a Content analysis of smokeless tobacco Coverage in U.s.

doi:10.1093/ntr/nts332

ORIGINAL INVESTIGATION

A Content Analysis of Smokeless Tobacco Coverage

in U.S. Newspapers and NewsWires

Olivia A.Wackowski PhD, MPH

, M. JaneLewis DrPH, MA

, Cristine D.Delnevo PhD, MPH

Pamela M.Ling MD, MPH

Center for Tobacco Surveillance & Evaluation Research, University of Medicine & Dentistry of NJ—School of Public Health,

New Brunswick, NJ;

Center for Tobacco Control Research & Education, University of California San Francisco,

San Francisco, CA

Corresponding Author: Olivia A.Wackowski, Ph.D., M.P.H., Center for Tobacco Surveillance & Evaluation Research,

University of Medicine & Dentistry of NJ—School of Public Health, New Brunswick, NJ, USA. Telephone: 732-235-9731;

Fax: 732-235-9777; E-mail: olivia.wacko[email protected]

Received July 23, 2012; accepted November 30, 2012

ABSTRACT

Introduction: Research attention on smokeless tobacco (SLT) has focused on SLT use, health risks, harm-reduction potential,

and risk perceptions, but few studies have examined mediated communications about SLT. This study aims to contribute to the

literature by providing the first description of SLT coverage in the news, an important communication channel given its ability

to educate and shape public opinion about tobacco issues.

Methods: A content analysis was conducted on SLT-related news and opinion articles between 2006 and 2010 from top cir-

culating national and state newspapers and select news wires. Articles were coded for the main SLT topic, SLT risk references,

and slant of opinion articles.

Results: SLT was discussed in news/feature articles (n=677) in terms of business (28%), new products, product regulation and

harm reduction (19%), prevention/cessation (11.4%), taxation (10.2%), profiles/trends in use (9%), bans (8.1%), and tobacco

industry promotional activities (4.9%). Health risk references (i.e., addictiveness, carcinogenicity, and specific health effects

including oral cancer) were found in 40% of articles, though frequency differed by article topic. Although the majority of opinion

articles (n=176) conveyed an anti-SLT slant (64%), 25.6% were pro-SLT.

Conclusions: SLT topics of both national and local importance are covered in the news. Public health professionals can par-

ticipate in SLT coverage by sending in press releases about new study findings, events, or resources and by submitting opinion

pieces to share views or respond to previous coverage. Research on SLT news should continue given its potential to shape the

public’s SLT knowledge and opinions.

INTRODUCTION

Smokeless tobacco (SLT) use is growing in the United States

and the last several years have seen a change in the SLT mar-

ketplace with the acquisition of two major SLT companies by

cigarette companies and the introduction of new SLT prod-

uct styles under cigarette brand names (e.g., Camel Snus,

Camel Dissolvables, Marlboro Snus) (Mejia & Ling, 2010).

Research attention has focused on SLT use (e.g., Rodu & Cole,

2009; Timberlake & Huh, 2009), health risks (e.g., Boffetta,

Hecht, Gray, Gupta, & Straif, 2008; Boffetta & Straif, 2009),

harm-reduction potential (e.g., Foulds, Ramstrom, Burke, &

Fagerstrom, 2003; Hatsukami, Lemmonds, & Tomar, 2004;

Levy et al., 2004), and risk perceptions (e.g., O’Connor,

Hyland, Giovino, Fong, & Cummings, 2005; O’Connor etal.,

2007; Tomar & Hatsukami, 2007). However, few studies have

examined mediated communications about SLT (Phillips,

Wang, & Guenzel, 2005; Waterbor etal., 2004) and none have

examined coverage of SLT in the news. Such research is signif-

icant given that the news media has played an important role in

informing the public about tobacco’s dangers since the 1950s

(Pierce & Gilpin, 2001).

The news media also plays a broader role than transferring

information to the public—by deeming certain topics

newsworthy it defines which issues are “important” (McCombs

& Shaw, 1972; Preiss, Gayle, Burrell, Allen, & Bryant, 2007).

