The analysis was based on a collection of 432 documents. 15 Further ‘snowball’ searches for contextual information were conducted using product types, brand names, document locations, dates and reference (Bates) numbers. Searches were focused using standard techniques. These searches yielded thousands of documents those related to flavoured ST use among youth and new users were selected. Initial search terms included ‘flavour’, ‘flavour*’, ‘other tobacco products’, ‘flavoured smokeless’, ‘new users’, ‘starters’, ‘youth’, etc. The searches were repeated and extended between August 2011 and August 2014. We searched tobacco industry document archives from the University of California, San Francisco Truth Tobacco Documents Library, between November 2010 and April 2011. 14 For this study, we included any natural or artificial candy, fruit, alcohol, herb (eg, menthol, wintergreen) and spice flavourings or substances added to tobacco to alter or enhance its taste, including ‘sweet’ or sugar flavouring. We analysed previously secret tobacco industry documents from RJ Reynolds (RJR), Brown & Williamson (B&W), Philip Morris (PM), British American Tobacco, Lorillard, US Smokeless Tobacco Company (USST, formerly US Tobacco Company) related to the development and marketing of flavoured smokeless products (including moist snuff, snus, loose leaf and chewing tobacco) in the USA to answer the following research questions: How and why did tobacco manufacturers use flavoured additives in ST products? Who were the target audiences for flavoured ST products? What was the function of flavours in ST, and how did the use of flavours affect ST patterns of use? What marketing strategies were used to promote flavoured ST brands? Flavour may be defined as the blend of taste and smell sensations evoked by a substance in the mouth. Additional research is needed to better understand the role of flavours in smokeless products. 10–13 ST was not included in this regulation. The 2009 US Family Smoking Prevention and Tobacco Control Act prohibited candy, fruit, alcohol and spice characterising flavours in cigarettes, as flavours make cigarettes easier to smoke and increase youth appeal. An analysis of candy and tobacco products found some tobacco products contained higher levels of flavour chemicals than candy. 8 A recent study by Brown et al 9 found that the same flavour chemicals that are used in popular brands of candy, such as Jolly Rancher candies or Life Savers, are used to engineer fruit-flavoured tobacco products. Prior studies used previously secret tobacco industry documents to determine whether tobacco manufacturers used flavours in cigarettes to promote initiation, 7 how nicotine content in ‘starter’ smokeless brands was manipulated to appeal to novices, 5 or developed ST products to encourage initiation of smokeless use among smokers. Research on the tobacco industry's use of flavours in ST to attract new users is limited. Therefore, the abundance of flavoured products raises concerns about youth initiation.
2–4 Flavoured products tend to contain lower levels of free nicotine and pH, 3, 5 features of ‘starter’ products. 1 Currently, Skoal, the most popular ST brand among youth, offers over 20 line extensions with flavourings. 1 The growth in ST sales may be due in part to flavoured products: sales of flavoured moist snuff products increased 72.1% between 20 and contributed to ∼60% of the growth in the moist snuff category overall. As cigarette sales in the USA continue to decline, sales of moist snuff (the most popular type of ST) increased by 65.6% between 20. Nicotine (mg/g) and Free Nicotine (mg/g) Levels in Smokeless Tobacco Products in the U.S.Smokeless tobacco (ST) products include moist snuff (including portion pouch products such as snus), chewing tobacco, dry snuff, and loose leaf or scrap. They should look for a smokeless substitute that satisfies them. The broad range of free nicotine levels among these products is good news for smokers.