{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T15:07:17Z","timestamp":1771945637320,"version":"3.50.1"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2025,2,26]],"date-time":"2025-02-26T00:00:00Z","timestamp":1740528000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Oklahoma Shared Clinical and Translational Resources","award":["U54GM104938"],"award-info":[{"award-number":["U54GM104938"]}]},{"DOI":"10.13039\/100019038","name":"HPRC","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100019038","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Little is known about the use of modified risk smokeless tobacco products (MRSTP) and flavored smokeless tobacco (ST) products among American Indians (AIs). Aim of this study is to evaluate differences in tobacco use characteristics, ST dependence, and cotinine levels according to the use of flavored ST and MRSTP among AI ST users.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Study was based on cross-sectional data collected from a community-based sample of 120 adult male AI exclusive ST users. Sociodemographic characteristics, tobacco use behaviors, ST dependence, and characteristics of ST products were obtained through phone surveys. Saliva samples were collected to measure cotinine levels. MRSTP users were defined as those who used Copenhagen Classic Snuff. Associations of flavored ST and MRSTP with tobacco use behaviors, cotinine, and ST dependence were evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The majority of study participants (58.3%) used non-flavored ST, whereas 12% reported MRSTP use. Flavored ST use was significantly more prevalent among young adults (62.5%). Flavored ST users had significantly lower number of dips per day, cotinine levels, and severity of dependence compared to non-flavored product users. MRSTP users were significantly older in age and had more years of ST use compared to non-MRSTP users. There were no differences in cotinine level, ST dependence, and past quit attempts based on MRSTP use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>AI ST users have high prevalence of non-flavored ST use. Findings of ST-related abuse liability among MRSTP users suggest a limited role of these products in facilitating complete tobacco cessation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications<\/jats:title>\n                    <jats:p>The study findings provide insights into the possible impact of FDA\u2019s smokeless tobacco-related regulations, such as the designation of certain ST products as modified risk tobacco products and the sale of flavored ST products on ST use. The high prevalence of flavored ST among young AI ST users underscores the need for stringent regulations of flavored ST products. Findings of ST-related abuse liability among MRSTP users suggest a limited role of these products in facilitating complete tobacco cessation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ntr\/ntaf047","type":"journal-article","created":{"date-parts":[[2025,2,25]],"date-time":"2025-02-25T08:22:50Z","timestamp":1740471770000},"page":"1633-1640","source":"Crossref","is-referenced-by-count":0,"title":["Use of Flavored and Modified Risk Smokeless Tobacco Products Among American Indian Adults"],"prefix":"10.1093","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2686-7601","authenticated-orcid":false,"given":"Nasir","family":"Mushtaq","sequence":"first","affiliation":[{"name":"Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center , Tulsa, OK ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kate","family":"Kouplen","sequence":"additional","affiliation":[{"name":"University of New Mexico School of Medicine , Albuquerque, NM ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5784-9203","authenticated-orcid":false,"given":"Laura A","family":"Beebe","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center , Oklahoma City, OK ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,2,26]]},"reference":[{"key":"2026022409165813100_CIT0001","volume-title":"Trends in Smokeless Tobacco Use and Initiation: 2002 to 2014. 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