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Weiger C, Cohen JE, David Kennedy R, Moran MB. Testing messaging strategies to correct beliefs about nicotine and relative harm perceptions of non-cigarette tobacco products compared to cigarettes: A 2 × 2 factorial experiment of factsheets. Addict Behav 2024; 150:107915. [PMID: 38042048 DOI: 10.1016/j.addbeh.2023.107915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/14/2023] [Accepted: 11/18/2023] [Indexed: 12/04/2023]
Abstract
INTRODUCTION The misperception that nicotine is a major cause of cancer is common and may relate to inaccurate relative harm perceptions about tobacco products. To assess if messaging can correct these misperceptions, we tested factsheets that manipulated presences vs absence of (1) a causal alternative (i.e., combustion, not nicotine, causes disease) and/or (2) a reason for the misinformation (i.e., nicotine is the focus of many health messages). METHODS We used an online 2 × 2 factorial experiment of n = 193 adults who smoke and believe nicotine causes cancer to assess the effect of different message strategies on perceptions of tobacco products and switch intention. Pre-post differences and between-condition differences were assessed. RESULTS Strength of agreement with the statement that nicotine is a major cause of cancer decreased and switch intentions increased after message exposure. The proportion of participants with low relative harm perceptions increased for e-cigarettes and smokeless tobacco (p <.0001) and decreased for very low nicotine cigarettes compared to cigarettes. The message with both strategies decreased agreement that nicotine causes cancer more than the message with only the causal alternative. There was no significant effect of condition on relative harm beliefs or switch intentions. CONCLUSIONS Messages with both corrective strategies can reduce the belief that nicotine causes cancer to a greater extent than messaging that only contains a causal alternative. Belief accuracy increased after any message exposure, but these findings should be interpreted cautiously given the study design. Combined strategies should be further investigated in larger samples.
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Affiliation(s)
- Caitlin Weiger
- Rutgers Center for Tobacco Studies Fifth Floor, 303 George St. New, Brunswick, NJ 08901, United States; Institute for Global Tobacco Control Johns Hopkins Bloomberg School of Public Health Department of Health, Behavior & Society, 2213 McElderry St. Fourth Floor, Baltimore, MD 21205, United States; Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior & Society, 624 N Broadway Seventh Floor, Baltimore, MD 21205, United States.
| | - Joanna E Cohen
- Rutgers Center for Tobacco Studies Fifth Floor, 303 George St. New, Brunswick, NJ 08901, United States; Institute for Global Tobacco Control Johns Hopkins Bloomberg School of Public Health Department of Health, Behavior & Society, 2213 McElderry St. Fourth Floor, Baltimore, MD 21205, United States; Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior & Society, 624 N Broadway Seventh Floor, Baltimore, MD 21205, United States
| | - Ryan David Kennedy
- Rutgers Center for Tobacco Studies Fifth Floor, 303 George St. New, Brunswick, NJ 08901, United States; Institute for Global Tobacco Control Johns Hopkins Bloomberg School of Public Health Department of Health, Behavior & Society, 2213 McElderry St. Fourth Floor, Baltimore, MD 21205, United States; Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior & Society, 624 N Broadway Seventh Floor, Baltimore, MD 21205, United States
| | - Meghan B Moran
- Rutgers Center for Tobacco Studies Fifth Floor, 303 George St. New, Brunswick, NJ 08901, United States; Institute for Global Tobacco Control Johns Hopkins Bloomberg School of Public Health Department of Health, Behavior & Society, 2213 McElderry St. Fourth Floor, Baltimore, MD 21205, United States; Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior & Society, 624 N Broadway Seventh Floor, Baltimore, MD 21205, United States
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Yong HH, Karmakar C, Motin MA, Borland R, Cummings KM, Gravely S, Fong GT. Individual and Conjoint Factors Associated With Beliefs About the Harmfulness of Nicotine Replacement Therapies Relative to Combustible Cigarettes Among People Who Smoke: Findings From the 2020 ITC Four Country Smoking and Vaping Survey. Nicotine Tob Res 2023; 25:1594-1602. [PMID: 37195899 PMCID: PMC10439491 DOI: 10.1093/ntr/ntad075] [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: 09/20/2022] [Revised: 04/20/2023] [Accepted: 05/15/2023] [Indexed: 05/19/2023]
Abstract