News coverage can also influence opinions and attitudes

by shaping how we think about issues given their framing

(National Cancer Institute [NCI], 2008). As such, analysis of

tobacco news coverage is important for understanding which

Advance Access publication January 3, 2013

Nicotine & Tobacco Research, Volume 15, Number 7 (July 2013) 1289–1296

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Smokeless tobacco news coverage

issues are perceived as important, how the problem of tobacco

is being defined for the public and policy makers, and the types

of solutions suggested (Lima & Siegel, 1999).

Analysis of tobacco news can also reflect and help us under-

stand existing attitudes and public sentiment toward tobacco

issues (Smith et al., 2008). Letters to the editor and op-ed

articles provide a public forum where members of the public

and tobacco control professionals can debate and express their

views about timely tobacco issues (Clegg Smith, Wakefield,

& Edsall, 2006). Letters and op-ed articles may also suggest

areas in which additional education, advocacy or intervention

are needed to gain public support for tobacco control measures

(Clegg Smith etal., 2006).

Given the potential of news stories to influence tobacco-

related knowledge, attitudes, behaviors, and policies, previ-

ous content analysis studies have been conducted of tobacco

news stories (NCI, 2008). These have mostly included studies

describing the prevalence and types of tobacco topics covered

in general (Clegg Smith etal., 2006; Long, Slater, & Lysengen,

2006; Nelson etal., 2007) or the framing within articles about

certain particular tobacco policy topics (Lima & Siegel, 1999;

Menashe & Siegel, 1998), such as smoking bans (Champion &

Chapman, 2005; Magzamen, Charlesworth, & Glantz, 2001;

Wackowski, Lewis, & Hyrwna, 2011). However, one recent

review concluded that news media has been relatively under-

studied in tobacco control and that more is needed (NCI, 2008).

In addition, only one study has previously analyzed content on

a specific type of tobacco, cigars (Wenger, Malone, & Bero,

2001). An analysis of SLT-specific news information could

document if and how these stories cover traditional tobacco

news topics such as business, bans, and taxes, and also whether

they refer to issues that might be more unique to SLT, such

as the variation in health risks among different types of SLT

(Hatsukami, Ebbert, Feuer, Stepanov, & Hecht, 2007), or SLT’s

debated role as a potentially less risky “harm reduction” alter-

native to smoking (Hatsukami, Lemmonds & Tomar, 2004).

This study aims to contribute to the small body of SLT com-

munication literature and also to the tobacco news literature

by providing the first general overview of SLT coverage in

U.S.newspapers and news wires.

METHODS

Consistent with previous research, this content analysis was

based primarily on SLT articles published in newspapers (NCI,

2008). The newspaper sample was limited to top circulat-

ing daily newspapers, including the top three national daily

U.S. newspapers (i.e., The Wall Street Journal, USA Today,

and The New York Times) and the top 2–3 circulating daily

newspapers in each state (the top third paper was included for

states in which it had a high circulation of 100,000 or more

or in which the top second and third papers had close circula-

tion numbers of at least 50,000). The top fourth paper was also

included for two states (New York and California) to obtain

geographic diversity within those two states. U.S. national

newspapers are distributed throughout the country focusing

on national and international news and issues of broad gen-

eral interest (e.g., health, science), while state papers typically

include greater focus on statewide and/or local community

issues of interest (e.g., state or local government and politics,

events, justice, crime, and human interest stories). Rankings of

paper circulation figures were obtained from the Audit Bureau

of Circulations and Mondo Times, a media guide profiling var-

ious media channels including U.S. newspapers. Two papers

based in the hometowns of the two major cigarette compa-

nies that have moved into the SLT market (i.e., RJ Reynolds,

Philip Morris) were also included in the sample—that is, The

Winston-Salem Journal and The Richmond Times, respectively.

SLT news stories were also obtained from select news wire

services, specifically the Associated Press (AP) (a national

news wire service) and two health-focused wire services:

Reuters Health eLine (a Reuters news service product based in

the United States) and UPI Consumer Health Daily (a national

health wire service from United Press International). Overall,

129 different news sources (i.e., 126 newspapers and 3 news

wires) were reviewed for unique SLT-related articles. Articles

were limited to those occurring between 2006 and 2010, a

period coinciding with cigarette companies’ movement into

the SLT market, the launch of new SLT products, and passage

of the Family Smoking Prevention and Tobacco ControlAct.

