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Fix BV, Wackowski OA, Sharma A, Diaz D, Bansal-Travers M, Cummings KM, Rees VW, Hatsukami DK, O'Connor RJ. Perceived Truthfulness of Reduced Lung Cancer Risk Advertising Claims Influences Consumers' Intention to try and to Purchase Snus. Tob Use Insights 2023; 16:1179173X231206042. [PMID: 37842177 PMCID: PMC10576425 DOI: 10.1177/1179173x231206042] [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: 02/27/2023] [Accepted: 09/20/2023] [Indexed: 10/17/2023] Open
Abstract
The objective of the current study was to evaluate the impact of a reduced risk claim about lung cancer, presented in various formats, on smokers' and non-smokers' interest in trying Camel Snus and intention to purchase Camel Snus. We varied claim formats by varying advertising messages for Camel Snus in 4 ways (1) text only; (2) bar chart; (3) text/testimonial; and (4) bar chart/testimonial. 3001 participants were recruited from a web-based consumer specialty panel via an email invitation. In 2015, a second study was conducted, using similar methods, where 3001 additional participants were recruited. Overall, controlling for other factors, the presence of an MRTP claim was not significantly related to interest in trying snus [X2 (4) = 8.567, P = .073], or purchase intentions [X2 (4) = 1.148, P = .887]. Relative to a control ad where no explicit health risk claim was made, the Graphic + testimonial [OR = 1.29] or Text only [OR = 1.41] claims did significantly increase interest in trying Camel Snus. However, the adverting format did not impact interest in purchasing Camel Snus. While current smokeless tobacco users (95%) and smokers (59%) expressed interest in trying Camel Snus, non-tobacco users (7%) showed low interest in trying or purchasing Camel Snus (P < .001). Interest in trying Camel Snus was stronger in younger smokers compared to older smokers. Among current smokers, worry about lung cancer (the key focus of the reduced risk claim) was not associated with interest in trying Camel Snus or with purchase intention [OR = .91, 95% CI: .72, 1.14] or intention to purchase snus [OR = 1.07, 95% CI: .86, 1.32]. Future research should evaluate how claim and messaging formats influence perceived truthfulness and whether this effect differs among sub-groups of consumers, such as adolescents, those with tobacco-related disease, and former smokers. It will also be helpful to understand whether perceptions of ad truthfulness result in changes in product use patterns over time. In sum, giving people truthful, credible information about relative product risks, such as through authorized MRTP claims, is important, but such information is likely insufficient to get smokers to switch.
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Affiliation(s)
- Brian V Fix
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Olivia A Wackowski
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Akshika Sharma
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Destiny Diaz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Vaughan W Rees
- Center for Global Tobacco Control, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Dorothy K Hatsukami
- Department of Psychiatry and Behavioral Sciences and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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Wackowski OA, Bover Manderski MT, Gratale SK, Weiger CV, O’Connor RJ. Perceptions about levels of harmful chemicals in e-cigarettes relative to cigarettes, and associations with relative e-cigarette harm perceptions, e-cigarette use and interest. Addiction 2023; 118:1881-1891. [PMID: 37218410 PMCID: PMC10640892 DOI: 10.1111/add.16258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/25/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND AND AIMS Exposure to chemicals contributes to harm from nicotine products, and e-cigarette communications often refer to chemicals. However, while e-cigarette studies commonly measure perceived harmfulness of e-cigarettes relative to cigarettes, few have assessed comparative perceptions about chemicals. This study measured perceived levels of harmful chemicals in e-cigarettes compared with cigarettes and associations with e-cigarette/cigarette relative harm perceptions, e-cigarette use and interest. DESIGN, SETTING AND PARTICIPANTS This was an on-line cross-sectional survey of adults/young adults from a nationally representative research panel in the United States conducted in January 2021. Participants were independent samples of 1018 adults who smoked cigarettes and 1051 young adult non-smokers (aged 18-29 years). MEASUREMENTS Participants were asked their perceptions of the level of harmful chemicals in e-cigarettes versus cigarettes (fewer/about the same/more/do not know), perceived harmfulness of using e-cigarette versus cigarettes (less/about the same/more/do not know) and their current e-cigarette use and use interest. FINDINGS Approximately 20% of all participants (18.1% of adult smokers, and 21.0% of young adult non-smokers) believed e-cigarettes contain fewer harmful chemicals than cigarettes, while 35.6% of adult smokers and 24.9% of young adult non-smokers responded 'do not know'. Participants more frequently reported 'do not know' to the chemicals item than the harm item. Approximately half (51.0-55.7%) of those who believed e-cigarettes contain fewer harmful chemicals also believed e-cigarettes are less harmful than cigarettes. Both beliefs were associated with higher odds of interest in using e-cigarettes [less harmful belief, odds ratio (OR) = 5.53, 95% confidence interval (CI = 2.93-10.43); fewer chemicals belief, OR = 2.45, 95% CI = 1.40-4.29] and past 30-day e-cigarette use (less harmful belief, OR = 2.53, 95% CI = 1.17-5.44; fewer chemicals belief, OR = 5.09, 95% CI = 2.31-11.19) for adults who smoke, but not young adult non-smokers. CONCLUSIONS In the United States, most adults who smoke cigarettes and young adult non-smokers do not appear to think that e-cigarettes have fewer harmful chemicals than cigarettes, and many are uncertain about how these levels compare.