INTRODUCTION This study examined individual and conjoint factors associated with beliefs about the harmfulness of nicotine replacement therapies (NRTs) relative to combustible cigarettes (CCs). AIMS AND METHODS Data analyzed came from 8642 adults (≥18 years) who smoked daily/weekly and participated in the 2020 ITC Four Country Smoking and Vaping Survey in Australia (n = 1213), Canada (n = 2633), England (n = 3057), and United States (n = 1739). Respondents were asked: "Compared to smoking cigarettes, how harmful do you think nicotine replacement products are?" Responses were dichotomized into "much less" versus otherwise for analysis using multivariable logistic regression models, complemented by decision-tree analysis to identify conjoint factors. RESULTS Percentages believing that NRTs are much less harmful than CCs were 29.7% (95% CI = 26.2% to 33.5%) in Australia, 27.4% (95% CI = 25.1% to 29.8%) in England, 26.4% (95% CI = 24.4% to 28.4%) in Canada, and 21.7% (95% CI = 19.2% to 24.3%) in the United States. Across all countries, believing nicotine is not at all/slightly harmful to health (aOR = 1.53-2.27), endorsing nicotine vaping products (NVPs) as less harmful than CCs (much less harmful: aOR = 7.24-14.27; somewhat less harmful: aOR = 1.97-3.23), and possessing higher knowledge of smoking harms (aOR = 1.23-1.88) were individual factors associated with increased odds of believing NRTs are much less harmful than CCs. With some country variations, these nicotine-related measures also interacted with each other and sociodemographic variables to serve as conjoint factors associated with the likelihood of accurate NRT relative harm belief. CONCLUSIONS Many people who regularly smoke cigarettes are unaware that NRTs are much less harmful than cigarettes. Additionally, beliefs about NRTs relative harmfulness appear to be influenced by both individual and conjoint factors. IMPLICATIONS This study demonstrates that despite past efforts to educate people who smoke about the harms of NRTs relative to CCs, misperceptions around the relative harmfulness of NRTs remain substantial. In all four studied countries, subgroups of people who smoke regularly who are misinformed about the relative harmfulness of NRTs, and who may be reluctant to use NRTs for smoking cessation can be reliably identified for corrective interventions based on their understanding of the harms related to nicotine, NVPs and smoking along with sociodemographic markers. The identified subgroup information can be used to prioritize and inform the development of effective interventions to specifically address the gaps in knowledge and understanding of the various subgroups identified. Our results suggest these may need to be tailored for each country.
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Affiliation(s)
| | | | | | | | | | | | - Geoffrey T Fong
- University of Waterloo, Waterloo, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
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Yang B, Popova L. Communicating risk differences between electronic and combusted cigarettes: the role of the FDA-mandated addiction warning and a nicotine fact sheet. Tob Control 2020; 29:663-671. [PMID: 31641058 PMCID: PMC7174095 DOI: 10.1136/tobaccocontrol-2019-055204] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 08/19/2019] [Accepted: 09/04/2019] [Indexed: 11/03/2022]
Abstract
INTRODUCTION The US Food and Drug Administration requires e-cigarettes to carry a nicotine addiction warning. This research compared the effects of messages communicating comparative risk of electronic and combusted cigarettes (CR messages) with and without the mandated warning and tested the effects of showing a nicotine fact sheet (NFS) before exposure to CR messages with warning. METHOD In an online experiment, 1528 US adult smokers were randomised to one of four conditions: (1) three CR messages, (2) three CR messages in condition one with an addiction warning, (3) an NFS followed by the three messages in condition 2 and (4) control messages. Outcomes included message reactions and perceived effectiveness, e-cigarette-related and cigarette-related beliefs and behavioural intentions and nicotine-related beliefs. RESULTS CR messages with and without an addiction warning did not differ. The NFS condition produced higher odds of correctly understanding the risk of nicotine and stronger beliefs that switching to e-cigarettes could reduce health risks (response efficacy) than other treatments. Compared with control, all messages made it more likely for people to report e-cigarettes are less harmful than cigarettes and increased response efficacy and switch intentions to e-cigarettes. Only NFS condition increased correct beliefs about the risk of nicotine and self-efficacy about switching to e-cigarettes. CONCLUSION Including an addiction warning on CR messages did not reduce intentions to switch to e-cigarettes. Communicating accurate risk of nicotine together with CR messages and addiction warning increased smokers' self-efficacy beliefs about switching completely to e-cigarettes, making it a potentially promising antitobacco communication strategy.
