Exposure and response to current text-only smokeless tobacco health warnings among smokeless tobacco users aged ≥ 18 years, United States, 2012-2013

Introduction. We assessed US adult smokeless tobacco (SLT) users' exposure and response to SLT health warnings, which are currently in text-only format, covering 30% of the two primary surfaces of SLT containers and 20% of advertisements. Methods. Data were from the 2012-2013 National Adult Tobacco Survey. Past 30-day exposure to SLT health warnings among past 30-day SLT users (n = 1626) was a self-report of seeing warnings on SLT packages: "Very often," "Often," or "Sometimes"(versus "Rarely" or "Never"). We measured the association between SLT health warning exposure and perceptions of SLT harmfulness and addictiveness using logistic regression. Results. Of past 30-day SLT users, 77.5% reported exposure to SLT health warnings, with lower prevalence reported among females and users of novel SLT products (snus/dissolvable tobacco). Furthermore, exposure reduced linearly with reducing education and annual household income (p < 0.01). Among exposed past 30-day SLT users, 73.9% reported thinking about the health risks of SLT, while 17.1% reported stopping SLT use on = 1 occasion within the past 30 days. Exposure to SLT warnings was associated with perceived SLT harmfulness (AOR = 2.16; 95% CI = 1.15-4.04), but not with perceived SLT addictiveness. Conclusion. Socioeconomic disparities found in exposure and response to SLT health warnings can be addressed through implementation of large pictorial warnings. Published by Elsevier Inc.