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Affiliation(s)
- Olivia A. Wackowski
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ
| | - Michelle T. Bover Manderski
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ
| | | | - Caitlin V. Weiger
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ
| | - Richard J. O’Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY
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Chaffee BW, Couch ET, Popova L, Halpern-Felsher B. Effects of a Reduced Risk Claim on Adolescents' Smokeless Tobacco Perceptions and Willingness to Use. J Adolesc Health 2023; 73:445-451. [PMID: 37294249 PMCID: PMC10527275 DOI: 10.1016/j.jadohealth.2023.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 03/13/2023] [Accepted: 04/18/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE United States Smokeless Tobacco Company LLC submitted a modified risk tobacco product application to the US Food and Drug Administration, proposing a claim that switching to Copenhagen snuff fine cut from cigarettes reduces lung cancer risk. This claim could affect adolescents' smokeless tobacco perceptions and its use. METHODS Students (N = 592; mean age: 15.3 years; 46% male; 32% nonHispanic White; 8% smokeless tobacco ever-users) at seven California high schools were randomized within a survey to view a Copenhagen snuff image, either with or without the proposed reduced risk claim. Participants were then asked about the harm of smokeless tobacco and their willingness to try Copenhagen snuff if a friend offered. Postimage harm rating and willingness were compared between image groups overall, stratified by past 30-day tobacco use (87% of tobacco users were e-cigarette users), and adjusted for participant characteristics using multivariable regression. RESULTS Participants who viewed the claim were less likely to perceive smokeless tobacco to cause "a lot" of harm (56% vs. 64%; p = .03), including after statistical adjustment (risk ratio [RR]: 0.84; 95% confidence interval [CI]: 0.75, 0.94), and with a numerically stronger effect among tobacco users (RR: 0.65; 95% CI: 0.48, 0.86). The claim did not increase willingness overall (17% vs. 20%; p = .41) but did increase willingness among tobacco users (RR: 1.67; 95% CI: 1.05, 2.67). DISCUSSION Brief exposure to a reduced-risk claim decreased adolescents' smokeless tobacco harm perceptions and increased willingness to try among tobacco users. The Food and Drug Administration order permitting this claim could increase some adolescents' susceptibility to smokeless tobacco, particularly those already using other tobacco products like e-cigarettes.
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Affiliation(s)
- Benjamin W Chaffee
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California.
| | - Elizabeth T Couch
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California
| | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, Georgia
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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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Sharma A, June KM, Norton KJ, Fix B, Bansal-Travers M, Rees VW, J O'Connor R. Intention to purchase alternative tobacco products as a function of smoking status and responses to advertising, packaging, and sensory experiences. Addict Behav 2022; 130:107291. [PMID: 35220153 PMCID: PMC9376882 DOI: 10.1016/j.addbeh.2022.107291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/07/2021] [Accepted: 02/18/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Tobacco manufacturers design and marketed products with appealing sensory characteristics to drive product uptake and continued use. We assessed smokers' and non-smokers' cognitive, affective, and sensory responses to Camel Snus (CS) and Nicotine gum (NG) to gauge future intentions to use. METHOD In a single laboratory session, 348 participants (including current smokers and nonsmokers in Buffalo, NY and Boston, MA) were exposed to CS and NG products in counterbalanced order. Exposure involved a cumulative set of 3 steps in which participants i) viewed an advertisement; ii) viewed the packaging, and iii) touched and smelled the product, without actual use. Current daily and non-daily smokers were invited to undertake a fourth exposure step by sampling the product. Following product exposure, participants completed perception measures and reported future intentions to use either product at the end of the survey. After each exposure, participants' reported feelings of valence and arousal. RESULTS Smokers reported greater preference to try NG (63.8%) compared with CS (17.4%) or neither (18.8%), whereas majority of nonsmokers preferred neither product (64.3%) (p < 0.01). Of those offered to sample the products, 78.3% daily smokers and 68.4% non-daily smokers opted to sample. When asked about intentions to try, a greater proportion of smokers stated a preference to try NG over CS, as did the small number of nonsmokers who expressed a preference. CONCLUSION Intentions to try CS were low despite different levels of exposure to product, and this low product appeal and interest in use may translate to limited potential of CS to serve as a reduced harm product for smokers.
