Smokers’ and Young Adult Non-Smokers’ Perceptions and Perceived Impact of Snus and E-Cigarette Modified Risk Messages
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants and Recruitment
2.2. Message Stimuli and Group Procedures
2.3. Data Analyses
3. Results
“…But by the end of the week I noticed physical feeling in my lung area that I did not like at all….And believe it or not smoking a cigarette never made me feel that way inside. So it was a little scary.”(e-cigarette group, female smoker)
3.1. Modified Risk (MR) Claim Reactions
3.1.1. Clear Communication That Snus Is Less Harmful
“It can still give you things in your mouth, I know that. So, that statement is not right.”(snus group, male smoker)
3.1.2. Clear Communication That Vaping Is Less Harmful
“It doesn’t have enough substance on my end to say it’s going be less harmful for me.”(e-cigarette group, male smoker)
3.1.3. Communication That Snus/Vaping Still Contains Risks
“…at the end it says it reduces the harms. It doesn’t say it eliminates them. So you can’t say that they’re not telling you that there are still harms.”(e-cigarette group, female YA)
“So [the claim] does dictate that it’s not going to completely get rid of all of your risk… But I don’t think it’s really hitting home that there are still negative consequences that come with this.”(snus group, female YA)
3.1.4. Motivation to Switch Completely/Start Using Snus or E-Cigarettes
“When I first saw that it says, ‘If you smoke,’ I was like, ‘Okay. So this does not apply to me, so I don’t care.”(e-cigarette group, female YA)
3.2. Perceptions of Modified Risk (MR) Claim Wordings and Variations
3.2.1. Switching Completely Phrasing
“That you cannot be using snus and using cigarettes at the same time. It’s like you have to give up cigarettes and you will exclusively just use this product so that you get the benefit of it”(snus group, female smoker)
“Switching, it kind of gives me a choice. Opposed to the other one was more final.”(snus group, female smoker)
“I mean, you’re not really quitting if you’re going to vaping.”(e-cigarette group, female smoker)
3.2.2. Use of “Greatly”
3.2.3. Health Conditions Present in Snus MR Claim
3.2.4. Attribution to “Scientific Studies”
3.2.5. With Emphasis on Smoking Harms
“I think it’d make a big difference….Because if they are going out of their way to say a message like this and attack smoking, then snus must be a much better alternative in which there is less risk of everything overall. So for them to come out and say this would be a big deal.”(snus group, male YA)
3.2.6. With Combustion Explanation
“…You’re kind of looking at it and saying ‘Oh, so because you’re burning tobacco or blowing smoke, that’s what’s causing the cancer or the lung disease?’ Nothing else? There’s a lot more that causes it by use of the cigarette…”(snus group, female smoker)
“When you vape with either product, there is still a burning and smoking that’s coming from it, regardless…”(e-cigarette group, female smoker)
3.3. Modified Exposure (ME) Claim Reactions
3.3.1. Clear Communication That Snus/Vaping Is Less Harmful
“I don’t think it clearly communicates that it’s less harmful and just says it exposes you to less chemicals. That doesn’t make it any less harmful, in my opinion.”(e-cigarette group, female smoker)
“I think it’s more obvious in the first one. This isn’t as powerful. Yes, it’s fewer harmful chemicals, but what does that mean as far as my health? So, I think I like the other one better.”(snus group, female smoker)
3.3.2. Communication That Snus/Vaping Still Contains Risks and Motivation to Switch/Start Using
3.3.3. Perceptions of ME Claim Variation
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
- Gottlieb, S.; Zeller, M. A Nicotine-Focused Framework for Public Health. N. Engl. J. Med. 2017, 377, 1111–1114. [Google Scholar] [CrossRef] [PubMed]
- Foulds, J.; Ramstrom, L.; Burke, M.; Fagerström, K. Effect of smokeless tobacco (snus) on smoking and public health in Sweden. Tob. Control 2003, 12, 349–359. [Google Scholar] [CrossRef] [PubMed]
- Levy, D.T.; Mumford, E.A.; Cummings, K.M.; Gilpin, E.A.; Giovino, G.; Hyland, A.; Sweanor, D.; Warner, K.E. The relative risks of a low-nitrosamine smokeless tobacco product compared with smoking cigarettes: Estimates of a panel of experts. Cancer Epidemiol. Biomark. Prev. 2004, 13, 2035–2042. [Google Scholar]
- National Academies of Sciences, Engineering, and Medicine. Public Health Consequences of E-Cigarettes; National Academies Press: Washington, DC, USA, 2018. [Google Scholar]
- McNeill, A.; Brose, L.S.; Calder, R.; Bauld, L.; Robson, D. Evidence Review of E-Cigarettes and Heated Tobacco Products 2018; Public Health England: London, UK, 2018; p. 6. [Google Scholar]
- Institute of Medicine (US), Committee on Scientific Standards for Studies on Modified Risk Tobacco Products. Scientific Standards for Studies on Modified Risk Tobacco Products; National Academies Press: Washington, DC, USA, 2012. [Google Scholar]
- Pearson, J.L.; Johnson, A.L.; Johnson, S.E.; Stanton, C.A.; Villanti, A.C.; Niaura, R.S.; Hyland, A. Adult interest in using a hypothetical modified risk tobacco product: Findings from wave 1 of the Population Assessment of Tobacco and Health Study (2013–14). Addiction 2018, 113, 113–124. [Google Scholar] [CrossRef] [PubMed]
- O’Brien, E.K.; Persoskie, A.; Parascandola, M.; Hoffman, A.C. US Adult Interest in Less Harmful and Less Addictive Hypothetical Modified Risk Tobacco Products. Nicotine Tob. Res. 2017, 20, 1317–1326. [Google Scholar] [CrossRef] [PubMed]
- US Food and Drug Administration. Draft Guidance for Industry: Modified Risk Tobacco Product Applications; US Government Printing Office: Washington, DC, USA, 2012.
