Background: The public receives mixed messages about the harmfulness of alternative tobacco products to cigarettes, and we know little about what present and potential users of these products actually think about their relative harmfulness. Methods: In a nationally representative survey of 2415 Norwegian adolescents aged 16-20, we asked participants to rate harmfulness of various available tobacco products and their own use of snus and smoking. We examined how adolescents rated the relative harm of tobacco products in general, and snus and cigarettes in particular, and how this varied with age, gender and own use of snus and smoking. Results: Cigarettes were generally rated as more harmful than snus, but 41% still rated snus as equally or more harmful than cigarettes. Males reported lower harm from all products than girls. Being a snus user was associated with lower ratings of the harm in snus, but being a smoker was not associated with reporting of harm in cigarettes. Conclusions: Compared with current scientific consensus, the participants overrate the harmfulness of snus, and as such, our results suggest a potential for changing peoples’ perceptions of relative health risks in various tobacco products. To the extent health information affects consumption, accurate information on relative risks may lead more people to choose snus over cigarettes.
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