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Affiliation(s)
- Bo Yang
- Department of Communication, University of Arizona, Tucson, Arizona, USA
| | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
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4
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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. Effects of a Nicotine Fact Sheet on Perceived Risk of Nicotine and E-Cigarettes and Intentions to Seek Information About and Use E-Cigarettes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010131. [PMID: 31878111 PMCID: PMC6981818 DOI: 10.3390/ijerph17010131] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/19/2019] [Accepted: 12/19/2019] [Indexed: 11/16/2022]
Abstract
We examined how a nicotine fact sheet influenced smokers’ beliefs about nicotine and electronic cigarettes (e-cigarettes), a potentially less harmful alternative to conventional cigarettes. In an exploratory online experiment, 756 US adult current and recent former smokers (quit in the past 2 years) were randomized to view a nicotine fact sheet or control messages (bottled water ads). Effects of the nicotine fact sheet on perceived nicotine addictiveness, nicotine risk, comparative risk of e-cigarettes, and dual use intentions were analyzed using log-Poisson regression with robust error. Linear regression analyzed effects on perceived absolute risk and switching and information seeking intentions about e-cigarettes. Compared to control, the nicotine fact sheet doubled the probability of disagreeing that nicotine is the main cause of smoking-related disease (26.2% vs. 12.7%, RR = 2.06, 95% CI = 1.51, 2.82, p < 0.001). However, nearly three quarters of participants viewing the nicotine fact sheet still thought that nicotine is the main cause of smoking-related disease. The nicotine fact sheet increased smokers’ intentions to seek information about e-cigarettes (b = 0.45, 95% CI = 0.15, 0.74, p = 0.003). We did not find evidence suggesting unintended consequences of the nicotine fact sheet on smokers’ e-cigarettes risk perceptions or use intentions (e.g., increased dual use intentions or reduced absolute e-cigarette risk perception).
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Affiliation(s)
- Bo Yang
- Department of Communication, University of Arizona, Tucson, AZ 85721, USA
| | - Daniel Owusu
- School of Public Health, Georgia State University, Atlanta, GA 30302, USA
| | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, GA 30302, USA
- Correspondence:
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Gerlach K, Shiffman S, Battista D, Polster M, Curtin G. Assessing likelihood of product use for snus with modified-risk information among adult current cigarette smokers, former tobacco users, and never tobacco users. Addict Behav Rep 2019; 10:100208. [PMID: 31467967 PMCID: PMC6710553 DOI: 10.1016/j.abrep.2019.100208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/16/2019] [Accepted: 07/19/2019] [Indexed: 11/04/2022] Open
Abstract
Introduction Switching from cigarettes to snus by smokers unlikely to quit would be expected to benefit overall population health, with any potential benefit needing to be weighed against potential harms from snus use by tobacco non-users and smokers likely to quit. This study evaluates likelihood of snus use among tobacco users and non-users provided modified-risk information. Methods An online sample of 11,302 U.S. adults was randomized to view advertisements for snus that either provided modified-risk information or only described snus. Intent to purchase ratings were converted to projected purchase (use) rates using an empirically derived algorithm. Results Projected product use for snus was significantly higher among current smokers than former or never tobacco users (p < 0.0001) for both the modified-risk and control information. A significant interaction effect between information and tobacco user group (p < 0.0001) indicated the modified-risk information differentially increased projected use among smokers (8.2% vs. 6.9%), with much lower projections for both the test and control information among former (1.2%) and never tobacco users (0.4%). Among never users, projected use was highest among those susceptible to smoking. These findings were generally similar for young adults, ages 18–24. Smokers expecting to quit who viewed modified-risk information had lower projected use (4.2%) than those not expecting to quit (8.7%). Conclusions Results suggest that providing modified-risk information for snus is unlikely to increase use among those not using tobacco. Interest in snus was greatest among current smokers who would benefit by switching to snus as communicated in the modified-risk advertisement. We tested the effect of communicating the reduced risk of snus compared to smoking. Such communication increased likely use of snus among smokers. Likely use of snus did not increase in never and former tobacco users. Projected use of snus was highest among smokers not likely to quit. Providing risk information is unlikely to cause harm and may confer benefits.