- US Food & Drug Administration. Modified Risk Tobacco Products Applications. Available online: https://www.fda.gov/tobacco-products/advertising-and-promotion/modified-risk-tobacco-products (accessed on 31 July 2020).
- Goniewicz, M.L.; Smith, D.M.; Edwards, K.C.; Blount, B.C.; Caldwell, K.L.; Feng, J.; Wang, L.; Christensen, C.; Ambrose, B.; Borek, N.; et al. Comparison of Nicotine and Toxicant Exposure in Users of Electronic Cigarettes and Combustible Cigarettes. JAMA Netw. Open 2018, 1, e185937. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Owusu, D.; Lawley, R.; Yang, B.; Henderson, K.; Bethea, B.; LaRose, C.; Stallworth, S.; Popova, L. The lesser devil you don’t know: A qualitative study of smokers’ responses to messages communicating comparative risk of electronic and combusted cigarettes. Tob. Control 2019, 29, 217–223. [Google Scholar] [CrossRef] [PubMed]
- McKelvey, K.; Baiocchi, M.; Halpern-Felsher, B. PMI’s heated tobacco products marketing claims of reduced risk and reduced exposure may entice youth to try and continue using these products. Tob. Control 2020. [Google Scholar] [CrossRef] [PubMed]
- Corporate Research Associates. Testing of Relative Risk Statements for Vaping Products—Final Report. Prepared for: Health Canada. 2018. Available online: https://epe.lac-bac.gc.ca/100/200/301/pwgsc-tpsgc/por-ef/health/2019/014-18-e/report.pdf (accessed on 31 July 2020).
- U.S. Food and Drug Administration. FDA Authorizes Marketing of IQOS Tobacco Heating Systems with “Reduced Exposure” Information. Press Release; 7 July 2020. Available online: https://www.fda.gov/news-events/press-announcements/fda-authorizes-marketing-iqos-tobacco-heating-system-reduced-exposure-information (accessed on 31 July 2020).
- Wackowski, O.A.; O’Connor, R.J.; Pearson, J.L. Smokers’ exposure to perceived modified risk claims for e-cigarettes, snus and smokeless tobacco in the United States. Nicotine Tob. Res. 2020. [Google Scholar] [CrossRef] [PubMed]
- Ding, F.; Li, Q.; Jin, L. The Practice of Public Health Emergency Operations Center (EOC) The Operations of Chinese Center for Disease Control and Prevention (China CDC)’s EOC. Infect. Dis. 2020. [Google Scholar] [CrossRef]
- Wackowski, O.; Lewis, M.J.; Delnevo, C.D. Interviews with smokers about smokeless tobacco products, risk messages and news articles. Tob. Control 2015, 25, 671–678. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- McQuarrie, E.F.; Krueger, R.A. Focus Groups: A Practical Guide for Applied Research. J. Mark. Res. 1989, 26, 371. [Google Scholar] [CrossRef]
- Clowes, R. Think Smaller: Think Mini Focus Groups. Quirk’s Marketing Research Review 1994. Available online: http://www.quirks.com/articles/a1994/19941201.aspx (accessed on 23 January 2016).
- Richardson, D. In Praise of Intimacy: Small Focus Groups. 12 June 2014. Available online: http://www.artemissg.com/2014/06/praise-small-focus-groups/ (accessed on 22 January 2016).
