January 1999

Grant Results

SUMMARY

The Michigan Public Health Institute, Okemos, Mich., organized a media briefing at the National Press Club in Washington, D.C., on April 26, 1995 to enhance dissemination of research findings published in the Spring 1995 issue of Tobacco Control related to nicotine manipulation in moist snuff products.

Tobacco Control is an international peer-reviewed scientific journal published quarterly by the British Medical Association.

Key Results

  • Hosted by the American Medical Association, which assisted in its planning and coordination, the briefing highlighted four papers on moist snuff that deal with the "graduation strategy," i.e., longer-term users seeking brands with higher pH and un-ionized nicotine levels, which may be exploited by manufacturers of moist snuff to create and sustain nicotine addiction among youth.
    • Two papers showed the wide variation in pH and levels of un-ionized nicotine in brands of moist snuff, and how different brands with different levels are sought out by novice and veteran users.
    • A third paper reviewed survey data on smokeless tobacco use among those aged 12–21 years, and noted the same "graduation strategy" among this population that was discussed in the other two papers.
    • The final paper reviewed information on marketing activities entered into evidence in an Oklahoma court case, Marsee vs US Tobacco Company, as well as trade literature, advertising, and promotional material that would appear to support the contention that marketing activities incorporate this "graduation strategy."
  • The media briefing received extensive radio and television coverage on April 26 and 27, 1995, including spots on all three network evening news programs and CNN and CNBC, coverage in 144 local television news programs on 69 stations, stories on national and local radio programs, and stories in each of the leading news services, which in turn, resulted in corollary stories in over 25 newspapers across the country.

Funding
The Robert Wood Johnson Foundation (RWJF) provided partial support for the briefing with a grant of $22,563 between April and July 1995.

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THE PROJECT

Four papers and an editorial about chewing tobacco, or moist snuff, were published in the Spring 1995 issue of Tobacco Control. The journal, established in 1992, is an international peer-reviewed scientific journal published quarterly by the British Medical Association. The four papers dealt with the "graduation strategy" that characterizes the use of increased pH and un-ionized nicotine in various brands of moist snuff. Nicotine is more rapidly absorbed from products with higher levels, and these products are therefore more attractive to veteran users of moist snuff who are no longer satisfied with the lower-nicotine products. As far back as 1986, the US Surgeon General concluded that use of this product causes oral cancer, gum disease, and nicotine addiction.

The Foundation of the American Medical Association (AMA), in cooperation with the Michigan Public Health Institute, coordinated a media briefing to enhance the dissemination of the research findings on moist snuff products published in the Spring issue of Tobacco Control. Also, around the same time, the Food and Drug Administration was also considering whether tobacco should be classified as a "drug" under the federal Food, Drug, and Cosmetic Act.

The Robert Wood Johnson Foundation (RWJF) provided partial funding for this briefing. A number of organizations collaborated with the Foundation and provided direct or in-kind support: the AMA, the Office on Smoking and Health at the Centers for Disease Control and Prevention, and the Michigan Department of Public Health.

While the articles in Tobacco Control, which formed the basis of the research findings that were presented in the media briefing, were not supported by this grant, the articles' authors whose names are listed in bold below were present to discuss the research findings in their respective articles:

  • "Estimation of available nicotine content of six smokeless tobacco products" (Henningfield, Radzius, and Cone).
  • "US commercial brands of moist snuff, 1994. Assessment of nicotine, moisture, and pH" (Djordjevic, Hoffmann, Glynn, and Connolly).
  • "Smokeless tobacco brand preference and brand switching among US adolescents and young adults" (Tomar, Giovino, and Eriksen).
  • "The marketing of nicotine addiction by one oral snuff manufacturer" (Connolly).

The authors were affiliated with the following institutions: Intramural Research Program (Addiction Research Center), National Institute on Drug Abuse (Henningfield); Massachusetts Department of Public Health (Connolly); and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (Tomar).

Two of the papers ("Estimation of available nicotine content of six smokeless tobacco products" and "US commercial brands of moist snuff, 1994. Assessment of nicotine, moisture, and pH") showed the wide variation in pH and levels of unionized nicotine in brands of moist snuff. Products assumed to be important in the initiation of snuff use (e.g., Skoal and Skoal Bandits) are much lower in pH and un-ionized nicotine, which makes them less harsh and easier for the new user. Products such as Copenhagen are much higher in pH and un-ionized nicotine; nicotine is much more rapidly absorbed from these products, making them attractive to the veteran user who has become tolerant to the lower-nicotine products.

