While cigarette smoking is higher than the use of smokeless tobacco (SLT), the percentage of adults using SLT has increased in the United States within the last decade. Promoting SLT for harm reduction among smokers has been debated as some research suggests SLT may have lower risks than smoking when used exclusively, and may reduce harm for smokers unable or unwilling to quit tobacco use. As such, one smokeless tobacco company recently applied to the FDA to be able to market its snus products, a Swedish style of smokeless tobacco, as having “substantially lower risks to health than cigarettes.” However, some public health professionals argue that promoting SLT use might encourage dual product use, deter quitting, and encourage new users who misperceive reduced-risk messages as meaning SLT is safe. Therefore, learning about how smokers perceive SLT risk messages is important given that their perceptions may influence their use of smokeless tobacco.
In a study published in Tobacco Control, Dr. Olivia A. Wackowski, assistant professor, Dr. M. Jane Lewis, associate professor, and Dr. Cristine D. Delnevo, professor and chair, all from the department of health education and behavioral science at the Rutgers School of Public Health, explored how smokers perceive smokeless tobacco and snus products, and news stories with different risk messages about them.
Researchers conducted 30 semi-structured interviews with current smokers who were asked to read one of three news stories about SLT and snus with different messages about their risks compared to cigarettes (i.e., ‘cautious,’ ‘favorable,’ or ‘mixed’). The articles were short news stories prepared by the research team, using information they gained from a previously conducted content analysis of SLT news.
Smokers felt somewhat more informed about snus after reading their assigned article and largely found quoted sources to be credible. Though some exposed to favorable SLT/snus messages appeared to modify their beliefs about the products’ acceptability and risks, many were left unchanged given pre-existing SLT risk perceptions influenced by prior SLT warnings, observed effects in known users, and concerns about SLT’s mode of use. Willingness to use/not use snus in the future was also influenced by non-risk-related factors (e.g., preference for smoking rituals). Many referenced e-cigarettes as being safer and more attractive smoking alternatives.
“Our results suggest that exposure to reduced-risk SLT information may influence smokers’ perceptions about and interest in SLT and snus,” said Wackowski. “However, strong and repeated exposure to such messages from credible sources may be needed to overcome deeply ingrained SLT attitudes and beliefs.”
Study results also suggest, however, that smokers’ willingness to use SLT appears to be strongly influenced by non-risk factors (e.g., perceived acceptability). Thus, reduced-risk SLT information may ultimately have limited impact, particularly given the growing popularity of e-cigarettes, which appear to already be seen by smokers as acceptable cigarette alternatives that are both less harmful and enjoyable.
“Interviews with smokers about smokeless tobacco products, risk messages and news articles” was published online in November in the journal Tobacco Control.