Smokeless Tobacco Labeling Matters: Impact of Warnings and Relative Risk Info

A study published in Nicotine & Tobacco Research (abstract here) reveals “high levels of appeal for ST [smokeless tobacco] among young adult Canadian cigarette smokers,” despite the fact that “more than one quarter (28%)…were unaware that using ST is less harmful than smoking.”  The lead author was William E. Callery at the University of Waterloo in Ontario, with co-authors from Roswell Park Cancer Institute and the Ontario Institute for Cancer Research.

Callery and coworkers recruited 611 Canadian smokers age 18-30 years old to participate in an online survey viewing photographs of four ST packages (duMaurier snus, Marlboro snus, Copenhagen moist snuff and Ariva dissolvable tobacco), altered to contain a mix of text or pictorial health warning labels tested by Health Canada, the federal health agency.  The ST packages were also altered to contain relative health risk messages that truthfully explained the difference in risk between ST products and cigarettes.

Callery  et al. found that “43.6% of respondents indicated that they were likely to try at least one of the ST products”; the preferred product was Ariva.  The pictorial warning labels significantly reduced the likelihood of trying the ST products, while the relative risk messages doubled the prospect of trial.  In other words, picture warnings increased the scare factor, while relative risk messages increased the chances of switching.

The young adults came in to the study grossly misinformed about the relative risks of ST products.  Callery observed that “between 30% and 47% of respondents incorrectly believed that ST and cigarettes are equally harmful, and a small proportion incorrectly believed that ST is more harmful than cigarettes.”  As one might expect, warning labels enhanced the misperceptions, while participants who saw the truthful relative risk messages “had higher odds of reporting correct beliefs about the health risk of ST compared with cigarettes.”

Callery and coworkers concluded that their study showed “relatively high levels of appeal for ST products and openness to trying ST products among young adult cigarette smokers in Canada.  Further research is needed to determine if the high level of openness to trying ST found in this study will translate into actual use and, if so, whether increased ST use might alter cigarette consumption.  The current study also suggests that pictorial warnings on ST products increase overall perceptions of risk and discourage use as intended.  However, pictorial warnings also exacerbated the false belief that smokeless products are equally as harmful as conventional cigarettes.  Regardless whether ST products serve as a harm-reduction product at the population level, greater efforts should be undertaken to promote more accurate perceptions of [the relative health risks] between tobacco products.”

The Canadian findings directly relate to tobacco regulation in the U.S.  The FDA should act on the petition filed nearly a year ago to change the misleading warning that smokeless tobacco “is not a safe alternative to cigarettes.” (discussed here)  Furthermore, the U.S. Centers for Disease Control, the National Cancer Institute and other federal agencies should “promote more accurate perceptions of [the relative health risks] between tobacco products.” 

In short, tell smokers the whole truth.