Use of Traditional Smokeless, Snus, and Dissolvable Tobacco Among U.S. Youth

Published:November 03, 2022DOI:


      Snus, dissolvable, and traditional smokeless tobacco product use is often amalgamated in youth epidemiologic research despite differences across these products. Prevalence, trends, and correlates of U.S. youth use across different classes of oral tobacco products are unknown.


      Using 2011–2020 National Youth Tobacco Survey (N=193,933) data, the authors tested for cross-year linear and quadratic trends in the weighted prevalence of ever and current use of traditional smokeless tobacco, snus, and dissolvable tobacco. Multivariable logistic regressions estimated the demographic and tobacco use factors associated with the use of different oral tobacco products in 2020. Analyses were conducted in 2022.


      During 2011–2020, there were declines in the prevalence of ever use of traditional smokeless tobacco (11.0% to 5.6%; linear trend, p<0.0001) and snus (5.2% to 2.4%; p<0.0001) but no change in ever dissolvable tobacco use (0.8%–1.2%). In 2020, an estimated 1,546,000 U.S. youth ever used traditional smokeless tobacco (7.7% high school, 3.0% middle school), 662,000 ever used snus (high school:3.5%, middle school:1.0%), and 326,000 ever used dissolvables (high school:1.5%, middle school:0.8%). In 2020, females and non-Hispanic Blacks and Hispanics had lower smokeless or snus ever use odds than males and non-Hispanic Whites, respectively, whereas sexual minorities (than heterosexuals) or those speaking a language other than English at home were more likely to report ever use of dissolvable tobacco. Flavored tobacco use was common, particularly for dissolvable current users (72.8% used any flavor).


      Differences in the epidemiology of oral tobacco use across product types among U.S. youth suggest that oral tobacco products should be disaggregated in future research and policy strategies.
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        • Wang Y
        • Duan Z
        • Emery SL
        • Kim Y
        • Chaloupka FJ
        • Huang J.
        The association between E-cigarette price and TV advertising and the sales of smokeless tobacco products in the USA.
        Int J Environ Res Public Health. 2021; 18: 6795
        • Southwell BG
        • Kim AE
        • Tessman GK
        • et al.
        The marketing of dissolvable tobacco: social science and public policy research needs.
        Am J Health Promot. 2012; 26: 331-332
      1. Smokeless tobacco: products and marketing.
        Centers for Disease Control and Prevention, 2021 (Updated May 14, Accessed August 14, 2022)
        • Campaign for Tobacco-Free Kids
        Smokeless tobacco in the United States.
        Campaign for Tobacco-Free Kids, Washington, DC2021 (PublishedAccessed August 14, 2022)
        • Delnevo CD
        • Hrywna M
        • Miller Lo EJ
        • Wackowski OA
        Examining market trends in smokeless tobacco sales in the United States: 2011–2019.
        Nicotine Tob Res. 2021; 23: 1420-1424
        • Choi K
        • Fabian L
        • Mottey N
        • Corbett A
        • Forster J.
        Young adults’ favorable perceptions of snus, dissolvable tobacco products, and electronic cigarettes: findings from a focus group study.
        Am J Public Health. 2012; 102: 2088-2093
      2. Smokeless tobacco: health effects.
        Centers for Disease Control and Prevention, 2020 (Updated August 13Accessed August 14, 2022)
        • Stepanov I
        • Jensen J
        • Hatsukami D
        • Hecht SSJN
        T. New and traditional smokeless tobacco: comparison of toxicant and carcinogen levels.
        Nicotine Tob Res. 2008; 10: 1773-1782
        • Hatsukami DK
        • Lemmonds C
        • Tomar SL.
        Smokeless tobacco use: harm reduction or induction approach?.
        Prev Med. 2004; 38: 309-317
        • Savitz DA
        • Meyer RE
        • Tanzer JM
        • Mirvish SS
        • Lewin F.
        Public health implications of smokeless tobacco use as a harm reduction strategy.
        Am J Public Health. 2006; 96: 1934-1939
        • Chang JT
        • Vivar JC
        • Tam J
        • et al.
        Biomarkers of potential harm among adult cigarette and smokeless tobacco users in the PATH Study Wave 1 (2013–2014): a cross-sectional analysis.
        Cancer Epidemiol Biomarkers Prev. 2021; 30: 1320-1327
        • Arrazola RA
        • Singh T
        • Corey CG
        • et al.
        Tobacco use among middle and high school students–United States, 2011-2014.
        MMWR Morb Mortal Wkly Rep. 2015; 64: 381-385
        • Gentzke AS
        • Wang TW
        • Jamal A
        • et al.
        Tobacco product use among middle and high school students–United States, 2020.
        MMWR Morb Mortal Wkly Rep. 2020; 69: 1881-1888
        • Agaku IT
        • Vardavas CI
        • Ayo-Yusuf OA
        • Alpert HR
        • Connolly GN.
        Temporal trends in smokeless tobacco use among U.S. middle and high school students, 2000–2011.
        JAMA. 2013; 309: 1992-1994
      3. FDA grants first-ever modified risk orders to eight smokeless tobacco products.
        The Food and Drug Administration, 2019 (Updated October 22, Accessed August 14, 2022)
        • The Truth Initiatives
        Smokeless tobacco: facts, stats, and regulations.
        The Truth Initiatives, Washington, DC2021 (Published September 24, Accessed August 14, 2022)
        • Craver R.
        Reynolds Vapor shifts dissolvable nicotine products to Velo brand.
        Winston Salem Journal. July 10, 2020; (Accessed August 14, 2022)
      4. Rogue nicotine on demand, convenience and satisfaction. Now on demand.,%2Dfree%20and%20stain%2Dfree. Updated January 1, 2022. Accessed April 25, 2022.