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Affiliation(s)
- Akshika Sharma
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, United States.
| | - Kristie M June
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, United States.
| | - Kaila J Norton
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, United States; Center for Tobacco Research, Ohio State University Comprehensive Cancer Center, United States.
| | - Brian Fix
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, United States.
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, United States.
| | - Vaughan W Rees
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, United States.
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, United States.
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Wackowski OA, Gratale SK, Rashid MT, Greene K, O'Connor RJ. Exploring the implications of modified risk claim placement in tobacco advertising. Prev Med Rep 2021; 24:101608. [PMID: 34976664 PMCID: PMC8684010 DOI: 10.1016/j.pmedr.2021.101608] [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: 05/17/2021] [Revised: 09/20/2021] [Accepted: 10/17/2021] [Indexed: 11/11/2022] Open
Abstract
The United States Food and Drug Administration (FDA) has developed a regulatory process by which tobacco companies can apply to make "modified risk tobacco product" (MRTP) marketing claims that their product poses a lower risk of disease or exposure to harmful constituents. The impact of MRTP claims to promote harm reduction may be limited by perceptions that claims come from the tobacco industry, lack of attention, and the simultaneous presence of health warnings on ads, which may be perceived as conflicting information. Some studies have examined the potential of alternative "modified risk warnings". We aimed to contribute to this literature by exploring issues of claim attention, perceived source and credibility when viewing MRTP claims within or outside of a warning label. We conducted 11 focus groups with adult smokers and young adult (ages 18-25) non-smokers (n = 54) who viewed three e-cigarette or snus advertisements which varied in where an MRTP message was placed: outside the warning label, inside the warning label, or in a modified label style. Results suggest that MRTP claims presented within or in the style of a warning label (compared to claims outside the label), may be perceived as coming from a government or health-related source rather than a tobacco industry, and thus seem more credible. Yet these formats may receive insufficient message attention, as they are smaller and appear as part of labels consumers are accustomed to ignoring. Future research should further probe effects of MRTP statements and how they vary by message source, channel and format.
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Affiliation(s)
- Olivia A. Wackowski
- Rutgers Center for Tobacco Studies, Rutgers University, 303 George Street, Suite 500, New Brunswick, NJ 08901, USA
| | - Stefanie K. Gratale
- Rutgers Center for Tobacco Studies, Rutgers University, 303 George Street, Suite 500, New Brunswick, NJ 08901, USA
| | - Mariam T. Rashid
- Rutgers Center for Tobacco Studies, Rutgers University, 303 George Street, Suite 500, New Brunswick, NJ 08901, USA
| | - Kathryn Greene
- Department of Communication, School of Communication and Information, Rutgers University, 4 Huntington Street, New Brunswick, NJ 08901, USA
| | - Richard J. O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263, USA
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Ahuja N, Kedia SK, Dillon PJ, Jiang Y, Yu X. Perception and intention of using less harmful and less addictive hypothetical modified risk tobacco products among never tobacco users in the united states. Addict Behav 2021; 122:107016. [PMID: 34147711 DOI: 10.1016/j.addbeh.2021.107016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 06/07/2021] [Accepted: 06/07/2021] [Indexed: 01/03/2023]
Abstract
AIMS There is limited research focusing on how never tobacco users respond to claims associated with modified risk tobacco products (MRTPs). The purpose of the present study is twofold: (1) to identify how never tobacco users perceive hypothetical modified risk tobacco product (MRTP) claims; and (2) to assess whether these perceptions impact their intentions of using MRTPs described as "less harmful" and "less addictive." METHOD The present study draws upon a nationally representative dataset of US adults aged ≥ 18 years (n = 850) from a cross-sectional survey (HINTS-FDA, Cycle 2, 2017). Weighted unadjusted and adjusted logistic regression analyses were performed to analyze the data. RESULTS Participants who perceived tobacco products labeled as having "no additives" to be less harmful were close to three times more likely to report intentions of using "less harmful" (Adjusted OR = 2.93 [95% CI: 1.12-7.65]) and "less addictive" (Adjusted OR = 2.72 [95% CI: 1.03-7.21]) tobacco products than those who perceived them to be more/equally harmful. Participants who believed that tobacco products could be manufactured without some chemicals were over five and six times more likely to report intentions of using "less harmful" (Adjusted OR = 5.53 [95% CI: 1.59-19.25]) and "less addictive" (Adjusted OR = 6.60 [95% CI: 2.65-16.46]) tobacco products than those who were unlikely to believe it. CONCLUSIONS Our findings have implications for FDA's regulation of MRTPs and provides insights regarding how the marketing of authorized MRTPs could impact population health in the future.
