Smokers’ perceptions of smokeless tobacco and harm reduction

Abstract

Existing survey data indicate that most smokers are not receptive to harm reduction incentives of switching to smokeless tobacco (SLT). Little is known about the underlying reasons for these views. To explore smokers' perceptions of SLT, we conducted a focus group (eight in total) study of daily smokers between 2009 and 2010 at the University of California, Irvine. We transcribed each 2-hour focus group verbatim and analyzed it using domain analysis. The discussions revealed several reasons why smokers are not receptive to SLT. First, smokers associated new spit-less SLT (that is, Snus) with historic images of chewing tobacco. Second, smokers viewed smoking as an incentive to take a break from their daily routine. Third, smokers expressed lack of control over nicotine delivery when using SLT, relative to cigarettes. These findings challenge tobacco manufacturers' strategies to market a smokeless alternative as a growing number of smoke-free policies are introduced.

Interviews with smokers about smokeless tobacco products, risk messages and news articles: Table 1

“…Our study was consistent with others in finding that smokers’ believe switching from smoking to SLT represents trading in some risks for others,24 31 that they mistakenly believe SLT users have a higher risk of oral cancer than smokers,18 39 and that SLT risk perceptions are impacted by SLT's mode of delivery, that is, its prolonged direct contact with the mouth 18 24 32 33. Another qualitative study also found that this direct contact with the mouth made smokers feel like they would have less control over their nicotine and toxin exposure with SLT versus cigarettes, which they perceived they could better control by varying their inhalation levels and by exhaling and ‘blowing out’ toxins 24. Given that these perceptions may seem intuitive and logical, it may be difficult for smokers to accept that SLT use may have lower oral cancer risks or that some forms like snus may not have a clear oral cancer association.…”

“…However, some felt the ‘pro-SLT’ information included in the stories ‘sent the wrong message’ and questioned the credibility of ‘pro-SLT’ message sources. Furthermore, many were left unconvinced that SLT and snus is (or could be) a safer alternative, a finding consistent with a previous qualitative study in which the moderator attempted to explain that studies have shown SLT poses lower cancer risk 24. These perceptions appeared to be influenced by several factors:…”

“…Interviews were conducted between February and March 2014. The interview recordings were transcribed and then coded using Atlas.ti qualitative software, using a list of codes developed deductively a priori based on our research questions and relevant previous studies24 27 31–33 and inductively based on repeated reading of the transcripts and memos. All 30 interviews were conducted and transcripts coded by the primary author (OAW) while another co-author (MJL) reviewed 15 coded transcripts and interview memos (5 from each condition) for agreement.…”

“…Research on whether exposure to reduced-risk information could change smokers’ SLT risk perceptions and interest is also scant and somewhat mixed. One focus group study found that smokers did not believe tobacco health information (including information on comparative risks) to be very valuable in thinking about switching to SLT 24. One study measuring effects of health information found that while exposure to a brochure with antismoking information increased smokers’ SLT demand, exposure to pro-SLT information did not 25.…”

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

“…Third, individuals may have been misled by public health authorities, which have provided misinformation on the risks of SLT relative to CCs in the USA, where most of the reviewed population surveys were conducted 17 18. Evidence from qualitative research may help reveal the reasons underlying RRPs 79 80…”