- Center for Disease Control and Prevention. Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products. Available online: https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html (accessed on 31 July 2020).
- Lempert, L.K.; Glantz, S.A. Analysis of FDA’s IQOS marketing authorisation and its policy impacts. Tob. Control 2020. [Google Scholar] [CrossRef] [PubMed]
- World Health Organziation. WHO Statement on Heated Tobacco Products and the US FDA Decision Regarding IQOS. 7 July 2020. Available online: https://www.who.int/news-room/detail/27-07-2020-who-statement-on-heated-tobacco-products-and-the-us-fda-decision-regarding-iqos (accessed on 31 July 2020).
- Campaign for Tobacco Free Kids. Comment RE: Modified Risk Tobacco Product Applications for Six Camel Snus Smokeless Tobacco Products Submitted by R.J. Reynolds Tobacco Company, Docket No. FDA-2017-N-4678. Available online: https://beta.regulations.gov/document/FDA-2017-N-4678-0035 (accessed on 31 July 2020).
- Huang, J.; Feng, B.; Weaver, S.R.; Pechacek, T.F.; Slovic, P.; Eriksen, M.P. Changing Perceptions of Harm of e-Cigarette vs. Cigarette Use among Adults in 2 US National Surveys from 2012 to 2017. JAMA Netw. Open 2019, 2, e191047. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Villanti, A.C.; Byron, M.J.; Mercincavage, M.; Pacek, L.R. Misperceptions of Nicotine and Nicotine Reduction: The Importance of Public Education to Maximize the Benefits of a Nicotine Reduction Standard. Nicotine Tob. Res. 2019, 21, S88–S90. [Google Scholar] [CrossRef] [PubMed]
- Abrams, D.B.; Glasser, A.M.; Villanti, A.C.; Pearson, J.L.; Rose, S.W.; Niaura, R.S. Managing nicotine without smoke to save lives now: Evidence for harm minimization. Prev. Med. 2018, 117, 88–97. [Google Scholar] [CrossRef] [PubMed]
- Kozlowski, L.T.; Sweanor, D.T. Young or adult users of multiple tobacco/nicotine products urgently need to be informed of meaningful differences in product risks. Addict. Behav. 2018, 76, 376–381. [Google Scholar] [CrossRef] [PubMed]
- Nelson, D.E.; Hesse, B.; Croyle, R.T. Making Data Talk; Oxford University Press (OUP): Oxford, UK, 2009. [Google Scholar]
- Wackowski, O.; Manderski, M.T.B.; Delnevo, C.D. Smokers’ sources of e-cigarette awareness and risk information. Prev. Med. Rep. 2015, 2, 906–910. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Case, K.R.; Lazard, A.J.; Mackert, M.; Perry, C.L. Source Credibility and E-Cigarette Attitudes: Implications for Tobacco Communication. Health Commun. 2017, 33, 1059–1067. [Google Scholar] [CrossRef] [PubMed]
- Weaver, S.R.; Jazwa, A.; Popova, L.; Slovic, P.; Rothenberg, R.B.; Eriksen, M.P. Worldviews and trust of sources for health information on electronic nicotine delivery systems: Effects on risk perceptions and use. SSM Popul. Health 2017, 3, 787–794. [Google Scholar] [CrossRef]
Message Type | Snus Groups | E-Cigarette Groups |
---|---|---|
Modified risk (MR) base claim | “If you smoke, consider this—switching completely from cigarettes to snus can greatly reduce your risk of lung cancer, mouth cancer, lung disease and heart disease.” | “If you smoke consider this—switching completely from cigarettes to vaping products can greatly reduce harms to your health.” |
Variations to MR claim * | ||
With “completely replacing” instead of “switching completely” | “…Completely replacing your cigarettes with snus can greatly reduce your risk of lung cancer, mouth cancer, lung disease and heart disease.” | “…Completely replacing your cigarettes with vaping products can greatly reduce harms to your health.” |
With “quitting smoking” instead of “switching completely” | “…Quitting smoking and switching to snus can greatly reduce your risk of lung cancer, mouth cancer, lung disease and heart disease.” | “…Quitting smoking and switching to vaping products can greatly reduce harms to your health.” |
Without “greatly” wording | “…Switching completely from cigarettes to snus can reduce your risk of lung cancer, mouth cancer, lung disease and heart disease.” | “… Switching completely from cigarettes to vaping products can reduce harms to your health.” |
With “much lower risk” instead of “greatly” | “…puts you at a much lower risk for lung cancer, mouth cancer, lung disease, and heart disease.” | |
