Although electronic cigarettes (e-cigarettes or electronic nicotine delivery systems) are aggressively promoted as smoking cessation aids,¹ studies of their effectiveness for cessation have been unconvincing.^2,3 One randomized trial comparing e-cigarettes with and without nicotine with a nicotine patch found no differences in 6-month quit rates.² Population-based, longitudinal studies have also not shown associations between e-cigarette use and quitting.^4,5 A longitudinal, international study found that, although 85% of smokers who used e-cigarettes reported using them to quit, e-cigarette users did not quit more frequently than nonusers (P = .52).⁴ Among US quitline callers, e-cigarette users were less likely to have quit at 7 months than nonusers.⁵ We conducted a longitudinal analysis of a national sample of current US smokers to determine whether e-cigarette use predicted successful quitting or reduced cigarette consumption.

Objectives. We investigated the frequency of alternative tobacco product use (loose leaf, moist snuff, snus, dissolvables, electronic cigarettes [e-cigarettes]) among smokers and the association with quit attempts and intentions. Methods. A nationally representative probability-based cross-sectional survey of 1836 current or recently former adult smokers was completed in November 2011. Multivariate logistic regressions evaluated associations between alternative tobacco product use and smoking cessation behaviors. Results. Of the smokers, 38% had tried an alternative tobacco product, most frequently e-cigarettes. Alternative tobacco product use was associated with having made a quit attempt, and those intending to quit were significantly more likely to have tried and to currently use the products than were smokers with no intentions to quit. Use was not associated with successful quit attempts. Interest in future use of alternative tobacco products was low, except for e-cigarettes. Conclusions. Alternative tobacco products are attractive to smokers who want to quit smoking, but these data did not indicate that alternative tobacco products promote cessation. Unsubstantiated overt and implied claims that alternative tobacco products aid smoking cessation should be prohibited.

Since 2006, RJ Reynolds (RJR) and Philip Morris have both introduced new smokeless “snus” tobacco products. We analyzed previously secret tobacco industry documents describing the history of RJR and Philip Morris's consumer research, smokeless product development, and marketing strategies. We found that RJR had invested in smokeless research, development, and marketing since 1968. RJR first targeted low-income males through sampling and sponsorship at fishing, rodeo, and baseball events, and through advertising portraying the user as “hard working.” In the early 1990s, Philip Morris and RJR hoped to attract more urban, female smokeless users. The current “snus” campaigns appear to appeal to these targeted consumers and smokers in smoke-free environments. These efforts may expand the tobacco market and undermine smoking cessation.

Objectives Describe tobacco companies' marketing strategies targeting low socioeconomic status (SES) females in the USA. Methods Analysis of previously secret tobacco industry documents. Results Tobacco companies focused marketing on low SES women starting in the late 1970s, including military wives, low-income inner-city minority women, ‘discount-susceptible’ older female smokers and less-educated young white women. Strategies included distributing discount coupons with food stamps to reach the very poor, discount offers at point-of-sale and via direct mail to keep cigarette prices low, developing new brands for low SES females and promoting luxury images to low SES African-American women. More recently, companies integrated promotional strategies targeting low-income women into marketing plans for established brands. Conclusions Tobacco companies used numerous marketing strategies to reach low SES females in the USA for at least four decades. Strategies to counteract marketing to low SES women could include (1) counteracting price discounts and direct mail coupons that reduce the price of tobacco products, (2) instituting restrictions on point-of-sale advertising and retail display and (3) creating counteradvertising that builds resistance to psychosocial targeting of low SES women. To achieve health equity, tobacco control efforts are needed to counteract the influence of tobacco industry marketing to low-income women.