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Liber AC, Seidenberg AB, Pesko MF. MRTP claim authorisation and General Snus sales in the USA: evidence from a difference-in-differences model. Tob Control 2024; 33:825-828. [PMID: 37344192 DOI: 10.1136/tc-2022-057890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 06/07/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND The 2009 Tobacco Control Act granted the US Food and Drug Administration (FDA) regulatory authority over tobacco products, including the ability to authorise modified-risk tobacco product (MRTP) claims. In October 2019, the FDA authorised the first-ever MRTP claim for General Snus, which allowed the product to be marketed as reduced risk (relative to cigarettes). MRTP authorisation may increase otherwise low rates of snus use in the USA (<0.5% for children and adults). METHODS Using 2017-2021 Nielsen sales data from 19 US states, we conducted a difference-in-differences analysis to determine whether logged unit sales of General Snus were affected by the MRTP authorisation, compared with (1) sales of other snus brands and (2) sales of non-snus smokeless products; we also examined (3) if sales of non-General Snus brands were affected by General Snus's MRTP authorisation, compared with sales of non-snus smokeless tobacco products. RESULTS Although sales declined in absolute terms, sales of General Snus relative to other snus brands were unchanged after MRTP authorisation (-9.0%, 95% CI -19.6% to 1.60%, p=0.098). However, compared with non-snus smokeless brand sales, sales of General Snus (+14.7%, 95% CI 5.23% to 24.2%, p=0.002) rose after MRTP authorisation. Compared with non-snus smokeless products, sales of non-General Snus brands also rose after MRTP authorisation (+23.7%, 95% CI 9.5% to 38.0%, p=0.001). CONCLUSIONS Although only General Snus received MRTP authorisation, this designation appears to have slowed declines for the entire snus category. This suggests consumers may make determinations regarding product risk to a product class rather than individual products.
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Affiliation(s)
- Alex C Liber
- Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | | | - Michael F Pesko
- Public Health, Georgia State University Andrew Young School of Policy Studies, Atlanta, GA, USA
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Whaley RC, Vogel EA, Clementel AC, Barrington-Trimis JL, McConnell R, Liu F, Sussman S, Harlow AF, Unger JB, Tackett AP, Leventhal AM. Effects of exposure to snus marketing with versus without modified risk tobacco product claims on snus use intention and perceived harm among young adults. Tob Control 2024:tc-2024-058651. [PMID: 39084902 DOI: 10.1136/tc-2024-058651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 07/09/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND We tested whether snus marketing with modified risk tobacco product (MRTP) claims: (a) promotes accurate knowledge about snus's health effects in young adults and (b) encourages use intentions in only those who use combustible tobacco without attracting other young adult populations. METHODS A randomised between-subjects experiment was embedded in a 2020 web survey of participants from Los Angeles (aged 19-23 years). Participants viewed mass-marketed snus advertising materials with (n=1212) vs without (n=1225) US Food and Drug Administration-authorised MRTP claims. After advertising exposure, snus use intention and perceptions of snus harms relative to cigarettes or e-cigarettes were measured. RESULTS Advertisements with versus without MRTP claims did not affect snus use intention (18.0% vs 19.4%) but produced a higher prevalence of perceptions that snus was less harmful than cigarettes (12.6% vs 9.1%; p=0.007) and e-cigarettes (8.0% vs 5.8%; p=0.04). MRTP claim exposure effects did not differ by past 30-day e-cigarette or combustible tobacco use. Snus use intentions after marketing exposure, collapsed across MRTP claim conditions, were higher in those who did versus did not report past 30-day use of e-cigarettes (38.4% vs 14.3%; adjusted OR (95% CI) 2.95 (2.28 to 3.81); p<0.001) or combustible tobacco (44.0% vs 16.2%; adjusted OR (95% CI) 2.26 (1.62 to 3.16); p<0.001). CONCLUSION Although some young adults who vape or smoke may have snus use intentions, snus MRTP claims might not affect young adults' snus use intentions, regardless of whether they vape/smoke. MRTP claims might modestly increase the accuracy of perceived harms of snus relative to cigarettes while also slightly causing unsubstantiated perceptions of lower harm than e-cigarettes.