The third paper ("Smokeless tobacco brand preference and brand switching among US adolescents and young adults") evaluated data on the smokeless tobacco use of those aged 12–21 years, and confirmed that the youngest users are more likely to use the Skoal brand, whereas older users and those who have used smokeless tobacco for four or more years are more likely to use Copenhagen and other higher pH products. In addition, users of Copenhagen are more likely than Skoal users to report withdrawal symptoms when they attempted to quit using the product.

The final paper ("The marketing of nicotine addiction by one oral snuff manufacturer") reviewed the concept of "graduation strategy" in light of information on marketing activities and trade literature that came to light during a 1986 Oklahoma court case, Marsee vs US Tobacco Company as well as a review of other trade advertising and promotional literature.

Communications

In addition to the distribution of a press release and media advisory, which was sent to 2,800 reporters nationwide a week before the briefing, a video news release (VNR) was distributed via satellite in the afternoon of the briefing. It was picked up by 144 local television news programs on 69 stations that reached an estimated total audience of 12 million. The extensive media coverage of the press conference also included: stories on leading electronic news services (Associated Press, Reuters, Dow Jones [Wall Street Journal], The New York Times, and Scripps Howard); corollary stories in 25 newspapers; broadcast stories on the evening news of the three major television networks (ABC, CBS, and NBC) and CNN and CNBC, and local and national radio programs (National Public Radio, the Business Radio Network, and KMOX in St. Louis). There was also coverage in four professional journals, including the British Medical Journal and Science.

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AFTER THE GRANT

This was a one-time dissemination project. The project director, who is the editor of Tobacco Control, stated he may wish to replicate it for important articles in future issues of the journal.

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GRANT DETAILS & CONTACT INFORMATION

Project

Media Briefing on Moist Snuff Research

Grantee

Michigan Public Health Institute (Okemos,  MI)

  • Amount: $ 22,563
    Dates: April 1995 to July 1995
    ID#:  027141

Contact

Ronald M. Davis, M.D.
(313) 874-6276
rdavis1@smtpgw.is.hfh.edu

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APPENDICES


Appendix 1

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Participants in Media Briefing

Gregory Connolly, D.D.S.
Massachusetts Department of Public Health

Rick Bender
Cancer victim and former snuff user

Ronald Davis, M.D.
Editor
Tobacco Control

Mirjana V. Djordjevic, Ph.D.
American Health Foundation

Jack Henningfield, Ph.D.
National Institute on Drug Abuse

John Slade, M.D.

Randolph Smoak, M.D.
American Medical Association Board of Trustees

Scott Tomar, D.M.D., Dr.P.H.
Office on Smoking and Health
Centers for Disease Control and Prevention

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Articles

Carnall D. "Oral Snuff 'Geared to Addiction,' Claim Researchers." British Medical Journal, 310(6988): 1159–1160, 1995.

Wilson AV. "UST Disputes New Studies Suggesting Nicotine Manipulation." IRRC Social Issues Reporter, May: 7–9, 1995.

"Dipping Into Nicotine Content In Snuff." Science News, May 13: 303, 1995.

"Researchers Ask FDA To Regulate Tobacco As A Drug." American Medical News, May 15, 1995.

Print Coverage

"Doctors Want Snuff, Tobacco Controlled," Scripps Howard News Service, April 26, 1995. This Scripps Howard story was run in whole or in part on April 27 by the following newspapers:

  • "Doctors Want Snuff Tobacco Controlled," Grand Rapids Press
  • "Doctors Urge Crackdown On Smokeless Tobacco,"Rocky Mountain News

"Health Groups Say Chewing Tobacco Aims To Hook Kids," Reuters, April 26, 1995.

