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Impact of modified risk tobacco product claims on beliefs of US adults and adolescents
  1. Sherine El-Toukhy1,
  2. Sabeeh A Baig2,
  3. Michelle Jeong2,3,
  4. M Justin Byron2,4,
  5. Kurt M Ribisl2,3,
  6. Noel T Brewer2,3
  1. 1 Intramural Research Program, National Heart, Lung, and Blood Institute, The National Institutes of Health, Bethesda, Maryland, USA
  2. 2 Department of Health Behavior, University of North Carolina, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
  3. 3 Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
  4. 4 Department of Family Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
  1. Correspondence to Dr Noel T Brewer, Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; ntb{at}


Objective Under US law, tobacco product marketing may claim lower exposure to chemicals, or lower risk of health harms, only if these claims do not mislead the public. We sought to examine the impact of such marketing claims about potential modified risk tobacco products (MRTPs).

Methods Participants were national samples of 4797 adults and 969 adolescent US smokers and non-smokers. We provided information about a potential MRTP (heated tobacco product, electronic cigarette or snus). Experiment 1 stated that the MRTP was as harmful as cigarettes or less harmful (lower risk claim). Experiment 2 stated that the MRTP exposed users to a similar quantity of harmful chemicals as cigarettes or to fewer chemicals (lower exposure claim).

Results Claiming lower risk led to lower perceived quantity of chemicals and lower perceived risk among adults and adolescents (all p<0.05, Experiment 1). Among adults, this claim led to higher susceptibility to using the MRTP (p<0.05). Claiming lower exposure led to lower perceived chemical quantity and lower perceived risk (all p<0.05), but had no effect on use susceptibility (Experiment 2). Participants thought that snus exposed users to more chemicals and was less safe to use than heated tobacco products or electronic cigarette MRTPs (Experiments 1 and 2).

Discussion Risk and exposure claims acted similarly on MRTP beliefs. Lower exposure claims misled the public to perceive lower perceived risk even though no lower risk claim was explicitly made, which is impermissible under US law.

  • public policy
  • advertising and promotion
  • packaging and labelling

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  • Contributors NTB, KMR, SAB and MJB designed the experiment. SAB conducted the analyses and SE-T led writing of the manuscript. All authors were involved in analysis and interpretation of data, as well as critical revision of the manuscript for important intellectual content.

  • Funding Research reported in this publication was supported by grant number P50CA180907 from the National Cancer Institute and FDA Center for Tobacco Products (CTP). The effort of SE-T was supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health (K99MD011755). This research was supported in part by the Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health.

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the Department of Health and Human Services, The National Institutes of Health or the Food and Drug Administration.

  • Competing interests None of the authors have received funding from tobacco product manufacturers. NTB and KMR have served as paid expert consultants in litigation against tobacco companies. The other authors declare no conflicts of interest.

  • Patient consent Not required.

  • Ethics approval The Institutional Review Board at the University of North Carolina approved study protocol and materials.

  • Provenance and peer review Not commissioned; externally peer reviewed.