Articles were largely obtained through two electronic

news databases: Access World News and Factiva. Relevant

articles from 18 papers not available through these databases

were obtained through paid searches of their individual Web

site archives. Only stories representing original content (i.e.,

staff written or contributing articles, opinion articles) from

each newspaper were included in the sample. Articles from

the select wire services were identified directly from the

AP, UPI Consumer Health Daily, and Reuters Health eLine

archives and were only coded in the sample one time. If these

same wire stories were found in the results of individual

newspapers, they were not again included in the sample of

articles from those papers. As such, this study sample should

be considered to be representative of unique stories from

national and state newspapers rather than of all SLT stories

found in them (which would include copies of all wire stories

actually printed).

Guidelines were developed to limit articles to those primar-

ily about a SLT-related issue or that focused on a SLT issue in

at least part of the article. To be included, articles identified

using keywords (tobacco and smokeless, snuff, snus, chew, dip,

spit, and/or dissolvable) needed to be at least four sentences

long; contain at least one paragraph related to tobacco; and

either include a SLT reference (e.g., snus) in the headline or in

at least three different sentences to avoid articles simply men-

tioning SLT in passing. Exceptions were made for letters to the

editor because of their inherently shorter length, for example,

letters only needed a SLT reference in two sentences.

A coding guide was developed based on review of previous

tobacco news studies and iterative review of SLT articles in

the sample. Each article was coded for standard variables such

as date, source, and type (e.g., news/feature, opinion), and the

presence of a SLT-related term in the headline. Additionally,

each article was coded for the main topic or issue of the SLT

content within the article (e.g., product regulation), as well as

certain subtopic details (e.g., reference to the Food & Drug

Administration [FDA]). All articles were coded for references

to SLT health risks and opinion articles were also coded for the

slant of the SLT-related content. To assess reliability, 10% of

articles from each year (2006–2010) were randomly selected

for double coding by a research assistant—results were good,

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with an average Kappa value of 0.89 (range of 0.65–1.0)

(Banerjee, Capozzoli, McSweeney, & Sinha, 1999). Chi-

square tests were used to determine if relationships between

certain categorical variables were statistically significant. All

results were prepared using SPSS 18.0.

RESULTS

A total of 877 unique articles related to SLT were identified.

The majority of articles (58.4%) were obtained from state

newspapers, followed by the two tobacco hometown news-

papers (17.4%), the AP (10.7%), national papers (9.1%), and

the two health wires (3.8%). Over three quarters of all articles

(77.2%) were news/feature articles, 20% were opinion articles

(i.e., editorials, op-ed articles, or letters to the editor), and 2.8%

were advice or health column articles. The next sections are

limited to news/feature articles only (n= 677), with opinion

articles discussed separately.

SLT-Related Terms and Headlines

Table1 presents the frequency with which different terms were

used to refer to SLT within news/feature articles (n=677). The

formal term/phrase “smokeless tobacco” was used most fre-

quently in national paper articles (100%) and least in state paper

articles (64.4%). In contrast, use of the least formal terms, that

is, “dip/dipping” and “spit tobacco,” were both most frequently

found in state papers. Articles also referred to SLT as “chewing

tobacco,” “chew” or “chaw” (46%), and as “snuff” or “moist

snuff” (39.6%). References to snus and dissolvable tobacco

appeared least frequently in state paper articles. ASLT-related

term (e.g., “chew”), company (e.g., Conwood), or brand name

(e.g., Skoal) was present in the headline of almost half of all

articles (48.3%) (data not in table).

Types of SLT Topics

Eight main categories of SLT-related news were identified, the

most frequent of which described and defined SLT as a busi-

ness (28%) (see Table1). The “SLT business news” category

included topics such as cigarette companies’ purchase of SLT

companies (54.5% of all business articles), SLT company or

brand profits (50.3%), new SLT products (47.1%), company

name, location and staff changes (18.8%), and corporate legal

issues (7.3%) (see Table2). Additionally, SLT business articles

referred to the increasing number of smoking bans (24.1%)

and to cigarette sales as declining (55%) while referring to SLT

sales as growing (49.2%).