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Affiliation(s)
- Reid C Whaley
- Department of Population and Public Health Sciences, Keck School of Medicine University of Southern California, Los Angeles, California, USA
- USC Institute for Addiction Science, Los Angeles, California, USA
| | - Erin A Vogel
- USC Institute for Addiction Science, Los Angeles, California, USA
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Ariana Coba Clementel
- Dana and David Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, California, USA
| | - Jessica L Barrington-Trimis
- USC Institute for Addiction Science, Los Angeles, California, USA
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Rob McConnell
- USC Institute for Addiction Science, Los Angeles, California, USA
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Feifei Liu
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Steve Sussman
- USC Institute for Addiction Science, Los Angeles, California, USA
- Departments of Population and Public Health Sciences and Psychology, and School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Alyssa F Harlow
- USC Institute for Addiction Science, Los Angeles, California, USA
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Jennifer B Unger
- USC Institute for Addiction Science, Los Angeles, California, USA
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Alayna P Tackett
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Adam M Leventhal
- USC Institute for Addiction Science, Los Angeles, California, USA
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
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Kong AY, Westneat SC, Anesetti-Rothermel A, van de Venne JG, Debnam C, Ribisl KM, Cohn AM, Rose SW. Neighborhood Inequities in Tobacco Product Descriptors, Washington, DC, 2018-2019. Nicotine Tob Res 2024; 26:S73-S81. [PMID: 38817025 PMCID: PMC11140226 DOI: 10.1093/ntr/ntad226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 11/02/2023] [Accepted: 11/07/2023] [Indexed: 06/01/2024]
Abstract
BACKGROUND The tobacco industry uses product descriptors to communicate reduced harm and increase appeal. This cross-sectional study assessed store-level racial, ethnic, and socioeconomic inequities in the distribution of retail tobacco product descriptors in a convenience sample of retailers in Washington, DC. METHODS Young adults (n = 146) who did not currently use tobacco reported real-time store visits over 14 days. Trained data collectors took high-resolution photographs of all tobacco (including e-cigarette) marketing in each store (n = 96) participants visited. We coded text descriptors on tobacco product advertisements and displays into descriptor categories (eg, fruit, sweet, concept). We fit multilevel models to examine relationships between store neighborhood census tract-level racial, ethnic, and socioeconomic characteristics and tobacco product descriptors in stores. As a supplementary analysis, we used geospatial methods to model predicted patterns of descriptors at the census tract level. RESULTS Stores located in census tracts with the highest versus lowest percentage of Black residents had a greater count of fruit, sweet or dessert, alcohol, and concept descriptors (p < .05), similar to findings from the geospatial approach. Adjusted models also indicated some inequities in stores in census tracts with higher percentages of Hispanic or Latino residents for fruit, alcohol, and concept descriptors; however, tract-level models showed opposite results for concept flavors. CONCLUSIONS In this convenience sample, fruit, alcohol, sweet/dessert, and concept FTP descriptors were prevalent in stores in neighborhoods with more Black residents demonstrated through two analytic approaches. Surveillance using representative samples of tobacco retailers could improve the ability to track the extent of this inequity. IMPLICATIONS We document inequities in the amount of fruit, sweet or dessert, alcohol, and concept flavor descriptors in stores across neighborhoods in Washington, DC. Federal, state, and local regulatory action is needed to reduce inequities in flavored tobacco product availability and marketing, including for concept flavors.