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Affiliation(s)
- Nikhil Ahuja
- Division of Social and Behavioral Sciences, University of Memphis, School of Public Health, Memphis, TN, USA.
| | - Satish K Kedia
- Division of Social and Behavioral Sciences, University of Memphis, School of Public Health, Memphis, TN, USA.
| | - Patrick J Dillon
- School of Communication Studies, Kent State University at Stark, North Canton, OH, USA.
| | - Yu Jiang
- Division of Epidemiology and Biostatistics, University of Memphis, School of Public Health, Memphis, TN, USA.
| | - Xinhua Yu
- Division of Epidemiology and Biostatistics, University of Memphis, School of Public Health, Memphis, TN, USA.
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Morgan JC, Silver N, Cappella JN. How did beliefs and perceptions about e-cigarettes change after national news coverage of the EVALI outbreak? PLoS One 2021; 16:e0250908. [PMID: 33930093 PMCID: PMC8087005 DOI: 10.1371/journal.pone.0250908] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 04/07/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Exposure to media content can shape public opinions about tobacco. In early September 2019, the outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) became headline news in the United States. METHODS In August and September 2019, we conducted two cross-sectional online surveys with current and former smokers assessing attitudes and beliefs about e-cigarettes. Study one (n = 865) was collected before the EVALI outbreak was widely covered and study two (n = 344) was collected after the outbreak had become nation-wide news. We examined differences in perceptions and beliefs between time points. RESULTS E-cigarette harm perceptions increased between study one (mean = 2.67) and study two (mean = 2.90, p < .05). Ever-users of e-cigarettes largely account for this change. Endorsement of the belief that e-cigarettes were risky and more likely to cause lung damage compared to cigarettes increased between studies (p < .05). Seventy eight percent of participants at study two were aware of the vaping illness story. Being aware of the story was associated with more endorsement of the belief that e-cigarettes were risky to use, but not that using e-cigarettes would make the participant more likely to get damaged lungs. DISCUSSION When the stories about the health and safety of tobacco products dominate the public information environment, it presents an opportunity to change beliefs that are frequently targeted by paid health campaigns. Changes in participant's perceptions of e-cigarettes were associated with coverage of this large news story, underscoring the importance of working to ensure that coverage is a scientifically accurate as possible.
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Affiliation(s)
- Jennifer C. Morgan
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Nathan Silver
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Joseph N. Cappella
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, United States of America
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McCaffrey SA, Zdinak JP, Plunkett S, Becker E, Lewis JN, Black RA. Development and validation of behavioral intention measures of an E-vapor product: intention to try, use, dual use, and switch. Health Qual Life Outcomes 2021; 19:123. [PMID: 33858450 PMCID: PMC8048046 DOI: 10.1186/s12955-021-01764-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 04/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The harm caused by tobacco use is primarily attributable to cigarette smoking. Switching completely to non-combustible products may reduce disease risks in adult cigarette smokers who are unable or unwilling to quit. Before a new tobacco product can enter the market or can be marketed as a modified risk tobacco product, the manufacturer must determine the impact that the product will have on the likelihood of changes in tobacco use behavior among both tobacco users and nonusers. One way to estimate change in tobacco use behavior is to assess tobacco users' and nonusers' behavioral intentions toward the product and its marketing, including intentions to try, use, dual use, and switch to the product from cigarettes. The purpose of this study was to develop and validate behavioral intention metrics appropriate for use with current, former, and never adult tobacco users. METHODS Preliminary items were subjected to cognitive testing with adult (1) smokers planning to quit cigarettes in the next 30 days, (2) smokers not planning to quit cigarettes in the next 30 days, (3) e-vapor users, (4) former tobacco users, and (5) never tobacco users. Items were iteratively revised based on feedback during cognitive testing, and surviving items were administered to a large sample of adults (N = 2943) representing the aforementioned sub-groups. Rating scale functioning, reliability, validity, bias, and ability to detect change were evaluated. RESULTS Examination of the response category thresholds generated by the Rasch model provided evidence that the rating scales were functioning appropriately. Results revealed good stability and excellent internal consistency and person reliability and provided evidence of unidimensionality and convergent validity. Estimates of reliability and validity were similar across sub-groups. A cross-validation sample generally confirmed findings from the validation sample. No items were discarded due to differential item function. Exploratory analyses provided support for ability to detect change. CONCLUSIONS Results from this rigorous, empirical evaluation using large validation and cross-validation samples provide strong support for the psychometric properties of the Intention to Try, Use, Dual Use, and Switch scales with current, former, and never adult tobacco users.