        • Unger JB
        • Barker J
        • Cruz TB
        • Leventhal AM
        • Pentz MA.
        Lucy-novel flavored nicotine gum, lozenges, and pouches: are they misleading consumers?.
        Subst Use Misuse. 2022; 57: 1328-1331
        • Czaplicki L
        • Patel M
        • Rahman B
        • Yoon S
        • Schillo B
        • Rose SW.
        Oral nicotine marketing claims in direct-mail advertising.
        Tob Control. 2022; 31: 663-666
        • Hammond H.
        Nicotine pouches: tobacco’s fast-growing subcategory.
        CSP. October 16, 2020; (Accessed August 14, 2022)
        • Marynak KL
        • Wang X
        • Borowiecki M
        • et al.
        Nicotine pouch unit sales in the U.S., 2016–2020.
        JAMA. 2021; 326: 566-568
        • Gentzke AS
        • Wang TW
        • Cornelius M
        • et al.
        Tobacco product use and associated factors among middle and high school students–national youth tobacco survey, United States, 2021.
        MMWR Surveill Summ. 2022; 71: 1-29
        • Gomez Y
        • Creamer M
        • Trivers KF
        • et al.
        Patterns of tobacco use and nicotine dependence among youth, United States, 2017-2018.
        Prev Med. 2020; 141106284
        • Ali M
        • Gray TR
        • Martinez DJ
        • Curry LE
        • Horn KA.
        Risk profiles of youth single, dual, and poly tobacco users.
        Nicotine Tob Res. 2016; 18: 1614-1621
        • Reynolds American Inc
        Reynolds submits first VELO dissolvable nicotine lozenge premarket tobacco product applications.
        PR Newswire. August 24, 2020; (Accessed February 22, 2022)
      5. National Youth Tobacco Survey (NYTS). Centers for Disease Control and Prevention. Updated March 14, 2022. Accessed April 26, 2022.

      6. Historical NYTS data and documentation.
        Centers for Disease Control and Prevention, 2022 (Updated March 14Accessed April 26, 2022)
        • Wang TW
        • Gentzke AS
        • Neff LJ
        • et al.
        Characteristics of e-cigarette use behaviors among U.S. youth, 2020.
        JAMA Netw Open. 2021; 4e2111336
      7. National Cancer Institute, Joinpoint Trend Analysis Software, Surveillance Research Program. Updated April 13, 2022. Accessed March 30, 2022.

        • Rubin DB.
        Multiple Imputation for Nonresponse in Surveys.
        John Wiley & Sons, Hoboken, NJ2004
        • Gentzke AS
        • Creamer M
        • Cullen KA
        • et al.
        Vital signs: tobacco product use among middle and high school students–United States, 2011-2018.
        MMWR Morb Mortal Wkly Rep. 2019; 68: 157-164
        • Goniewicz ML
        • Smith DM
        • Edwards KC
        • et al.
        Comparison of nicotine and toxicant exposure in users of electronic cigarettes and combustible cigarettes.
        JAMA Netw Open. 2018; 1e185937
        • Dai H
        • Khan AS.
        A longitudinal study of exposure to tobacco-related toxicants and subsequent respiratory symptoms among U.S. adults with varying E-cigarette use status.
        Nicotine Tob Res. 2020; 22: S61-S69
        • Azagba S
        • Shan L
        • Latham K.
        Adolescent dual use classification and its association with nicotine dependence and quit intentions.
        J Adolesc Health. 2019; 65: 195-201
        • Brener ND
        • Billy JO
        • Grady WR.
        Assessment of factors affecting the validity of self-reported health-risk behavior among adolescents: evidence from the scientific literature.
        J Adolesc Health. 2003; 33: 436-457
        • The Truth Initiatives
        What is Zyn and what are oral nicotine pouches?.
        The Truth Initiatives, Washington, DC2021 (Published February 9Accessed August 14, 2022)