With “scientific studies” attribution | “…Scientific studies have shown that switching completely from cigarettes to snus can greatly reduce your risk of lung cancer, mouth cancer…” | “…Scientific studies have shown that switching completely from cigarettes to vaping products can greatly reduce harms to your health.” |
With second statement emphasizing smoking harms | “… Switching completely to Snus can greatly reduce your risk of lung cancer, mouth cancer, lung disease, and heart disease. | “… Switching completely from cigarettes to vaping products can greatly reduce harms to your health. |
Smoking is deadly. Think seriously about switching.” | Smoking is deadly. Think seriously about switching.” | |
With explanatory second statement related to combustion and smoke | “…Switching completely to snus can greatly reduce your risk of lung cancer, mouth cancer…” | “…Switching completely from cigarettes to vaping products can greatly reduce harms to your health. |
Why? Because there is no burning of tobacco or smoke with snus.” (Version in groups 1,2,4) | ||
OR | Why? Because there’s no tobacco burning or smoke with vaping products.” | |
Why? Because there’s no smoke to inhale with snus.” (version in groups 3, 5, 6) | ||
Modified exposure (ME) base claim | “If you smoke, consider this—scientific studies have shown that snus products contain fewer harmful chemicals than cigarette smoke.” | “If you smoke, consider this—scientific studies have shown that vaping products release fewer harmful chemicals than cigarette smoke.” (groups 7, 8, 9) |
“…that vaping products expose users to fewer harmful chemicals than cigarette smoke.” (groups 10, 11, 12) | ||
Variations to ME Claim * | ||
With “far fewer” or “a lot less” wording | “…Scientific studies have shown that snus products contain [far fewer/a lot less] harmful chemicals than cigarette smoke.” | “…Scientific studies have shown that vaping products expose users to [far fewer/a lot less] harmful chemicals than cigarette smoke.” |
With high number of chemicals in cigarettes | “…Scientific studies have shown that snus products contain fewer harmful chemicals than the 7000 in cigarette smoke.” | “…Scientific studies have shown that vaping products [release/expose users to] far fewer harmful chemicals than the 7000 in cigarette smoke.” |
A. Perceptions that claim is not specific enough; desire for more facts, statistics |
Snus Groups |
|
|
E-cigarette Groups |
|
B. Believability concerns based on existing product risk beliefs (that harmful/still harmful) |
Snus Groups |
|
E-cigarette Groups |
|
C. Believability concerns based on acute effects of vaping and EVALI outbreak (E-cigarette Groups) |
|
A. Positive perceptions of “greatly” qualifier |
|
B. Negative/skeptical perceptions of “greatly” qualifier |
|
C. Positive perceptions of attribution to “scientific studies” |
|
D. Negative/skeptical perceptions of attribution to “scientific studies” |
|
E. Positive perceptions of “Smoking is Deadly” addition to MR claim |
|
F. Negative/skeptical perceptions of “Smoking is Deadly” addition to MR claim |
|
A. Clear communication that Snus/Vaping is less harmful |
|
B. Perceptions that claim is vague about chemical type/quantity and harm reduction |
|
C. Skepticism about e-cigarette claim believability because of the chemical nature of e-cigarettes |
|
D. Perceptions that reference to 7000 chemicals in cigarette could be effective: |
|
E. Perceptions that reference to 7000 chemicals in cigarette could be less effective: |
|
© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Wackowski, O.A.; Rashid, M.; Greene, K.L.; Lewis, M.J.; O’Connor, R.J. Smokers’ and Young Adult Non-Smokers’ Perceptions and Perceived Impact of Snus and E-Cigarette Modified Risk Messages. Int. J. Environ. Res. Public Health 2020, 17, 6807. https://doi.org/10.3390/ijerph17186807
Wackowski OA, Rashid M, Greene KL, Lewis MJ, O’Connor RJ. Smokers’ and Young Adult Non-Smokers’ Perceptions and Perceived Impact of Snus and E-Cigarette Modified Risk Messages. International Journal of Environmental Research and Public Health. 2020; 17(18):6807. https://doi.org/10.3390/ijerph17186807
Chicago/Turabian StyleWackowski, Olivia A., Mariam Rashid, Kathryn L. Greene, M. Jane Lewis, and Richard J. O’Connor. 2020. "Smokers’ and Young Adult Non-Smokers’ Perceptions and Perceived Impact of Snus and E-Cigarette Modified Risk Messages" International Journal of Environmental Research and Public Health 17, no. 18: 6807. https://doi.org/10.3390/ijerph17186807