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Affiliation(s)
- Stacey A McCaffrey
- JUUL Labs, Inc., 1000 F Street NW, Suite 800, Washington, DC, 20004, USA
| | | | - Stephanie Plunkett
- Altria Client Services LLC, 601 East Jackson Street, Richmond, VA, 23219, USA
| | - Elizabeth Becker
- Altria Client Services LLC, 601 East Jackson Street, Richmond, VA, 23219, USA.
| | - Jennifer N Lewis
- Altria Client Services LLC, 601 East Jackson Street, Richmond, VA, 23219, USA
| | - Ryan A Black
- JUUL Labs, Inc., 1000 F Street NW, Suite 800, Washington, DC, 20004, USA
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10
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Wackowski OA, O’Connor RJ, Pearson JL. Smokers' Exposure to Perceived Modified Risk Claims for E-Cigarettes, Snus, and Smokeless Tobacco in the United States. Nicotine Tob Res 2021; 23:605-608. [PMID: 32812028 PMCID: PMC7885787 DOI: 10.1093/ntr/ntaa159] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/13/2020] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Based on arguments for harm reduction and health benefits, tobacco companies in the United States can apply for regulatory authorization to make "modified risk tobacco product" (MRTP) marketing claims. The impact of future MRTP claims may depend on whether they are noticed, believed, and lead to smokers switching products. This study provides baseline data about smokers' exposure to perceived MRTP claims ahead of any MRTP authorizations. AIMS AND METHODS We analyzed measures from Wave 3 of the US-based Population Assessment of Tobacco and Health (PATH) study which asked smokers to indicate if they had seen any e-cigarettes, snus, or other smokeless tobacco (SLT) products that claim to be "less harmful" in the past 12 months, and their likelihood of using products with these claims in the next 30 days. RESULTS Significantly fewer smokers noted having seen snus (5.1%) or other SLT (5.6%) with "less harmful" claims compared with e-cigarettes (29.1%). For each product, the prevalence of MRTP claim exposure was higher among smokers who perceived the product to be less harmful than smoking, who currently used the product, and who had higher rates of tobacco advertising exposure at the point of sale. Among smokers who noticed products with "less harmful" claims, about one-quarter said they would use them in the future (24%-27%). CONCLUSIONS Ahead of any Food & Drug Administration (FDA) authorization for MRTP claims, some smokers already perceive exposure to "less harmful" claims for e-cigarettes, but few do for SLT. MRTP claims may motivate some smokers to use these products. IMPLICATIONS This study provides new baseline data about smokers' perceived exposure to MRTP claims in the United States ahead of any regulatory claim authorization. Using data from Wave 3 of the US PATH study, we found that some smokers already perceive exposure to "less harmful" claims for e-cigarettes (29%), but few do for SLT (5%-6%). Among smokers who noticed products with "less harmful" claims, about one-quarter said they would use them in the future (24%-27%), suggesting MRTP claims may motivate some smokers to use products described as "less harmful."
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Affiliation(s)
- Olivia A Wackowski
- Rutgers Center for Tobacco Studies, Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Rutgers University, New Brunswick, NJ
| | - Richard J O’Connor
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY
| | - Jennifer L Pearson
- Department of Health Administration and Policy, School of Community Health Sciences, University of Nevada, Reno, NV
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Morgan JC, Cappella JN. Harm Perceptions and Beliefs about Potential Modified Risk Tobacco Products. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E576. [PMID: 33445525 PMCID: PMC7827331 DOI: 10.3390/ijerph18020576] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/31/2020] [Accepted: 01/05/2021] [Indexed: 01/17/2023]
Abstract
Under US law, tobacco products may be authorized to claim lower exposure to chemicals, or lower risk of health harms. We sought to examine the harm perceptions and beliefs about potential modified risk tobacco products (MRTPs). We recruited 864 adult current and former smokers in August 2019. Participants read a paragraph describing the potential for the FDA to authorize MRTPs and a brief description of MRTPs. The most endorsed beliefs for each product were that they contained nicotine and that they were risky. Believing that e-cigarettes can help smokers quit smoking, that they tasted good, and looked cool were associated with greater odds of intending to try e-cigarettes after controlling for demographic and use factors. For snus, the beliefs that the product was not addictive and tasted good were associated with increased odds of intending to try snus. The beliefs that heated tobacco would taste good and would be a good quit aid was associated with increased odds of intentions to try heated tobacco products. Understanding what the public believes about products currently or potentially authorized to be marketed as modified risk tobacco products can inform communication efforts.
