Sarah E. Adkison

Electronic Nicotine Delivery Systems: International Tobacco Control Four-Country Survey

BACKGROUND Electronic nicotine delivery systems (ENDS) initially emerged in 2003 and have since become widely available globally, particularly over the Internet. PURPOSE Data on ENDS usage patterns are limited. The current paper examines patterns of ENDS awareness, use, and product-associated beliefs among current and former smokers in four countries. METHODS Data come from Wave 8 of the International Tobacco Control Four-Country Survey, collected July 2010 to June 2011 and analyzed through June 2012. Respondents included 5939 current and former smokers in Canada (n=1581); the U.S. (n=1520); the United Kingdom (UK; n=1325); and Australia (n=1513). RESULTS Overall, 46.6% were aware of ENDS (U.S.: 73%, UK: 54%, Canada: 40%, Australia: 20%); 7.6% had tried ENDS (16% of those aware of ENDS); and 2.9% were current users (39% of triers). Awareness of ENDS was higher among younger, non-minority smokers with higher incomes who were heavier smokers. Prevalence of trying ENDS was higher among younger, nondaily smokers with a high income and among those who perceived ENDS as less harmful than traditional cigarettes. Current use was higher among both nondaily and heavy (≥20 cigarettes per day) smokers. In all, 79.8% reported using ENDS because they were considered less harmful than traditional cigarettes; 75.4% stated that they used ENDS to help them reduce their smoking; and 85.1% reported using ENDS to help them quit smoking. CONCLUSIONS Awareness of ENDS is high, especially in countries where they are legal (i.e., the U.S. and UK). Because trial was associated with nondaily smoking and a desire to quit smoking, ENDS may have the potential to serve as a cessation aid.

Impact of smokeless tobacco packaging on perceptions and beliefs among youth, young adults, and adults in the U.S: findings from an internet-based cross-sectional survey

BackgroundResearch demonstrates that tobacco packaging elements (including health warning labels, descriptive characteristics, and corporate branding) are associated with knowledge of health risks and product appeal with cigarettes. Yet, little research has assessed this with smokeless tobacco (SLT) packaging. This study evaluates the association between three SLT packaging elements with knowledge of health risks and perceptions of novelty and appeal. Additionally, we assess how effects of these messages may differ across age groups, including youth (14-17 years), young adults (18-25 years), and older adults (26-65 years).Methods1000 participants were administered a web-based survey in 2010 and shown three sets of SLT packs in random order, varied by descriptor (flavor descriptor vs. none), warning label format (graphic vs. text), and corporate branding (branded vs. plain packaging). Participants rated the packs compared with “no difference” on appeal, novelty, and risk perceptions associated with product use. Chi-square tests were used to test for significant differences in pack selections. Multinomial regression was employed to evaluate the association between effects of packaging elements and participant age.ResultsMore respondents selected the pack with the graphic warning label as the pack to make them consider the health risks associated with SLT use, attract their attention, and be least attractive to a smoker. The product with the text warning label was the product someone their age would want to be seen using and would appeal to peers. The SLT pack with the flavor descriptor was not associated with health risks associated with product use. The pack with corporate branding was selected as more appealing, to attract attention, and one they would want to be seen using; the plain pack was less attractive to smokers. Youth and young adults were more likely to indicate that pack elements affected their perceptions of appeal and risk associated with SLT products.ConclusionThese results suggest that SLT pack characteristics have a measurable effect on perceptions of health risk and product appeal. Future research should assess these findings in the context of harm reduction. Specifically, research is needed to determine whether pack elements on SLT products can effectively convey risk and harm.

Perceptions of “Natural” and “Additive-Free” Cigarettes and Intentions to Purchase

In August 2015, the Food and Drug Administration (FDA) issued warning letters to cigarette manufacturers promoting brands as “natural” or “additive-free” because of concerns that such marketing claims might mislead consumers into believing that these brands are less dangerous to smoke than others. The current study examined consumer beliefs about the relative harms of “natural” cigarettes, and whether these beliefs influenced perceptions of advertising and purchase intentions when participants were shown an advertisement for American Spirit cigarettes. Data were collected using a web-based survey conducted in 2013 among 3,006 U.S.-based web panel members aged 15 to 65 years. Ratings of “natural” cigarette health risks (i.e., misperceptions) differed by sex, race, education, smoking status, and age. Controlling for perceived risks of other cigarette types, never smokers (B = −0.31, p < .001) and ever/former smokers (B = −0.15, p = .002) had significantly fewer misperceptions of “natural” cigarettes than current smokers. Current smoking (odds ratio [OR] = 17.8), believing the ad was truthful (OR = 1.18), and having more misperceptions about “natural” cigarette health risks (OR = 1.13) were independently associated with greater purchase intention. Consumers perceived cigarettes marketed as “natural” or “additive-free” as less harmful, and this influenced their perceptions of advertising claims and intention to purchase, controlling for other factors. These findings underscore Food and Drug Administration’s recent warning letters.