News articles also frequently discussed issues surround-

ing new SLT products, product regulation (e.g., FDA related),

and SLT as a smoking alternative or harm-reduction product,

issues that tended to co-occur and were coded as one thematic

category (19%) called “new products/product regulation/harm

reduction” (see Table1). Articles in this category differed from

business news articles that referred to new products because

they also included general interest, public health, and policy

Table 1. Percentage of News/Feature Articles Referring to Different Smokeless Tobacco (SLT) Terms and Covering

Various SLT-Related Main Topics, by News Source

By all news source types

National

papers (%)

(n=61)

Associated

Press (%)

(n=94)

Tobacco

hometown

(%) (n=152)

State papers

(%) (n=337)

Health wires

(%) (n=33)

Total—all news/

feature articles (%)

(n=677)

Type of SLT terms/phrases

SLT 100% 86.2% 87.5% 64.4% 84.8% 520 (76.8%)

Chew, chaw, chewing

tobacco

31.1% 60.6% 13.8% 60.5% 36.4% 313 (46.2%)

Snuff 37.7% 55.3% 50.5% 30.0% 48.5% 268 (39.6%)

Dip, dipping 13.1% 8.5% 5.9% 17.5% 3.0% 85 (12.6%)

Spit tobacco 3.3% 3.2% 4.6% 14.8% 0.0% 62 (9.2%)

Snus 45.9% 41.5% 39.5% 11.0% 24.2% 174 (25.7%)

Dissolvable tobacco 21.3% 12.8% 23.7% 10.4% 9.1% 99 (14.6%)

Type of SLT main topics

Business news 47.5% 59.6% 57.9% 5.3% 0 191 (28.2%)

New products/product

regulation/harm reduction

37.7% 9.6% 32.2% 13.4% 12.1% 130 (19.2%)

Prevention and/or cessation 1.6% 5.3% 0.7% 19.9% 9.1% 77 (11.4%)

SLT taxes 0 2.1% 3.3% 18.4% 0 69 (10.2%)

Profiles/trends in SLT use 1.6% 5.3% 2.6% 12.8% 24.2% 61 (9.0%)

SLT bans 0 11.7% 2.0% 12.2% 0 55 (8.1%)

Tobacco industry

promotional activities

4.9% 1.1% 0 8.3% 3.0% 33 (4.9%)

Health risks 3.3% 1.1% 0.7% 3.9% 48.5% 33 (4.9%)

Other topics 3.3% 4.3% 0.7% 5.9% 3.0% 28 (4.1%)

Note.

Read as column percentages.

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Smokeless tobacco news coverage

perspectives (e.g., quotes from public health professionals, sci-

entists, citizens, legislators, etc.). Notably, about 58% of these

articles referred to SLT products as being/possibly being less

risky or harmful than smoking (see Table 2). This topic cat-

egory was most frequently found both in national (37.7%) and

tobacco hometown papers (32.2%) (see Table1).

Articles focusing on other SLT issues were generally present

more frequently among state papers. SLT prevention/cessation-

related articles included references to local events or programs

(32.5%), SLT cessation methods or resources (16.9%), and

personal stories of SLT cessation (26%) (see Table 2). News

articles also discussed SLT in terms of taxation, with about half

(52.2%) of these referring to changing SLT’s taxation method,

that is, moving toward taxing by weight versus percentage of

price or vice versa. Nine percent of articles focused on profiles/

trends in SLT use (including among particular populations or

individuals) with about 28% of these describing SLT preva-

lence as having grown or as being above average. News articles

also discussed SLT-related bans (8.1%) (e.g., in public places

such as parks, schools) and issues related to SLT promotional

activities (5%), such as SLT company sponsorship of racing or

rodeo events as well as opposition to such activities.

Regardless of the main topic, articles were also coded for

various user or lifestyle associations made with SLT. About

10% included some association with baseball, such as SLT

prevalence among baseball players, player use as poor role

modeling for youth, and banning SLT in baseball. In addition,

8.6% of articles included some non-health-related negative

SLT perception (e.g., characterizations of SLT spitting as “dis-

gusting”) (data not in table).