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Affiliation(s)
- Jennifer C. Morgan
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA 19104, USA;
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Pillitteri JL, Shiffman S, Sembower MA, Polster MR, Curtin GM. Assessing comprehension and perceptions of modified-risk information for snus among adult current cigarette smokers, former tobacco users, and never tobacco users. Addict Behav Rep 2020; 11:100254. [PMID: 32467843 PMCID: PMC7244929 DOI: 10.1016/j.abrep.2020.100254] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/05/2020] [Accepted: 01/21/2020] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Snus, a low nitrosamine smokeless tobacco product, presents less risks to health than cigarettes. Effectively communicating such risk information could facilitate smokers switching completely to snus, thereby benefiting public health. METHODS This study assessed comprehension and perceptions of modified-risk information regarding snus. Adult cigarette smokers, former tobacco users, and never tobacco users (N = 3,922) from a US internet panel viewed an advertisement stating that smokers who switched completely to snus could greatly reduce risk of lung cancer, respiratory disease, heart disease, and oral cancer. Respondents answered questions regarding the modified-risk information and rated perceived risks of snus relative to cigarettes and other smokeless tobacco products. RESULTS Across the four diseases mentioned in the advertisement, most respondents (49.7%-68.6%, across tobacco user groups) understood that snus presents less risk than cigarettes but is not completely safe. Some indicated snus presents the same risk as cigarettes; this was highest for oral cancer (33.7%-42.02%) and lowest for lung cancer (15.4%-23.1%) and respiratory disease (15.6%-23.4%). Majorities understood snus is addictive (77.7%-87.9%), quitting all tobacco is the best option for smokers (83.6%-93.1%), and non-users of tobacco should not use snus (80.4%-87.8%). Only 2.1%-5.8% indicated smokers would receive a health benefit if they continued to smoke while using snus. CONCLUSIONS The modified-risk information, conveying that snus presents less risk than cigarettes but is not completely safe, was understood by majorities of respondents. Differential risk beliefs across diseases suggest responses were shaped not only by the modified-risk information, but also by intuitions and pre-existing beliefs about tobacco products.
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Affiliation(s)
- Janine L. Pillitteri
- PinneyAssociates, Inc., 201 North Craig Street, Suite 320, Pittsburgh, PA 15213, United States
| | - Saul Shiffman
- PinneyAssociates, Inc., 201 North Craig Street, Suite 320, Pittsburgh, PA 15213, United States
| | - Mark A. Sembower
- PinneyAssociates, Inc., 201 North Craig Street, Suite 320, Pittsburgh, PA 15213, United States
| | | | - Geoffrey M. Curtin
- RAI Services Company, 401 North Main Street, Winston-Salem, NC 27101, United States
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Yang B, Owusu D, Popova L. Testing messages about comparative risk of electronic cigarettes and combusted cigarettes. Tob Control 2019; 28:440-448. [PMID: 30104408 PMCID: PMC6374208 DOI: 10.1136/tobaccocontrol-2018-054404] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 07/16/2018] [Accepted: 07/26/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Health agencies are grappling with communicating risks of electronic cigarettes (e-cigarettes) compared with combusted cigarettes. This study examined smokers' responses to two types of comparative risk messages with one type incorporating more negative antismoking elements in the design. METHODS In an online experiment, 1400 US adult (18+ years) current smokers and recent quitters were randomised to view one of three comparative risk messages about e-cigarettes (CR messages), one of three comparative risk messages that included more negative antismoking elements in the design (CR- messages) or a control message. Selection of outcomes was guided by the antismoking message impact framework. Multivariate analyses of covariance and logistic regression models analysed effects of messages on message evaluations, e-cigarette-related and cigarette-related beliefs and behavioural intentions. RESULTS Both CR and CR- messages decreased smokers' intentions to smoke cigarettes, increased intentions to switch to e-cigarettes completely and increased perceptions that e-cigarettes are less harmful than combusted cigarettes. Neither message type increased dual use intentions relative to exclusive e-cigarettes use or smoking cessation. CR messages decreased perceived absolute risks of e-cigarettes and self-exempting beliefs about smoking, whereas CR- versus CR messages produced higher self-efficacy to quit smoking. CONCLUSION Comparative risk communication might encourage smokers to switch to lower-harm tobacco products. Comparative risk messages with more negative antismoking elements in the design might be particularly effective, because they led to higher self-efficacy to quit smoking. Regulatory agencies may consider using comparative risk messages with more negative antismoking elements to educate the public about lower risk of e-cigarettes.