Psychometric Characteristics of the Brief Wisconsin Inventory of Smoking Dependence Motives Among a Nonclinical Sample of Smokers

INTRODUCTION Attempts to validate the Brief Wisconsin Inventory of Smoking Dependence Motives (WISDM) have produced mixed results. The objectives for the current research were to (1) evaluate the test-retest reliability, internal consistency, and concurrent validity for each of the motive scales (2) evaluate three models to determine fit based on previous research: (i) 11-factor model, (ii) 11-factor model with four error covariances specified by previous research, and (iii) 11-factor model with two higher order primary and secondary dependence motive factors, and (3) evaluate the discriminant and convergent validity of the Brief WISDM scales. METHODS Smoking adults aged 18-65 completed a survey about their smoking behaviors and nicotine dependence with a web-based instrument that was administered at a 3-month test-retest interval. Psychometric properties and test-retest reliability were evaluated for each instrument. The 11-factor Brief WISDM was evaluated with confirmatory factor analyses; the scales were evaluated for convergent and discriminant validity. RESULTS The Brief WISDM demonstrated good to excellent test-retest reliability. Confirmatory factor analysis showed the model with the second order primary and secondary dependence motive factors demonstrated the best fit for the data at both administrations. Discriminant validity issues were present for most of the primary dependence motive scales. CONCLUSIONS To date, the theoretically derived smoking motives for the Brief WISDM have demonstrated mixed support when submitted to confirmatory factor analysis. While these scales tap critical motives of nicotine dependence, further refinement of primary dependence motives is necessary to ensure each latent variable assesses a unique construct.

Development of measures assessing attitudes toward contraband tobacco among a web-based sample of smokers

BackgroundAs regulation of tobacco products tightens, there are concerns that illicit markets may develop to supply restricted products. However, there are few validated measures to assess attitudes or purchase intentions toward contraband tobacco (CT). As such, it is important to investigate individual level characteristics that are associated with the purchase and use of contraband tobacco.MethodsIn May 2013, a pilot survey assessed attitudes, behaviors, and purchase intentions for contraband tobacco based on previous research regarding non-tobacco contraband. The survey was administered via Amazon Mechanical Turk, a crowdsourcing resource, among current smoking respondents in the United States and Canada. Structural equation modeling was used to evaluate the validity of the proposed model for understanding attitudes toward contraband tobacco.ResultsCT purchasers were more likely to report norms supportive of counterfeit products, more intentions toward purchasing counterfeit products, a lowered risk associated with these products, and to have more favorable attitudes toward CT than those who had not purchased CT. Attitudes toward CT mediated the relationship between subjective norms and prior purchase with behavior intentions. Perceived risk had a significant direct effect on intentions and an indirect effect through attitudes toward CT. The structural model fit the data well and accounted for over half (53%) of the variance in attitudes toward tobacco.ConclusionsUnderstanding the mechanisms associated with CT attitudes and purchase behaviors may provide insight for how to mitigate possible iatrogenic consequences of newly implemented regulations. The measures developed here elucidate some elements that influence attitudes and purchase intentions for CT and may inform policy efforts to curtail the development of illicit markets.

Evaluation of modified risk claim advertising formats for Camel Snus

Objectives: The US Food and Drug Administration (FDA) has regulatory authority for modified risk tobacco product advertising claims. To guide future regulatory efforts, we investigated how variations in modified risk claim advertisements influence consumer perceptions of product risk claims for Camel Snus. Methods: Young people and adults (15–65), including current, never, and former smokers, were randomised to view one of five Camel Snus print advertisements as part of a web-based survey. Four of the advertisements presented information related to nitrosamine content of snus using four formats: (1) text, (2) a bar chart, (3) a text/testimonial and (4) a bar chart/testimonial. The fifth format, used as a control, was a current advertisement for Camel Snus without the explicit claims made about nitrosamine content. After viewing advertisements for all products, participants were asked which product they would be most interested in trying. Results: Participants exposed to advertisements that contained an explicit reduced risk message agreed the advertising claim for that product posed fewer health risks than cigarettes. However, advertisements containing the reduced risk messages were also viewed as containing less truthful information and respondents were more sceptical of the information presented. Advertisement claim format was not associated with selecting snus over the other tobacco products, nor was it associated with purchase intentions. Conclusion: The results of this research indicate that consumers respond to reduced risk messages, though perhaps not in the direct way anticipated. We found no significant differences by advertisement format (numerical, graphical, testimonial).

