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Table 2 Key factors influencing tobacco control efforts against smokeless tobacco—USA up to 1986

From: Origins in the USA in the 1980s of the warning that smokeless tobacco is not a safe alternative to cigarettes: a historical, documents-based assessment with implications for comparative warnings on less harmful tobacco/nicotine products

Factor Before: 1960s–1980 During: 1981–1986
1) Evidence of disease Smokeless was not judged officially to cause any disease in the USA, while smoking was judged a major cause of serious disease and disability. Smokeless was judged “not safe”:
1) An NCI study treated as definitive on oral cancer
2) Prominent case of young man viewed as dying from oral cancer from smokeless
2) Use of smokeless Declining use by mostly older adults in rural areas and some occupations Rising use in general population and by youth
3) Public perception and industry marketing of smokeless as a safe alternative to cigarettes Marketing of smokeless tobacco with no health warnings, but for cigarettes health warnings and several years no radio/TV marketing Widespread radio/TV and print marketing of Skoal Bandits® with “Take a pouch instead of a puff” slogan and endorsements by athletes
4) Evidence-based assessment that smokeless is not safe, needs a warning label, and other control measures None a) Petition to Federal Trade Commission
b) Action by several states to require warning labels
c) Legislation on rotating warnings, ban of electronic advertising, and other measures
5) Evidence-based assessment that smokeless tobacco is not safer than cigarettes None None