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Affiliation(s)
- Bo Yang
- Tobacco Center of Regulatory Science, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Daniel Owusu
- Tobacco Center of Regulatory Science, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Lucy Popova
- Tobacco Center of Regulatory Science, School of Public Health, Georgia State University, Atlanta, GA, USA
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Wackowski OA, Ray AE, Stapleton JL. Smokers' perceptions of risks and harm from snus relative to cigarettes: A latent profile analysis study. Addict Behav 2019; 91:171-174. [PMID: 30501991 PMCID: PMC6358499 DOI: 10.1016/j.addbeh.2018.11.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 11/07/2018] [Accepted: 11/13/2018] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Certain types of smokeless tobacco (SLT) products, particularly snus, carry fewer health risks than cigarette smoking and might be able to serve as harm-reduction products for smokers. However, studies frequently find that smokers misperceive SLT and snus to be as or more harmful than smoking. This perception is often measured with a single general harm question, and research on underlying risk perceptions is limited. METHODS Using a sample of 256 current smokers, we utilized Latent Profile Analysis to examine response profiles to items that assessed perceived risk of specific health outcomes (lung cancer, heart disease, oral cancer) from snus relative to cigarettes, along with the typical single item measure of overall harm from snus compared to cigarettes. RESULTS Three smoker response profiles emerged. Almost half (44.9%) of smokers perceived snus to be as or more risky than cigarettes for all three specific health outcomes (group 1), while over one third (38.3%) had an elevated perceived risk for oral cancer only (group 2). About 17% of smokers perceived snus to have lower risks for lung cancer only (group 3). Across each profile, perceived risk was highest for oral cancer. CONCLUSIONS If smokers are to consider snus for harm-reduction, efforts may be needed to better inform smokers about their lower relative risks, including for particular health outcomes of interest. This study also suggests that smokers may vary in their level of need for information to correct their relative risk misperceptions.
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Affiliation(s)
- Olivia A Wackowski
- Center for Tobacco Studies, Department of Social and Behavioral Health Sciences, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854, USA.
| | - Anne E Ray
- Center for Tobacco Studies, Department of Social and Behavioral Health Sciences, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854, USA
| | - Jerod L Stapleton
- Rutgers Cancer Institute of New Jersey, Department of Medicine, Rutgers University, 195 Little Albany Street, New Brunswick, NJ 08901, USA
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The Impact of E-Cigarette Warnings, Warning Themes and Inclusion of Relative Harm Statements on Young Adults' E-Cigarette Perceptions and Use Intentions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16020184. [PMID: 30634618 PMCID: PMC6352031 DOI: 10.3390/ijerph16020184] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/21/2018] [Accepted: 01/07/2019] [Indexed: 11/17/2022]
Abstract
Although e-cigarettes in the United States are required to carry one nicotine addiction warning, little is known about the impact of other potential e-cigarette warning themes, nor about pairing warnings with messages that communicate e-cigarettes' reduced-harm potential relative to cigarettes. We randomly assigned 876 young adults (ages 18⁻29) to view e-cigarette ads in a 3 × 2 plus control online experiment that varied by warning theme (i.e., nicotine addiction; nicotine's impact on adolescent brain development; presence of harmful chemicals) and warning type-i.e., the presence ("relative harm warning") or absence ("standard warning") of a relative harm (RH) statement in the warning label ("e-cigarettes may cause harm to health but are less harmful than cigarettes"). Warning believability, informativeness, understandability and support were high across conditions and there were no significant differences by warning theme on e-cigarette harm perceptions or use intentions nor on nicotine (mis)perceptions. Perceived warning effectiveness for discouraging youth initiation was higher for the "brain" and "chemicals" warnings compared to the addiction warning. Warnings with the included RH statement were perceived as less believable and credible and were less frequently correctly recalled. Research should continue to investigate the impact of different e-cigarette warning themes and formats with priority audiences.