SLT HealthRisks

Although health risks were not frequently a main article topic

(see Table1), reference to some SLT health risk was present

in 36.9% of articles. Specifically, articles referred to SLT as

addictive (25.6%), carcinogenic or toxic (8.9%), and as being

associated with particular health effects (25.4%) (e.g., cancer)

(Table3). The presence of any SLT health risk references was

significantly associated with the main SLT topic of the article

=189.6, df = 7, p < .001)—for example, risk references

were most frequent in articles about new products/product reg-

ulation/harm reduction (69.2%) and least frequent in articles

about taxes (8.7%) and business (5.8%) (Table3).

Among articles referring to SLT-associated health effects

(n=172), oral cancer was by far the most frequently mentioned

effect (59.9%) (Table3). Articles also referred to other oral effects

(leukoplakia, gum and teeth issues), numerous other cancer

types (pancreatic, throat or neck, esophageal, larynx, bladder,

liver, stomach, kidney, colon, lung), cardiovascular-related

issues, and other potential health effects (e.g., reproductive

health problems). About 24% of these articles also referred to a

personal story of someone with health effects attributed toSLT.

SLT health effect information was also included in 46.3%

and 44.6% of all nonbusiness (i.e., more general news) arti-

cles that discussed snus (n=95) or dissolvable SLT (n=83),

respectively. However, only about half of these referred to

health effects specifically associated with either product.

The most frequent effects associated with snus were pancre-

atic cancer (41.7%), oral cancer (25%), or cancer in general

(33.3%), and cardiovascular-related effects/disease (29.2%)

(see Table3). Some articles qualified these effects by indicat-

ing that risk was very low or that research on such effects had

been mixed. Health effects associated with dissolvable tobacco

included child poisoning from accidental ingestion (76.5%),

cancer (23.5%), and other effects (17.6%). Only about 18%

of nonbusiness articles discussing snus or dissolvable tobacco

included some indication that different types of SLT vary in

their levels of toxicity or risks.

Opinion Articles

Other than business news, opinion articles discussed the same

SLT topics found in news/feature articles, although in some-

what different proportions. The issues of new products/product

regulation/harm reduction (34.6%), SLT taxes (16.5%), and

SLT bans (16.5%) were discussed most frequently in opinion

articles (see Table4). Opinion articles (50%) were also signifi-

cantly more likely than news articles (36.9%) to include refer-

ence to any type of SLT health risk (X

=9.98, df=1, p < .01)

and the majority of all opinion articles (63.6%) contained an

anti-SLT/protobacco control slant. In contrast, about a quar-

ter reflected a pro-SLT/antitobacco control slant, a slant more

frequently expressed in opinion articles related to new prod-

ucts/product regulation/harm reduction (42.6%) and SLT bans

(37.9%). These included, for example, messages from writers

supporting the promotion or communication of SLT as being

a safer alternative to smoking and messages opposing policy

efforts to ban SLT in public places/situations such as parks or

Table 2. Percentage of News/Feature Articles

Referring to Various Subtopic Details, by Main

Smokeless Tobacco (SLT) Topics of Articles

Business news articles (n=191)

Cigarette sales or smoking prevalence as declining 55.0%

Purchase of SLT companies by cigarette companies 54.5%

Market updates about SLT brand/company profits 50.3%

SLT consumption or sales as growing 49.2%

Development, testing, or launch of new products 47.1%

Rise in number of smoking bans 24.1%

SLT company name, location, and staff changes 18.8%

Corporate legal issues 7.3%

New products/regulation/harm reduction (n=130)

SLT company 85.4%

SLT brand 75.4%

SLT is/may be less harmful than smoking 57.7%

FDA in context of SLT discussion 56.9%

SLT prevention and/or cessation articles (n=77)

Particular SLT-related events or programs 32.5%

Personal stories of SLT cessation attempts 26.0%

SLT cessation methods or resources 16.9%

SLT tax articles (n=69)

Changing SLT taxation method 52.2%

Profiles/trends in SLT use articles (n=61)

Prevalence of SLT use—youth 31.1%

Prevalence as growing or above average 27.9%

SLT prevalence among baseball players 16.4%

Prevalence of SLT use—adults, general population 13.1%

Tobacco industry promotional activities articles (n=33)

Rodeos 42.4%

Free samples or coupons 27.3%

FDA-related changes to SLT advertising 15.2%

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baseball games. Pro-SLT articles were also significantly more

likely to be found in national (52.9%) versus state (22.8%)

papers (X

=5.8, df=1, p=.016), and in articles submitted to

papers (letters, op-ed pieces) rather than staff-generated arti-

cles (editorials, columns).