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Affiliation(s)
- Amanda Y Kong
- Family & Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Susan C Westneat
- University of Kentucky, Center for Health Equity Transformation and Behavioral Science College of Medicine, Lexington, KY, USA
| | - Andrew Anesetti-Rothermel
- University of Kentucky, Center for Health Equity Transformation and Behavioral Science College of Medicine, Lexington, KY, USA
| | - Judy G van de Venne
- University of Kentucky, Center for Health Equity Transformation and Behavioral Science College of Medicine, Lexington, KY, USA
| | | | - Kurt M Ribisl
- Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Amy M Cohn
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Shyanika W Rose
- University of Kentucky, Center for Health Equity Transformation and Behavioral Science College of Medicine, Lexington, KY, USA
- Markey Cancer Center, Lexington, KY, USA
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Seidenberg AB, Boynton MH, Brewer NT, Lazard AJ, Sheeran P, Ribisl KM. Effects of Modified Risk Tobacco Product Claims on Consumer Responses. Nicotine Tob Res 2024; 26:435-443. [PMID: 37791605 PMCID: PMC10959159 DOI: 10.1093/ntr/ntad187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 09/06/2023] [Accepted: 09/27/2023] [Indexed: 10/05/2023]
Abstract
INTRODUCTION US tobacco manufacturers can seek authorization from the US Food and Drug Administration (FDA) to market products using modified risk tobacco product (MRTP) claims. To inform regulatory decisions, we examined the impact of MRTP claim specificity and content, including whether the claims produced halo effects (ie, inferring health benefits beyond what is stated). AIMS AND METHODS Participants were 3161 US adult cigarette smokers. Using a two (general vs. specific) × 2 (risk vs. exposure) plus independent control design, we randomized participants to view one message from these conditions: general risk claim (eg, "smoking-related diseases"), general exposure claim (eg, "chemicals in smoke"), specific risk claim (eg, "lung cancer"), specific exposure claim (eg, "arsenic"), or control. Claims described the benefits of completely switching from cigarettes to the heated tobacco product IQOS. RESULTS MRTP claims of any sort elicited a higher willingness to try IQOS relative to control (d = 0.09, p = .043). Claims also elicited lower perceived risk of disease and exposure to harmful chemicals for completely switching from cigarettes to IQOS (d = -0.32 and -0.31) and partially switching (d = -0.25 and d = -0.26; all p < .05). Relative to specific MRTP claims, general MRTP claims led to lower perceived risk and exposure for complete switching (d = -0.13 and d = -0.16) and partial switching (d = -0.14 and d = -0.12; all p < .05). Risk and exposure MRTP claims had similar effects (all p > .05). DISCUSSION MRTP claims led to lower perceived risk and exposure, and higher willingness to try IQOS. General claims elicited larger effects than specific claims. MRTP claims also promoted unintended halo effects (eg, lower perceived risk of disease and chemical exposure for partial switching). IMPLICATIONS We found evidence that MRTP claims promoted health halo effects. In light of these findings, the FDA should require research on halo effects prior to authorization. Further, if an MRTP claim is authorized, FDA should require tobacco manufacturers to conduct post-market surveillance of how the claim affects consumer understanding, including partial switching perceived risk and exposure beliefs, as well as monitoring of dual-use behaviors.
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Affiliation(s)
- Andrew B Seidenberg
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Schroeder Institute, Truth Initiative, Washington, DC, USA
| | - Marcella H Boynton
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Allison J Lazard
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Paschal Sheeran
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kurt M Ribisl
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Noar SM, Jang Y, Nguyen Zarndt A, Zhao X, Ross JC, Cappella JN. Achieving Public Health Impact: Health Communication Research to Inform Tobacco Regulatory Science. HEALTH COMMUNICATION 2024:1-8. [PMID: 38478963 PMCID: PMC11393175 DOI: 10.1080/10410236.2024.2326250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
Health communication research applies communication science to develop generalizable knowledge capable of improving the health and well-being of individuals and communities. But to what extent does the knowledge generated by the health communication field actually achieve public health impact? To answer this question, we discuss the application of health communication science and research within a tobacco regulatory science framework. We describe three areas in which health communication research funded by the Food and Drug Administration (FDA) Center for Tobacco Products (CTP) contributed to 1) youth tobacco prevention campaigns, 2) cigarette health warnings, and 3) regulation of labeling, advertising, and marketing claims. These examples demonstrate how communication regulatory science achieves public health impact in the real world by informing national policies, regulatory actions, and public health practice.