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Affiliation(s)
- Karen Gerlach
- PinneyAssociates, Inc., 201 North Craig Street, Suite 320, Pittsburgh, PA 15213, United States of America
| | - Saul Shiffman
- PinneyAssociates, Inc., 201 North Craig Street, Suite 320, Pittsburgh, PA 15213, United States of America
| | - Deena Battista
- PinneyAssociates, Inc., 201 North Craig Street, Suite 320, Pittsburgh, PA 15213, United States of America
| | - Michael Polster
- NAXION, 1835 Market Street, Philadelphia, PA 19103, United States of America
| | - Geoffrey Curtin
- RAI Services Company, 401 North Main Street, Winston-Salem, NC 27101, United States of America
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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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Cornacchione Ross J, Noar SM, Sutfin EL. Systematic Review of Health Communication for Non-Cigarette Tobacco Products. HEALTH COMMUNICATION 2019; 34:361-369. [PMID: 29236542 PMCID: PMC5999530 DOI: 10.1080/10410236.2017.1407274] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The Food and Drug Administration, which now has regulatory authority over all tobacco products meeting the statutory definition, is tasked with communicating the risks of these products to the public through health warnings and public education. However, there have been no attempts to summarize what is known about non-cigarette tobacco product (NCTP) health messaging. We conducted a systematic review to examine the existing literature on health communication for NCTPs and identify key research gaps. A total of 45 unique studies were retrieved and coded, with the majority focused on messaging for smokeless tobacco (SLT, k = 32, 71.1%), followed by waterpipe tobacco (WT, k = 9, 20%), electronic nicotine delivery systems (ENDS, k = 2, 4.4%), cigars (k = 2, 4.4%), and a potentially reduced exposure product (k = 1, 2.2%). Studies most commonly examined tobacco product warnings (k = 26, 57.8%) and public education (k = 19, 42.2%), which included mass media campaigns. Most studies examined knowledge, attitudes, and beliefs as outcomes (k = 27, 60%), while behavior was an outcome in the minority of studies (k = 8, 17.8%). Pictorial warnings and public education about NCTPs demonstrated positive impact in some studies, although the literature is nascent. Given the increasing use of NCTPs such as ENDS, WT, and cigars, particularly among adolescents and young adults, more research is needed on effective ways to communicate product risk to those audiences most at risk.
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Affiliation(s)
- Jennifer Cornacchione Ross
- Department of Social Sciences & Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine
| | - Seth M. Noar
- School of Media and Journalism, University of North Carolina, Chapel Hill
| | - Erin L. Sutfin
- Department of Social Sciences & Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine
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Wackowski OA, Manderski MTB, Lewis MJ, Delnevo CD. The Impact of Smokeless Tobacco Risk Information on Smokers' Risk Perceptions and Use Intentions: A News Media Experiment. HEALTH COMMUNICATION 2019; 34:325-332. [PMID: 29236547 PMCID: PMC6128772 DOI: 10.1080/10410236.2017.1407226] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Little research exists on the impact of risk information comparing smokeless tobacco (SLT) use, particularly snus, to cigarette smoking. This study explored this topic using a communication channel where smokers may be exposed to such information-the news media. We randomly assigned 1008 current smokers to read one of three constructed news stories or to a control group (no article). The "favorable" story framed snus as a "safer" smoking alternative while the "cautious" story described snus risks. The "mixed" version described potential risks and harm-reduction benefits. Participants completed a post-article survey with snus risk and harm perception and use intention measures. Article condition was significantly associated with perceived harm of daily snus use relative to smoking (1 = a lot less harmful - 5 = a lot more harmful; p < .0001), and mean ratings of snus harm in the favorable (2.46) and mixed conditions (2.66) were significantly lower than those of the cautious (2.96) and control conditions (2.98). Mean interest in trying snus in the next 6 months was low, but significantly higher for those in the favorable (1.55) and mixed conditions (1.32) versus those in the cautious (1.17) and control conditions (1.16)(1 = not at all - 5 = extremely interested, p < .0001). There were no significant differences by group in terms of the story's perceived interestingness, importance, or relevance. Exposure to reduced-risk news messages about SLT and snus relative to cigarettes may impact smokers' SLT harm perceptions and use intentions. Tobacco control professionals and FDA officials should consider the potential impact of the news media when communicating about tobacco risks.