DISCUSSION

This study provides the first description of SLT-related cover-

age in major newspapers and select news wires throughout the

country. Articles reported on a variety of SLT topics perceived

as being “newsworthy” enough to gain coverage, issues that

may in turn work to define ways in which SLT may be viewed

and thought about, for example, as a health risk, as a smoking

alternative, as a business, as growing in use, as a product in

need of various forms of regulation, and as a traditional product

or new type of tobacco product.

Our content analysis found that news articles frequently

portrayed SLT as a harmful or potentially harmful product,

with almost half of general SLT news articles referring to

known or possible risks. Articles frequently referred to the risk

most commonly associated with SLT in scientific literature

(i.e., oral cancer), and often brought this risk to life by sharing

“human interest” stories of individuals who had suffered from

it, including well-known baseball figures and private citizens

turned antitobacco advocates.

Repeated references to SLT health risks may be important

not only for public education but also for building public sup-

port toward policy efforts to regulate SLT. Previous studies

have found that news articles relating to tobacco policy issues

have tended to lack tobacco risk information, thus leaving out

the fundamental rationale for such policies (Lima & Siegel,

1999; Long etal., 2006). While this study similarly found that

references to SLT health risks were largely missing in articles

related to some policy issues such as SLT taxes and bans, they

were found in the majority focusing on new SLT products,

product regulation, and/or harm-reduction issues. This is sig-

nificant as such information may shape how the public and

policy makers think and “weigh in” on future policies regard-

ing these issues, issues that remain at debate within the tobacco

control community.

Table 3. Percentage of News/Feature Articles Referring to Various Types of Smokeless Tobacco (SLT) Health

Risks and Health Effects

Reference to SLT

health effects

Reference to SLT

as addictive

Reference to SLT

as carcinogenic

Reference to any

SLT health risks

By type of SLT topic

Health risks (n=33) 60.6% 45.5% 39.4% 100%

New products/regulation/harm

reduction (n=130)

42.3% 57.7% 26.2% 69.2%

Prevention and/or cessation

(n=77)

50.6% 31.2% 2.6% 58.4%

Profiles/trends in SLT use (n=61) 42.6% 36.1% 1.6% 50.8%

Tobacco industry promotional

activities (n=33)

24.2% 27.3% 15.2% 30.3%

SLT bans (n=55) 16.4% 16.4% 0 29.1%

Other topics (n=28) 21.4% 17.9% 3.6% 28.6%

SLT taxes (n=69) 4.3% 5.8% 0 8.7%

Business news (n=191) 2.6% 5.2% 2.1% 5.8%

Total (n=677) 25.4% 25.6% 8.9% 36.9%

Various SLT health effects among news articles with:

References to any SLT health effects (n=172) References to snus-specific health effects (n=24)

Cancer related Pancreatic cancer 41.7%

Oral cancer 59.9% Oral cancer 25.0%

Cancer—general 22.1% Cancer—general 33.3%

Pancreatic cancer 15.7% Cardiovascular effects 29.2%

Throat or neck cancer 10.4% References to dissolvable-specific effects (n=17)

Esophageal cancer 5.8% Accidental poisoning of children 76.5%

Other cancer type 9.3% Form of cancer or cancer—general 23.5%

Facial disfigurement 16.8% Other effect (e.g., gum disease) 17.6%

Leukoplakia (oral lesions) 15.1%

Other health effects

Cardiovascular or stroke related 17.4%

Gum related 14.0%

Teeth related 7.6%

Other health effects 15.7%

Personal story of health effects 24.4%

Note.

Read as row percentages.