"New Studies May Rekindle Debate On Nicotine Manipulation of Tobacco," The Associated Press, April 26, 1995. This AP story was carried in whole or part by the following newspapers on April 27, 1995:

  • "AMA Snuffs Out Tobacco," New York Newsday
  • "AMA Wants Controls On Chewing Tobacco," Minneapolis Star Tribune
  • "Chewing Tobacco Under Fire," San Francisco Chronicle
  • "Doctors Group Alarmed By Study Of Teen's Tobacco Use," Raleigh News & Observer
  • "Study: Teens Move To Higher Nicotine Chews," Charlotte Observer
  • "Doctors Want Snuff Controlled," Grand Rapids Press
  • "Findings On Snuff Alarm The AMA," San Jose Mercury News
  • "Nicotine In Snuff Fixed To Hook Teens," Denver Post
  • "Nicotine Levels Seen As Tool To Hook Users," Boston Globe
  • "Nicotine Lure Seen In Chewing Tobacco," Philadelphia Inquirer
  • "Regulate Tobacco As Drug, Say AMA, Others," Commercial Appeal (Memphis)
  • "Smokeless Tobacco," USA Today
  • "Studies Add Bite To Teen Chewing-Tobacco Fight," Newark Star Ledger
  • "Studies Show Teens Start With Low Nicotine Chewing Tobacco, Move To Stronger Brands," Dallas Morning News
  • "Studies Trace Teens' Tobacco Preferences," Kansas City Star
  • "Teens Increase Nicotine Levels In Chew, Studies Show," Seattle Post-Intelligencer
  • "Tobacco-Chewing Teens Move To Stronger Brands," Hartford Courant
  • "Tobacco Debate Resumed," Cleveland Plain Dealer

"Snuff Makers Accused Of Manipulating Nicotine To Lure Young," The New York Times, April 27, 1995. This story was distributed through The New York Times News Service and was carried in whole or in part on April 27 by several other newspapers including:

  • "Altering Nicotine Levels Hooks Children On Snuff, Articles Say," Arizona Republic
  • "Nicotine Levels Manipulated In Snuff," Lexington Herald Leader
  • "Scientists Say Makers Of Snuff Use Nicotine Levels To Hook Kids," San Diego Union-Tribune
  • "Snuff Makers Target Kids, Scientists Say," Houston Chronicle

"Young Snuff Users Advance to Brands With More Nicotine, 2 Studies Suggest," The Wall Street Journal, April 27, 1995.

Television Coverage

"ABC News Tonight," American Medical Association and the Centers for Disease Control cracking down on chewing tobacco among teens, ABC Network Programming, April 26, 1995.

"ABC World News Now," smokeless tobacco, ABC Network Programming, April 27, 1995.

"ABC World News This Morning," smokeless tobacco products and the companies that make them under fire again, ABC Network Programming, April 27, 1995.

"CBS Evening News," doctors lobby accused tobacco lobby of hurting children's health by getting men addicted to smokeless tobacco products, CBS Network Programming, April 26, 1995.

"Up To The Minute," American Medical Association accuses tobacco companies of making smokeless tobacco more addictive, CBS Network Programming, April 27, 1995.

"The Money Wheel," American Medical Association accuses tobacco companies of making smokeless tobacco more addictive, CNBC Cable Programming, April 26, 1995.

"Steals & Deals," AMA study charges makers of chewing tobacco with trying to get users hooked, but Smokeless Tobacco Council denies comment, CNBC Cable Network, April 26, 1995.

"EarlyPrime," Tobacco debate. critic calls smokeless tobacco a timber for youngsters, CNN Cable Programming, April 26,1995.

"Nightside," Smokeless tobacco, health officials accuse producers of smokeless tobacco of adding nicotine, NBC Network Programming, April 27, 1995. "The Morning Show," teens chewing smokeless tobacco usually graduate to stronger brands, WJLA-TV (ABC), Washington, D.C., April 27,1995.

"News 4 Live at 5," new study claims makers of smokeless tobacco increased the level of nicotine in their products, WRC-TV (NBC), Washington, D.C., April 26, 1995.

"Eyewitness News at 5," smokeless tobacco and teenagers, WUSA-TV (CBS), Washington, D.C., April 26, 1995.

