,however, flavored products did not appear to lead to greater dependence or increased exposure to nicotine or carcinogens. Conclusions: More treatment seeking ST users began by using mint-flavored product and switched to and were current users of mint-flavored products. It is possible that mint products play a role in the initiation and maintenance of ST use.