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Affiliation(s)
- Olivia A Wackowski
- a Department of Social & Behavioral Health Sciences , Center for Tobacco Studies, Rutgers University
| | | | - M Jane Lewis
- a Department of Social & Behavioral Health Sciences , Center for Tobacco Studies, Rutgers University
| | - Cristine D Delnevo
- a Department of Social & Behavioral Health Sciences , Center for Tobacco Studies, Rutgers University
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10
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Ramström L. Insufficient knowledge about use of multiple tobacco/nicotine products. Addict Behav 2018; 76:384-385. [PMID: 28161154 DOI: 10.1016/j.addbeh.2017.01.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/23/2017] [Indexed: 11/26/2022]
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Nduaguba SO, Ford KH, Bamgbade B, Iwuorie O. Comparison of pharmacy students' knowledge and self-efficacy to provide cessation counseling for hookah and cigarette use. CURRENTS IN PHARMACY TEACHING & LEARNING 2017; 9:37-42. [PMID: 29180151 DOI: 10.1016/j.cptl.2016.08.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 07/15/2016] [Accepted: 08/20/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVES We aimed to assess pharmacy students' self-efficacy to provide cessation counseling for commercial cigarette and hookah tobacco use. METHODS A cross-sectional study including PharmD students at a College of Pharmacy was conducted in Spring 2014. Confidence in counseling and perception of knowledge were self-rated and based on the Ask-Advise-Assess-Assist-Arrange follow-up (5A's) model and general tobacco cessation counseling skills. Comparisons were made between cigarettes and hookahs and by program level using t-tests, Wilcoxon signed-rank test, analyses of variance, and Tukey-Kramer tests. RESULTS Overall, 82% and 16% of the students, respectively, reported receiving training on cigarette smoking and hookah tobacco use cessation. Students were moderately confident in their ability to counsel. Compared to hookah tobacco use cessation counseling, students were more confident in their general counseling skills and ability to counsel on cigarette smoking cessation using the 5A's (p < 0.001 in each case). Students perceived themselves to be more knowledgeable about cigarette smoking cessation than about hookah tobacco use cessation. Almost half of the students (42.0%) thought hookah tobacco was less harmful than traditional cigarettes. CONCLUSIONS Pharmacy students need further training to address hookah and other alternative tobacco products to support patients' cessation needs, decrease risks for tobacco-related morbidity and mortality, and increase medication effectiveness.
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Affiliation(s)
- Sabina O Nduaguba
- Health Outcomes and Pharmacy Practice Division, College of Pharmacy, The University of Texas at Austin, Austin, TX
| | - Kentya H Ford
- Health Outcomes and Pharmacy Practice Division, College of Pharmacy, The University of Texas at Austin, Austin, TX.