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Berman ML, Bickel WK, Harris AC, LeSage MG, O’Connor RJ, Stepanov I, Shields PG, Hatsukami DK. Consortium on Methods Evaluating Tobacco: Research Tools to Inform US Food and Drug Administration Regulation of Snus. Nicotine Tob Res 2018; 20:1292-1300. [PMID: 29059363 PMCID: PMC6154989 DOI: 10.1093/ntr/ntx228] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 09/28/2017] [Indexed: 11/13/2022]
Abstract
Introduction The US Food and Drug Administration (FDA) has purview over tobacco products. To set policy, the FDA must rely on sound science, yet most existing tobacco research methods have not been designed to specifically inform regulation. The NCI and FDA-funded Consortium on Methods Evaluating Tobacco (COMET) was established to develop and assess valid and reliable methods for tobacco product evaluation. The goal of this article is to describe these assessment methods using a US manufactured "snus" as the test product. Methods In designing studies that could inform FDA regulation, COMET has taken a multidisciplinary approach that includes experimental animal models and a range of human studies that examine tobacco product appeal, addictiveness, and toxicity. This article integrates COMET's findings over the last 4 years. Results Consistency in results was observed across the various studies, lending validity to our methods. Studies showed low abuse liability for snus and low levels of consumer demand. Toxicity was less than cigarettes on some biomarkers but higher than medicinal nicotine. Conclusions Using our study methods and the convergence of results, the snus that we tested as a potential modified risk tobacco product is likely to neither result in substantial public health harm nor benefit. Implications This review describes methods that were used to assess the appeal, abuse liability, and toxicity of snus. These methods included animal, behavioral economics, consumer perception studies, and clinical trials. Across these varied methods, study results showed low abuse-liability and appeal of the snus product we tested. In several studies, demand for snus was lower than for less toxic nicotine gum. The consistency and convergence of results across a range of multi-disciplinary studies lends validity to our methods and suggests that promotion of snus as a modified risk tobacco products is unlikely to produce substantial public health benefit or harm.
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Affiliation(s)
- Micah L Berman
- College of Public Health, Ohio State University, Columbus, OH
- Moritz College of Law, Ohio State University, Columbus, OH
| | | | - Andrew C Harris
- Minneapolis Medical Research Foundation, Minneapolis, MN
- Department of Medicine, University of Minnesota, Minneapolis, MN
- Department of Psychology, University of Minnesota, Minneapolis, MN
| | - Mark G LeSage
- Minneapolis Medical Research Foundation, Minneapolis, MN
- Department of Medicine, University of Minnesota, Minneapolis, MN
- Department of Psychology, University of Minnesota, Minneapolis, MN
| | | | - Irina Stepanov
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Peter G Shields
- Comprehensive Cancer Center, Ohio State University, Columbus, OH
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El-Toukhy S, Baig SA, Jeong M, Byron MJ, Ribisl KM, Brewer NT. Impact of modified risk tobacco product claims on beliefs of US adults and adolescents. Tob Control 2018; 27:s62-s69. [PMID: 30158212 PMCID: PMC6202195 DOI: 10.1136/tobaccocontrol-2018-054315] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 04/26/2018] [Accepted: 04/30/2018] [Indexed: 01/23/2023]
Abstract
Objective Under US law, tobacco product marketing may claim lower exposure to chemicals, or lower risk of health harms, only if these claims do not mislead the public. We sought to examine the impact of such marketing claims about potential modified risk tobacco products (MRTPs). Methods Participants were national samples of 4797 adults and 969 adolescent US smokers and non-smokers. We provided information about a potential MRTP (heated tobacco product, electronic cigarette or snus). Experiment 1 stated that the MRTP was as harmful as cigarettes or less harmful (lower risk claim). Experiment 2 stated that the MRTP exposed users to a similar quantity of harmful chemicals as cigarettes or to fewer chemicals (lower exposure claim). Results Claiming lower risk led to lower perceived quantity of chemicals and lower perceived risk among adults and adolescents (all p<0.05, Experiment 1). Among adults, this claim led to higher susceptibility to using the MRTP (p<0.05). Claiming lower exposure led to lower perceived chemical quantity and lower perceived risk (all p<0.05), but had no effect on use susceptibility (Experiment 2). Participants thought that snus exposed users to more chemicals and was less safe to use than heated tobacco products or electronic cigarette MRTPs (Experiments 1 and 2). Discussion Risk and exposure claims acted similarly on MRTP beliefs. Lower exposure claims misled the public to perceive lower perceived risk even though no lower risk claim was explicitly made, which is impermissible under US law.
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Affiliation(s)
- Sherine El-Toukhy
- Intramural Research Program, National Heart, Lung, and Blood Institute, The National Institutes of Health, Bethesda, Maryland, USA
| | - Sabeeh A Baig
- Department of Health Behavior, University of North Carolina, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Michelle Jeong
- Department of Health Behavior, University of North Carolina, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - M Justin Byron
- Department of Health Behavior, University of North Carolina, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.,Department of Family Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kurt M Ribisl
- Department of Health Behavior, University of North Carolina, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Noel T Brewer
- Department of Health Behavior, University of North Carolina, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
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