Validation of a Measure of Normative Beliefs About Smokeless Tobacco Use

INTRODUCTION Validated methods to evaluate consumer responses to modified risk tobacco products (MRTPs) are needed. Guided by existing literature that demonstrates a relationship between normative beliefs and future intentions to use tobacco the current research sought to (1) develop a measure of normative beliefs about smokeless tobacco (ST) and establish the underlying factor structure, (2) evaluate the structure with confirmatory factor analysis utilizing an independent sample of youth, and (3) establish the measures concurrent validity. METHODS Respondents (smokers and nonsmokers aged 15-65; N = 2991) completed a web-based survey that included demographic characteristics, tobacco use history and dependence, and a measure of attitudes about ST adapted from the Normative Beliefs about Smoking scale. A second sample of youth (aged 14-17; N = 305) completed a similar questionnaire. RESULTS Exploratory factor analysis produced the anticipated three-factor solution and accounted for nearly three-quarters of the variance in the data reflecting (1) perceived prevalence of ST use, (2) popularity of ST among successful/elite, and (3) approval of ST use by parents/peers. Confirmatory factor analysis with data from the youth sample demonstrated good model fit. Logistic regression demonstrated that the scales effectively discriminate between ST users and nonusers and are associated with interest in trying snus. CONCLUSIONS Assessment of MRTPs for regulatory purposes, which allows messages of reduced risk, should include measurement of social norms. Furthermore, surveillance efforts that track use of new MRTPs should include measures of social norms to determine how norms change with prevalence of use.

Impact of reduced ignition propensity cigarette regulation on consumer smoking behavior and quit intentions: evidence from 6 waves (2004-11) of the ITC Four Country Survey

BackgroundAlthough on the decline, smoking-related fires remain a leading cause of fire death in the United States and United Kingdom and account for over 10% of fire-related deaths worldwide. This has prompted lawmakers to enact legislation requiring manufacturers to implement reduced ignition propensity (RIP) safety standards for cigarettes. The current research evaluates how implementation of RIP safety standards in different countries influenced smokers’ perceptions of cigarette self-extinguishment, frequency of extinguishment, and the impact on consumer smoking behaviors, including cigarettes smoked per day and planning to quit.MethodsParticipants for this research come from Waves 3 through 8 of the International Tobacco Control (ITC) Four Country Survey conducted longitudinally from 2004 through 2011 in the United States, United Kingdom, Australia, and Canada.ResultsPerceptions of cigarette self-extinguishment and frequency of extinguishment increased concurrently with an increase in the prevalence of RIP safety standards for cigarettes. Presence of RIP safety standards was also associated with a greater intention to quit smoking, but was not associated with the number of cigarettes smoked per day. Intention to quit was higher among those who were more likely to report that their cigarettes self-extinguish sometimes and often, but we found no evidence of an interaction between frequency of extinguishment and RIP safety standards on quit intentions.ConclusionsOverall, because these standards largely do not influence consumer smoking behavior, RIP implementation may significantly reduce the number of cigarette-related fires and the associated death and damages. Further research should assess how implementation of RIP safety standards has influenced smoking-related fire incidence, deaths, and other costs associated with smoking-related fires.

Application of the Smokeless Tobacco Expectancies Questionnaire to Snus.

OBJECTIVE Measures of consumer perceptions of emerging tobacco products are needed for understanding the potential for product adoption and use. The purpose of this research was to evaluate the applicability of the Smokeless Tobacco Expectancies Questionnaire to snus, and examine its association with interest in using snus. METHODS We recruited 116 adolescents (14-17 years of age), 463 young adults (18-34 years of age), and 596 older adults (35-65 years of age) from a Web-based opt-in panel. Participants completed a 10-item Snus Expectancies Questionnaire and questions about their interest in trying snus in the next month. RESULTS Confirmatory factor analysis supported a latent factor structure representing Positive Reinforcement (PR) and Negative Health Consequences (NHC) within each age group. The scales differentiate smokers and smokeless tobacco users and nonusers. Each scale was associated with interest in purchasing snus for younger (PR: OR 1.90; NHC: OR 0.66) and older (PR: OR 1.36; NHC: OR 0.69) adults controlling for tobacco use status. CONCLUSIONS The modified Smokeless Tobacco Expectancies Questionnaire is a valid measure of snus-related outcome expectancies, which are in turn, associated with self-reported tobacco use, and may help to identify groups who are susceptible to snus initiation and use.