| | - Benita Bamgbade
- Health Outcomes and Pharmacy Practice Division, College of Pharmacy, The University of Texas at Austin, Austin, TX
| | - Ogechi Iwuorie
- Health Outcomes and Pharmacy Practice Division, College of Pharmacy, The University of Texas at Austin, Austin, TX
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Czoli CD, Fong GT, Mays D, Hammond D. How do consumers perceive differences in risk across nicotine products? A review of relative risk perceptions across smokeless tobacco, e-cigarettes, nicotine replacement therapy and combustible cigarettes. Tob Control 2016; 26:e49-e58. [DOI: 10.1136/tobaccocontrol-2016-053060] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 08/05/2016] [Accepted: 08/10/2016] [Indexed: 11/03/2022]
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Ryan MP, Hinojosa JJ. Conceptual obstacles to making use of four smoking-cessation strategies: What reasons do light smokers give for rejecting strategies? Health Psychol Open 2015; 2:2055102915624928. [PMID: 28070381 PMCID: PMC5193272 DOI: 10.1177/2055102915624928] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Some smokers have safety and cost concerns about nicotine replacement therapy which discourage its use. We recruited 56 young adult light smokers to read detailed descriptions of a hybrid nicotine replacement therapy, a prescription drug treatment, scheduled reduced smoking, and a menu of self-help tactics. Participants listed five reasons smokers might reject each strategy. An emergent-category content analysis classified each response with a high degree of inter-rater reliability. Only one-third of 32 concerns were strategy-specific; the majority focused on the general difficulty of quitting. Most prevalent were “continued cravings,” “addiction too strong,” “takes too long,” and “won’t work.” These and other concerns reflect conceptual obstacles to be surmounted in smoking-cessation interventions.
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Borgida E, Loken B, Williams AL, Vitriol J, Stepanov I, Hatsukami D. Assessing Constituent Levels in Smokeless Tobacco Products: A New Approach to Engaging and Educating the Public. Nicotine Tob Res 2015; 17:1354-61. [PMID: 25634934 PMCID: PMC4612344 DOI: 10.1093/ntr/ntv007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 12/15/2014] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Providing accurate information about the constituents in nicotine-containing products may help tobacco users make informed decisions about product choices. An experimental study examined a novel approach for presenting accurate constituent information about brands and types of smokeless tobacco (SLT) that could be understood by the general public. METHODS Participants were recruited through Amazon's Mechanical Turk and presented information online about 2 constituent dimensions of SLT products-nicotine and/or toxicity (for simplicity, "toxicity" in this study refers to carcinogenic constituents) Participants completed measures of knowledge and tobacco health risks at 2 time points: before and after exposure to constituent information. RESULTS Participants were found to increase their knowledge that toxicity contributes to disease risk and nicotine contributes to addiction, that SLT products vary in their levels of nicotine and toxicity, and that both SLT and cigarette products have higher toxicity than medicinal nicotine replacement therapies (e.g., nicotine lozenges). Study results showed no differences when presenting toxicity information alone versus presenting it in conjunction with nicotine information, and found no misperceptions or confusions about the relative harmfulness of cigarettes, SLT, or nicotine replacement therapy. CONCLUSIONS Providing tobacco constituent information to smokers and nonsmokers will improve their knowledge about the relative toxicity across products and variations within a class of tobacco products without compromising the health risks associated with tobacco use.