Clips from a video news release, "Smokeless Tobacco: A Call for FDA Regulation," were used by 69 television stations for stories on April 26 and April 27, according to ORBIS Broadcast Group, a tracking service. Many reports appeared several times on early and late evening and morning newscasts. Story length varied between 7 seconds and 2.5 minutes, with most ranging from 30 to 90 seconds. The stations, listed by ORBIS in order of market size were:

  • KCOP, Los Angeles, Calif.
  • KTLA, Los Angeles, Calif.
  • KTTV, Los Angeles, Calif.
  • WPVI, Philadelphia, Pa.
  • WTTG, Washington, D.C.
  • WUSA, Washington, D.C.
  • WXIA, Atlanta, Ga.
  • KNWS, Houston, Texas
  • KOMO, Seattle, Wash.
  • WAKC, Akron/Cleveland, Ohio
  • WMFD, Mansfield, Ohio
  • KSAX, Alexandria, Minn.
  • KSTP, St. Paul, Minn.
  • KETV, Omaha, Neb.
  • KTVW, Phoenix, Ariz.
  • WTOG, St. Petersburg, Fla.
  • WCIX, Miami, Fla.
  • WTVT, Tampa, Fla.
  • WTAE, Pittsburgh, Pa.
  • KCNC, Denver, Colo.
  • KMOV, St. Louis, Mo.
  • KUSK, Prescott, Ariz.
  • WMAR, Baltimore, Md.
  • WBTV, Charlotte, N.C.
  • WISN, Milwaukee, Wis.
  • WSOC, Charlotte, N.C.
  • WKRC, Cincinnati, Ohio
  • KMBC, Kansas City, Mo.
  • WCMH, Columbus, Ohio
  • KUTV, Salt Lake City, Utah
  • KSAT, San Antonio, Texas
  • KWTV, Oklahoma City, Okla.
  • WHTM, Harrisburg, Pa.
  • WLYH, Lebanon, Pa.
  • KOB, Albuquerque, N.M.
  • WNAL, Gadsden, Ala.
  • WRGB, Schenectady, N.Y.
  • WDTN, Dayton, Ohio
  • WWBT, Richmond, Va.
  • KFSN, Fresno, Calif.
  • WPMI, Mobile, Ala.
  • WKYT, Lexington, Ky.
  • WLEX, Lexington, Ky.
  • WYMT, Hazard, Ky.
  • GB, Schenectady, N.Y.
  • WDTN, Dayton, Ohio
  • WWBT, Richmond, Va.
  • KFSN, Fresno, Calif.
  • WPMI, Mobile, Ala.
  • WKYT, Lexington, Ky.
  • WLEX, Lexington, Ky.
  • WYMT, Hazard, Ky.
  • KETV, Omaha, Neb.
  • KTAL, Shreveport, La.
  • KLAS, Las Vegas, Nev.
  • KFVS, Cape Girardeau, Mo.
  • KXLY, Spokane, Wash.
  • KCRG, Cedar Rapids, Iowa
  • WKOW, Madison, Wis.
  • KHGI, Kearneyville, Neb.
  • WEVU, Ft. Myers, Fla.
  • WPTA, Fort Wayne, Ind.
  • WITN, Washington, N.C.
  • WJBF, Augusta, Ga.
  • KHBS, Fort Smith, Ark.
  • KHOG, Fort Smith, Ark.
  • WWTV, Tustin, Mich.
  • KTVB, Boise, Idaho
  • KBMT, Beaumont, Texas
  • WOAY, Oak Hill, W.Va.
  • KTAB, Abilene, Texas
  • WJHG, Panama City Beach, Fla.
  • KTVQ, Billings, Mont.
  • KPAX, Missoula, Mont.
  • KECY, El Centro, Calif.
  • WTAP, Parkersburg, W.Va.
  • WDBB, Tuscaloosa, Ala.
  • WJSU, Anniston, Ala.

Radio Coverage

"News/Business Day," AMA study claims makers of smokeless tobacco manipulating levels of nicotine to hook kids, Business Radio Network, April 26, 1995.

"Fresh Air," teenagers get hooked on low nicotine chewing tobacco and move to stronger brands, National Public Radio, April 26, 1995.

News Conferences

News Conference: Media Briefing on Moist Snuff Research, National Press Club, Washington, D.C., April 26, 1995.

Press Kits and News Releases

Press release mailed to 2,800 reporters, April 19, 1995.

A video news release: "Smokeless Tobacco: A Call For FDA Regulation," was distributed via satellite to television stations nationwide, April 26, 1995.

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Report prepared by: Todd Shapera
Reviewed by: Timothy F. Murray
Reviewed by: Marian Bass
Program Officer: Nancy J. Kaufman

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