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Smokeless tobacco news coverage

This study also found that new SLT products (e.g., snus, dis-

solvable tobacco) generated considerable news coverage over

the period examined, timely press given their launch in the last

several years. Differences were observed between business

news articles, which discussed these more “simply” in terms of

their growth and profit potential, and more general news stories,

which discussed broader perspectives including those related to

health and policy. It was also observed that while general news

articles describing these new products discussed health risks as

well as SLT’s potential role in tobacco harm reduction, health

risks between snus, dissolvable SLT, and other SLT types or

SLT in general were not always differentiated. This is important

and potentially problematic since different forms of SLT (e.g.,

moist snuff, oral snuff, chew, snus, dissolvable) are known to

vary in toxicant levels (Hatsukami, Ebbert, Feuer, Stepanov, &

Hecht, 2007), and because public health arguments for using

SLT as a means of harm reduction have largely focused on

using lower nitrosamine forms of SLT such as snus and dissolv-

able tobacco (Levy etal., 2004; Zeller & Hatsukami, 2009).

Without product differentiation, readers might consider snus

use to pose the same risk for oral cancer as other SLT types or

vice versa (i.e., perceive traditional moist snuff brands to be as

useful for harm reduction as snus). It should be noted, however,

that to date there are no data on the clinical outcomes of snus

products sold in the United States, nor are there data on the

effects of snus promotion on tobacco use in the population.

The amount of press coverage related to dissolvable

SLT was also notable considering new brands (e.g., Camel

Dissolvables) have not yet been nationally launched and the

category’s low market share to date (less than 1%) (Delnevo,

Wackowski, Manderski, Hrywna, & Ling, under review).

Such coverage was likely related to their novelty and con-

troversial nature. Indeed, news articles captured quotes from

public health professionals and legislators expressing concern

over their marketing, their resemblance to breath mints and

candy, and potential appeal to youth. The framing of dissolv-

able products as potentially appealing to youth was important

as it became the basis for an amendment made to the Family

Smoking Prevention and Tobacco Control Act before it was

signed into law, putting review of dissolvable tobacco on

the Center for Tobacco Product’s tobacco regulation agenda

(“Hardly Candy”, 2009).

While much of SLT news coverage focused on new prod-

ucts, articles also covered a more traditional SLT-related

issue—its use in baseball. Articles frequently portrayed SLT’s

presence in baseball as something negative, for example, refer-

ring to players’ negative role modeling on youth and their

struggles with addiction. These articles were timely given their

lead up to Major League Baseball’s (MLB) contract discus-

sions in late 2011 and the importance of press coverage for

shaping public support toward policy issues (McCombs &

Shaw, 1972; Preiss etal., 2007). Indeed, following additional

press coverage through 2011 and advocacy by public health

organizations, a new MLB contract was reached limiting

SLT’s use and visibility during games and public appearances

(Campaign for Tobacco Free Kids, n.d.). News articles also

discussed other policy issues of local importance to states and

communities, fulfilling a traditional news value for stories of

“proximity” (Curtin & Rhodenbaugh, 2001; The Oregonian,

n.d.). For example, articles reflected community conflict over

various issues such as banning SLT company sponsorships of

local rodeo events, and proposed changes to SLT taxation.

Consistent with previous research (Clegg Smith et al.,

2006), this study also found that the majority of opinion

articles expressed slants supportive of various tobacco con-

trol measures, such as regulating tobacco sponsorships and

banning SLT use in baseball. However, a substantial propor-

tion (25%) included protobacco slants. While these included

Table 4. Slant of Opinion Articles, by Article Type, Topic, and Source

Anti-SLT/

protobacco control

Pro-SLT/

antitobacco control

Neutral/

mixed slant

Type of opinion article

Editorial/opinion column (n=70) 70.0% 12.9% 17.1%

Letters to the editor (n=89) 59.6% 33.7% 6.7%

Op-ed article (n=17) 58.8% 35.3% 5.9%

Any opinion article (n=176) 63.6% 25.6% 10.8%

SLT topic of opinion articles (n=176)

Health risks (n=4) 100% 0 0

Prevention and/or cessation (n=14) 92.9% 0 7.1%

Tobacco promotional activities (n=11) 90.9% 9.1% 0

Profiles/trends in SLT use (n=24) 75.0% 12.5% 12.5%

SLT taxes (n=29) 69.0% 13.8% 17.2%

SLT bans (n=29) 48.3% 37.9% 13.8%

New products/regulation/harm reduction (n=61) 50.8% 42.6% 6.6%