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Affiliation(s)
- Eugene Borgida
- Department of Psychology, University of Minnesota-Twin Cities, Minneapolis, MN;
| | - Barbara Loken
- Department of Marketing, Carlson School of Management, University of Minnesota-Twin Cities, Minneapolis, MN
| | - Allison L Williams
- Department of Psychology, University of Minnesota-Twin Cities, Minneapolis, MN
| | - Joseph Vitriol
- Department of Psychology, University of Minnesota-Twin Cities, Minneapolis, MN
| | - Irina Stepanov
- Division of Environmental Health Sciences, University of Minnesota-Twin Cities, Minneapolis, MN
| | - Dorothy Hatsukami
- Department of Psychiatry, School of Medicine, University of Minnesota-Twin Cities, Minneapolis, MN
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15
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Burris JL, Studts JL, DeRosa AP, Ostroff JS. Systematic Review of Tobacco Use after Lung or Head/Neck Cancer Diagnosis: Results and Recommendations for Future Research. Cancer Epidemiol Biomarkers Prev 2015; 24:1450-61. [PMID: 26282629 PMCID: PMC4592460 DOI: 10.1158/1055-9965.epi-15-0257] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 07/29/2015] [Indexed: 11/16/2022] Open
Abstract
Tobacco use after cancer diagnosis is associated with adverse cancer outcomes, yet reliable prevalence estimates for this behavior are lacking. We conducted a systematic literature review of the prevalence of current tobacco use among individuals with a history of lung or head/neck cancer (CRD #42012002625). An extensive search of electronic databases (MEDLINE, EMBASE, Cochrane Library, CINAHL, PsycINFO, and Web of Science) identified 7,777 potentially relevant articles published between 1980 and 2014 and 131 of these yielded pertinent information. Aggregating results across heterogeneous study designs and diverse patient samples, the overall mean prevalence rate of current tobacco use (mostly cigarette smoking) was 33.0% (median, 31.0%). Among current tobacco users at cancer diagnosis, the mean prevalence rate of current tobacco use (mostly cigarette smoking) was 53.8% (median, 50.3%). In many cases, an operational definition of "current" tobacco use was absent, and biochemical verification of self-reported smoking status was infrequent. These and other observed methodologic limitations in the assessment and reporting of cancer patients' tobacco use underscore the necessity of uniform tobacco use assessment in future clinical research and cancer care.
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Affiliation(s)
- Jessica L Burris
- Lucille P. Markey Cancer Center, Cancer Prevention and Control Program, Lexington, Kentucky. University of Kentucky, Department of Psychology, Lexington, Kentucky.
| | - Jamie L Studts
- Lucille P. Markey Cancer Center, Cancer Prevention and Control Program, Lexington, Kentucky. University of Kentucky, Department of Behavioral Science, Lexington, Kentucky
| | - Antonio P DeRosa
- Memorial Sloan Kettering Cancer Center, Medical Library, New York, New York
| | - Jamie S Ostroff
- Memorial Sloan Kettering Cancer Center, Psychiatry and Behavioral Sciences Service, New York, New York
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16
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Rodu B, Plurphanswat N, Hughes JR, Fagerström K. Associations of Proposed Relative-Risk Warning Labels for Snus With Perceptions and Behavioral Intentions Among Tobacco Users and Nonusers. Nicotine Tob Res 2015; 18:809-16. [PMID: 26253616 DOI: 10.1093/ntr/ntv168] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 07/27/2015] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The US Food and Drug Administration can require changes in warning statements for modified risk tobacco products. We report an independent analysis of a consumer perception survey sponsored by Swedish Match as part of a Modified Risk Tobacco Product application to change warning labels for Swedish snus products. METHODS The survey exposed each of 4324 daily exclusive cigarette smokers, 1033 daily smokeless tobacco users, 1205 daily other tobacco users, 726 former users, and 5915 triers/never users to one of four current warnings and two proposed relative-risk labels (No tobacco product is safe, but this product presents lower risks to health than cigarettes, or No tobacco product is safe, but this product presents substantially lower risks to health than cigarettes) for snus. Descriptive and logistic regression analyses examined four outcomes: believability, harmfulness, motivation to use, and intention to buy snus. RESULTS Compared with the current not-safe-alternative warning, adult tobacco users who viewed the proposed labels perceived them as less believable, perceived snus as less harmful and were more likely to use and buy snus. The proposed labels had no impact on former smokers' likelihood to use and buy snus; triers/never users viewing the substantially lower risk label were more likely to buy snus. CONCLUSIONS Tobacco users viewing the proposed labels perceived snus as less harmful than cigarettes and may be more likely to use and buy snus. If labeling changes lead to increased snus use and cigarette reduction or abstinence, public health may benefit. If the opposite occurs, public health could suffer.