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Affiliation(s)
- Seth M Noar
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Youjin Jang
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Anh Nguyen Zarndt
- Office of Health Communication and Education, FDA Center for Tobacco Products
| | - Xiaoquan Zhao
- Office of Health Communication and Education, FDA Center for Tobacco Products
- Department of Communication, George Mason University
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Berg CJ, Duan Z, Wang Y, Thrasher JF, Abroms LC, Khayat A, Romm KF, Levine H, Bar-Zeev Y. Impact of different health warning label and reduced exposure messages in IQOS ads on perceptions among US and Israeli adults. Prev Med Rep 2023; 33:102209. [PMID: 37223575 PMCID: PMC10201851 DOI: 10.1016/j.pmedr.2023.102209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/16/2022] [Accepted: 04/12/2023] [Indexed: 05/25/2023] Open
Abstract
Heated tobacco products (HTPs; e.g., IQOS) are advertised as safer than cigarettes or an alternative, yet required health warning labels (HWLS) in many countries, including the US and Israel, do not consider whether HTP ads undermine HWLs, particularly those that do not explicitly address HTPs. In 2021, a randomized 4 × 3 factorial experiment among 2,222 US and Israeli adults examined IQOS ads with differing: 1) HWLs (i.e., smoking risks, prompt to quit, HTP-specific, control); and 2) ad messages (i.e., slight distancing: "cigarette-like satisfaction, no odor", clear distancing: "looking for an alternative?", control). Outcomes were perceived relative harm (vs cigarettes), exposure to harmful chemicals, and disease risk and likelihood of trying or suggesting IQOS to smokers. Ordinal logistic regression was used, adjusted for covariates. One HWL effect was found: risk (vs control) increased perceived relative harm (aOR = 1.21, CI = 1.03-1.41) and exposure (aOR = 1.22, CI = 1.04-1.42) and decreased likelihood of trying IQOS (aOR = 0.82, CI = 0.69-0.97). Both slight and clear distancing ads (vs control) decreased perceived harm (aOR = 0.85, CI = 0.75-0.97; aOR = 0.63, CI = 0.55-0.72, respectively) and increased likelihood of suggesting IQOS to smokers (aOR = 1.23, CI = 1.07-1.41; aOR = 1.28, CI = 1.11-1.47); slight distancing decreased perceived disease risk (aOR = 0.85, CI = 0.75-0.97); and clear distancing decreased perceived exposure (aOR = 0.73, CI = 0.64-0.83). Clear (vs slight) distancing decreased perceived relative harm (aOR = 0.74, CI = 0.65-0.85) and exposure (aOR = 0.82, CI = 0.71-0.93). One interaction effect was found: the quitting HWL and clear distancing led to particularly low perceived relative harm (aOR = 0.63, CI = 0.43-0.93). Regulatory agencies must monitor the impacts of advertising, including reduced risk/exposure messaging on perceptions of HWL messages, to inform future regulatory efforts.
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Affiliation(s)
- Carla J. Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Zongshuan Duan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - James F. Thrasher
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Lorien C. Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Amal Khayat
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah, Jerusalem, Israel
| | - Katelyn F. Romm
- TSET Health Promotion Research Center, Stephenson Cancer Center; Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah, Jerusalem, Israel
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah, Jerusalem, Israel
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Chen-Sankey JC, Kechter A, Barrington-Trimis J, McConnell R, Krueger EA, Cruz TB, Unger JB, Chaffee BW, Leventhal A. Effect of a hypothetical modified risk tobacco product claim on heated tobacco product use intention and perceptions in young adults. Tob Control 2023; 32:42-50. [PMID: 34059552 PMCID: PMC8630081 DOI: 10.1136/tobaccocontrol-2021-056479] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/01/2021] [Accepted: 04/06/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Modified risk tobacco product (MRTP) claims for heated tobacco products (HTPs) that convey reduced exposure compared with conventional cigarettes may promote product initiation and transition among young people. We assessed the effects of a hypothetical MRTP claim for HTPs on young adults' intention and perceptions of using HTPs and whether these effects differed by their current cigarette and e-cigarette use. METHODS We embedded a randomised between-subjects experiment into a web-based survey administered among a cohort of 2354 Southern California young adults (aged 20-23) in 2020. Participants viewed depictions of HTPs with an MRTP claim (n=1190) or no claim (n=1164). HTP use intention and HTP-related harm and use perceptions relative to cigarettes and e-cigarettes were assessed. RESULTS Overall, participants who viewed versus did not view the claim did not differ in HTP use intention (28.5% vs 28.7%) but were more likely to perceive HTPs as less harmful than cigarettes (11.4% vs 7.0%; p<0.001). The experimental effect on HTP use intention did not differ among past 30-day cigarette smokers versus non-smokers (interaction adjusted OR (AOR)=0.78, 95% CI 0.36 to 1.76) but differed among past 30-day e-cigarette users versus non-users (interaction AOR=1.67, 95% CI 1.02 to 2.68). DISCUSSION The hypothetical MRTP claim may lower young adults' HTP harm perceptions compared with cigarettes but may not change HTP use intention overall or differentially for cigarette smokers. The larger effect on HTP use intention among e-cigarette users than non-users raises the question of whether MRTP claims may promote HTP use or HTP and e-cigarette dual use among young e-cigarette users.
