Effects of a Reduced Risk Claim on Adolescents' Smokeless Tobacco Perceptions and Willingness to Use

Benjamin W Chaffee; Elizabeth T Couch; Lucy Popova; Bonnie Halpern-Felsher

doi:10.1016/j.jadohealth.2023.04.025

Effects of a Reduced Risk Claim on Adolescents' Smokeless Tobacco Perceptions and Willingness to Use

J Adolesc Health. 2023 Sep;73(3):445-451. doi: 10.1016/j.jadohealth.2023.04.025. Epub 2023 Jun 9.

Authors

Benjamin W Chaffee¹, Elizabeth T Couch², Lucy Popova³, Bonnie Halpern-Felsher⁴

Affiliations

¹ Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California. Electronic address: Benjamin.chaffee@ucsf.edu.
² Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California.
³ School of Public Health, Georgia State University, Atlanta, Georgia.
⁴ Department of Pediatrics, Stanford University, Stanford, California.

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.

Keywords: Adolescents; Electronic cigarettes; Public health; Smokeless tobacco; Tobacco control; Tobacco marketing.

Publication types

Randomized Controlled Trial
Research Support, N.I.H., Extramural

MeSH terms

Adolescent
Electronic Nicotine Delivery Systems*
Female
Humans
Male
Surveys and Questionnaires
Tobacco Products* / adverse effects
Tobacco Use
Tobacco, Smokeless*
United States

Abstract

Publication types

MeSH terms

Grants and funding