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Affiliation(s)
- Brad Rodu
- Department of Medicine, School of Medicine, University of Louisville, Louisville, KY; James Graham Brown Cancer Center, University of Louisville, Louisville, KY;
| | | | - John R Hughes
- Center for Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT
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17
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Biener L, Nyman AL, Stepanov I, Hatsukami D. Public education about the relative harm of tobacco products: an intervention for tobacco control professionals. Tob Control 2014; 23:385-8. [PMID: 23481906 PMCID: PMC4119095 DOI: 10.1136/tobaccocontrol-2012-050814] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND In the USA, new regulations require the collection of information on tobacco constituents by brand and variety and publication of this information in a way not likely to be misconstrued by consumers. Understanding of such information becomes increasingly important as new tobacco products are marketed and modifications are made to reduce the toxicity of some products. This pilot study assessed the current knowledge of tobacco control professionals regarding the relative harmfulness of several tobacco products, and evaluated an online educational intervention aimed at improving understanding of variations in nicotine and tobacco-specific N-nitrosamines (TSNAs). METHODS Fifty-two tobacco control professionals participated in an online intervention which presented and discussed the results of constituent analyses of Camel Snus and Marlboro Snus compared to several conventional smokeless tobacco products. Comparisons with cigarettes were also discussed. Pre- and post-intervention questions assessed understanding of the concepts. RESULTS Pre-intervention responses demonstrated that 31% did not know that cigarettes are more harmful than smokeless tobacco, 67% did not know that smokeless products higher in nicotine are likely to be more effective substitutes for cigarettes, 52% did not know TSNAs are the major carcinogens in tobacco and 81% did not know new snus products tend to be lower in TSNAs than conventional spit tobacco. After intervention participation, knowledge increased on all points except one where pretest results were 100% correct. CONCLUSIONS Public education campaigns are urgently needed for tobacco control professionals and consumers to increase awareness and understanding of the continuum of risk among tobacco products.
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Affiliation(s)
- Lois Biener
- Center for Survey Research, University of Massachusetts Boston, 100 Morrissey Blvd., Boston, MA 02125, 617-287-7200, 617-287-7210 (fax),
| | - Amy L. Nyman
- Center for Survey Research, University of Massachusetts Boston, 100 Morrissey Blvd., Boston, MA 02125,
| | - Irina Stepanov
- Masonic Cancer Center, University of Minnesota, MMC 806, 420 Delaware St SE, Minneapolis, MN 55455,
| | - Dorothy Hatsukami
- University of Minnesota, Tobacco Research Programs, 717 Delaware St SE, Minneapolis, MN 55414,
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18
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Burris JL, Carpenter MJ, Wahlquist AE, Cummings KM, Gray KM. Brief, instructional smokeless tobacco use among cigarette smokers who do not intend to quit: a pilot randomized clinical trial. Nicotine Tob Res 2013; 16:397-405. [PMID: 24130144 DOI: 10.1093/ntr/ntt161] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Low-nitrosamine smokeless tobacco (SLT) may have efficacy for smoking reduction and cessation, but its public health impact depends on how smokers use it. METHODS This pilot study explored brief, instructional low-nitrosamine SLT use among smokers unmotivated to quit. Participants (N = 57) were randomized to either a free 2-week supply of Camel Snus group or a no-supply group. Of those randomized to use Camel Snus, half were told to use it to cope with smoking restrictions (Snus to Cope), and the remaining half were advised to use it to reduce smoking (Snus to Reduce). Participants were assessed before, during, and immediately after the intervention. RESULTS Many Snus to Cope and Snus to Reduce participants reported daily use of Camel Snus, although the amount of use was low. Snus to Cope (18.4%) and Snus to Reduce (37.6%) participants reported a decline in number of cigarettes used per day, which was not reported by the control participants (p < .001). Intention to quit smoking and intention to quit all tobacco use (ps < .001) increased to a greater extent among Snus to Cope and Snus to Reduce participants than among control participants. CONCLUSIONS This study replicates previous work that shows that low-nitrosamine SLT use can lead to reduced smoking and increased intention to quit, and it adds direct evidence to suggest that the function of low-nitrosamine SLT use-either to cope with smoking restrictions or to reduce smoking-can have a differential impact on smoking behavior. Overall, the results highlight the importance of messaging and, more specifically, marketing of low-nitrosamine SLT to smokers.
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Affiliation(s)
- Jessica L Burris
- Department of Psychiatry and Behavioral Sciences and Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
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