Federal Warnings Undermine Smokeless Tobacco Harm Reduction Messages

I recently discussed research showing that warnings on smokeless tobacco (ST or SLT) products discourage smokers from switching, while messages describing risk differentials between ST products and cigarettes encourage switching (here).

A new study provides further evidence that federally-mandated warnings in ST advertisements undermine the likelihood of comparative risk information motivating switching.  The study was published in the Journal of Consumer Affairs (abstract here) by Michael L. Capella, Charles R. Taylor and Jeremy Kees, professors in the School of Business at Villanova University.

Capella and colleagues modified Camel Snus advertisements to display a current federal health warning (“This product can cause mouth cancer”) with or without a harm reduction statement (HRS), such as “Using This Product is 90% Safer Than Cigarettes” or “Using This Product is 90% Less Hazardous Than Cigarettes.”  They measured the effect these messages had on perceptions of ST risks and the intention to use ST among smokers and non-smokers. 

The authors report, “In the presence of a conflicting message from the government, it is apparent that consumers are not easily swayed by the presence of an HRS…the presence of harm reduction information in an ad did not reduce smokers’ perceptions of the relative harm of SLT (vs. cigarettes) when a warning was present.  The most likely explanation for this is that the simultaneous presence of a government-mandated warning on the dangers of SLT offset the impact of the HRS…When smokers were presented with an HRS in an ad in the absence of any warning information, they reported higher beliefs that SLT is safer than cigarettes.”

This research demonstrates that federally-mandated warnings on ST products would essentially negate harm reduction messages.  The data also suggests that these warnings reinforce smokers’ mistaken beliefs that ST is as dangerous as cigarettes, effectively discouraging smokers from switching.  This is consistent with the federal government’s abstinence-only public health messaging, which basically abandons nicotine-addicted inveterate smokers.

For non-smokers, the results were promising: “While perceptions of SLT risk were generally lowered and attitudes toward SLT ads were significantly more positive as a result of exposure to harm reduction messages among nonsmokers, there was not a significant difference in intention to use SLT. Moreover, nonsmokers showed very low raw levels of intention to use SLT in any condition.  Thus, the argument that the inclusion of an HRS could help serve as a ‘gateway’ for nonsmokers is not supported by this study.”

Why did Capella and colleagues include non-smokers in their research?  They explain, “Under the law, promoting new SLT products associated with lower health risks as ‘harm reducing’ can be approved only if makers can demonstrate health benefits to society as a whole. The SLT products would need to be sure to not induce nonsmokers or would-be quitters to try SLT rather than abstaining.” (emphasis added).  In other words, a manufacturer must prove that an HRS will not induce a non-smoker, or a smoker who would otherwise quit smoking, to switch to ST. 

Capella and colleagues pefectly frame the question that the FDA must consider: “Specifically, switching to SLT reduces the risk of fatal heart and lung diseases because the tobacco is not incinerated. Hence, the primary question is no longer about whether SLT is considered by the scientific community to be of significantly less risk than cigarette smoking, but whether the population as a whole could benefit from information which communicates the relative risk of using SLT vs. smoking cigarettes.”

Scientific research would require the FDA to answer “Yes.”