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Affiliation(s)
- Julia C Chen-Sankey
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA
| | - Afton Kechter
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Jessica Barrington-Trimis
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, California, USA
| | - Rob McConnell
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Evan A Krueger
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Tess Boley Cruz
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Jennifer B Unger
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Benjamin W Chaffee
- Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, USA
| | - Adam Leventhal
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, California, USA
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Wackowski OA, O'Connor RJ, Diaz D, Rashid M, Lewis MJ, Greene K. '95% less harmful'? Exploring reactions to quantitative modified risk claims for snus and e-cigarettes. Tob Control 2022; 31:730-736. [PMID: 33753549 PMCID: PMC8455704 DOI: 10.1136/tobaccocontrol-2020-056303] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/03/2021] [Accepted: 02/11/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Studies examining perceptions of 'modified risk tobacco product' (MRTP) messages for e-cigarettes and smokeless tobacco have indicated consumers want statistics and quantification of harm reduction. However, limited research exists on reactions to quantitative MRTP messages. DESIGN We conducted 12 focus groups in the USA in 2019-6 focused on e-cigarette messages and 6 on snus messages. Eight groups were with current smokers (ages 21-66) and four with young adult (ages 18-25) non-smokers (n=57). Participants discussed messages stating that use of snus and vaping products have been estimated by scientists to be about 90% and 95% less harmful than smoking cigarettes, respectively. RESULTS Several participants agreed the messages strongly communicated that the products are less harmful than cigarettes, were attention getting and could be 'convincing'. However, participants expressed scepticism about the source and accuracy of the stated figures, and some noted the claims could be misleading and attractive to young people. Comments also reflected some claim misunderstandings (eg, that e-cigarettes only pose a 5% chance of harm). Participants also agreed that stating e-cigarette risks 'are unlikely to exceed 5% of cigarette smoking harms' was confusing and less impactful than the '95% less harmful' wording. CONCLUSIONS Quantitative claims suggesting high levels of reduced risk when comparing e-cigarettes or smokeless tobacco/snus relative to cigarettes may be successful in gaining attention and being persuasive for some audiences, particularly, if from more credible sources. However, message developers, users and evaluators should be mindful of message limitations and aim to mitigate unintended consequences.
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Affiliation(s)
- Olivia A Wackowski
- Center for Tobacco Studies, Rutgers The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Destiny Diaz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Mariam Rashid
- Center for Tobacco Studies, Rutgers The State University of New Jersey, New Brunswick, New Jersey, USA
| | - M Jane Lewis
- Center for Tobacco Studies, Rutgers The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Kathryn Greene
- Department of Communication, Rutgers University, New Brunswick, New Jersey, USA
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9
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Yang B, Massey ZB, Popova L. Effects of modified risk tobacco product claims on consumer comprehension and risk perceptions of IQOS. Tob Control 2022; 31:e41-e49. [PMID: 33688084 PMCID: PMC8426425 DOI: 10.1136/tobaccocontrol-2020-056191] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/30/2020] [Accepted: 01/06/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Tobacco industry studies on consumers' perceptions of modified risk claims (MRCs) often had important omissions (eg, no control group, not investigating whether consumers understand what 'switching completely' means). This study examined the effects of IQOS MRCs on risk perceptions and behavioural intentions. METHOD Based on tobacco companies' MRCs, we manipulated three MRC language features: explanation about 'switching completely' (absent vs present), number of diseases (single vs multiple) and language certainty (hypothetical vs certain). In an online experiment, we randomised 1523 US adult current smokers and 1391 young adult non-smokers to 1 of 9 conditions following a 2×2×2+1 control design. People reported their comprehension of 'switching completely', IQOS risk perceptions and behavioural intentions after message exposure. RESULTS More smokers exposed to MRCs that included an explanation about 'switching completely' (22.2%) (vs explanation absent (11.2%) and control (10.7%)) mentioned that 'switching completely' meant smoking 0 cigarettes. Compared with the control, several MRCs (eg, certain language) produced lower perceived risk of IQOS, including for diseases not mentioned in the MRCs. MRCs using certain and hypothetical language did not differ on any outcomes. MRCs highlighting reduced risk for a single disease and multiple diseases did not differ on any outcomes. MRCs did not influence behavioural intentions. CONCLUSION The Food and Drug Administration should ensure that consumers understand what 'switching completely' means in an MRC and recognize that some language features may mislead consumers into believing that a product reduces the risk of diseases not mentioned in an MRC.
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Affiliation(s)
- Bo Yang
- Department of Communication, University of Arizona, Tucson, Arizona, USA
| | - Zachary B Massey
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
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Stubbs T, Thomas S, Pitt H, Daube M. Do health halos and conspicuous consumption influence the appeal and risk perceptions of e-cigarettes among young Cambodian men? Tob Control 2021; 31:505-510. [PMID: 33504583 DOI: 10.1136/tobaccocontrol-2020-056110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/10/2020] [Accepted: 11/18/2020] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Reduced risk perceptions influence young people's consumption behaviours of e-cigarettes, suggesting that a health halo effect may be associated with these devices. Product, performative, and social factors contribute to the appeal of e-cigarettes, with young people using e-cigarettes with friends as part of social interactions. This study explored the factors that influence the appeal and risk perceptions associated with e-cigarettes among young Cambodian men. METHODS A mixed-method, interviewer-administered survey with 147 young men in Cambodia, who were aged between 18 and 24 years and identified as cigarette smokers. Participants described their attitudes and consumption behaviours surrounding e-cigarettes, recalled e-cigarette promotions, and described their risk perceptions towards e-cigarettes. Descriptive statistics were calculated for quantitative data, and thematic analysis was conducted for qualitative data. RESULTS Some participants associated e-cigarettes with affluence and exclusivity, describing these devices as products that rich and/or younger people use. Participants also described product attributes that were appealing about e-cigarettes, such as variety of flavours, vapour, and performing smoke 'styles' with friends, which differentiated the product from combustible cigarettes. Participants also had reduced risk perceptions towards e-cigarettes, with some commenting that e-cigarettes were not harmful or might be health-enhancing. CONCLUSION Some young people may perceive e-cigarettes as a form of conspicuous consumption, which they associated with social status and identity. A health halo effect appears to be associated with e-cigarettes among some young people. This may influence young people to underestimate the potential health risks associated with these devices.
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Affiliation(s)
- Thomas Stubbs
- Institute of Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Samantha Thomas
- Institute of Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Hannah Pitt
- Institute of Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Mike Daube
- Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
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Delnevo CD, Hrywna M, Miller Lo EJ, Wackowski OA. Examining Market Trends in Smokeless Tobacco Sales in the United States: 2011-2019. Nicotine Tob Res 2020; 23:1420-1424. [PMID: 33241271 DOI: 10.1093/ntr/ntaa239] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/23/2020] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The smokeless tobacco (SLT) industry in the U.S. continues to transform with novel products amid an evolving regulatory environment. We report SLT sales trends in the U.S. by analyzing retail market scanner data from 2011 through 2019. METHODS National SLT sales data were obtained from Nielsen's Convenience Track System for January 2011 to December 2019. UPC codes were used to classify products by attributes including type, parent company, brand, form, and flavor. Market share was calculated as percentage of total unit sales. Detailed product analysis was presented for moist snuff, snus, and tobacco-free nicotine products. RESULTS SLT sales increased by 5.8% between 2011 and 2016 but declined by 3.9% from 2016 to 2019. Moist snuff sales increased by 8.1% between 2011 and 2016 and then declined 7.4% from 2016 to 2019 but still accounted for roughly 90% of the overall market annually. Between 2011 and 2019, snus sales consistently increased while sales of chew, dry snuff, and dissolvables decreased. Tobacco-free nicotine products emerged in 2016 and captured 4.0% of the market by 2019. Portion pouch packaging and flavors showed consistent growth although their popularity varied by the type of smokeless product. CONCLUSION This study extends our previous work on U.S. SLT market trends through 2019. Overall sales increased between 2011 and 2016 but there were signs of leveling off including declining sales of moist snuff. Newer products continue to gain market share. Continued monitoring of SLT sales is needed, particularly given the new modified risk status of several products. IMPLICATIONS This study analyzed the last 9 years of smokeless tobacco market data (2011-2019) to describe recent trends in sales. Overall, the smokeless product category is quite resilient although signs suggest downward trends among some product categories and features. New types of smokeless tobacco products (eg, snus and tobacco-free nicotine pouches) account for a growing share of the market.
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Affiliation(s)
- Cristine D Delnevo
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ.,Department of Health Behavior, Society & Policy, Rutgers School of Public Health, Piscataway, NJ
| | - Mary Hrywna
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ.,Department of Health Behavior, Society & Policy, Rutgers School of Public Health, Piscataway, NJ
| | - Erin J Miller Lo
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ
| | - Olivia A Wackowski
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ.,Department of Health Behavior, Society & Policy, Rutgers School of Public Health, Piscataway, NJ
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