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Effect of a hypothetical modified risk tobacco product claim on heated tobacco product use intention and perceptions in young adults
  1. Julia C Chen-Sankey1,
  2. Afton Kechter2,
  3. Jessica Barrington-Trimis2,3,
  4. Rob McConnell2,
  5. Evan A Krueger2,
  6. Tess Boley Cruz2,
  7. Jennifer B Unger2,
  8. Benjamin W Chaffee4,
  9. Adam Leventhal2,3
  1. 1 Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA
  2. 2 Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California, USA
  3. 3 Institute for Addiction Science, University of Southern California, Los Angeles, California, USA
  4. 4 Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Julia C Chen-Sankey, Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20814, USA; Julia.Chen-Sankey{at}


Introduction Modified risk tobacco product (MRTP) claims for heated tobacco products (HTPs) that convey reduced exposure compared with conventional cigarettes may promote product initiation and transition among young people. We assessed the effects of a hypothetical MRTP claim for HTPs on young adults’ intention and perceptions of using HTPs and whether these effects differed by their current cigarette and e-cigarette use.

Methods We embedded a randomised between-subjects experiment into a web-based survey administered among a cohort of 2354 Southern California young adults (aged 20–23) in 2020. Participants viewed depictions of HTPs with an MRTP claim (n=1190) or no claim (n=1164). HTP use intention and HTP-related harm and use perceptions relative to cigarettes and e-cigarettes were assessed.

Results Overall, participants who viewed versus did not view the claim did not differ in HTP use intention (28.5% vs 28.7%) but were more likely to perceive HTPs as less harmful than cigarettes (11.4% vs 7.0%; p<0.001). The experimental effect on HTP use intention did not differ among past 30-day cigarette smokers versus non-smokers (interaction adjusted OR (AOR)=0.78, 95% CI 0.36 to 1.76) but differed among past 30-day e-cigarette users versus non-users (interaction AOR=1.67, 95% CI 1.02 to 2.68).

Discussion The hypothetical MRTP claim may lower young adults’ HTP harm perceptions compared with cigarettes but may not change HTP use intention overall or differentially for cigarette smokers. The larger effect on HTP use intention among e-cigarette users than non-users raises the question of whether MRTP claims may promote HTP use or HTP and e-cigarette dual use among young e-cigarette users.

  • non-cigarette tobacco products
  • public policy
  • advertising and promotion

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  • Contributors Concept and design: JCC-S, AL, JB-T and BWC. Acquisition, analysis or interpretation of data: all authors. Drafting of the manuscript: JCC-S, AK and AL. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: JCC-S and AL. Obtained funding: AL. Administrative, technical or material support: AL. Supervision: AL.

  • Funding This study was funded by the National Institutes of Health (NIH) grant numbers U54CA180905, U54HL147127, R01CA229617, K24DA048160, K99CA242589 and K01DA042950. JCC-S is also supported by the Division of Intramural Research, National Institute on Minority Health and Health Disparities. Comments and opinions expressed belong to the authors and do not necessarily represent the views of the US Government, National Institutes of Health, National Cancer Institute, National Institute on Drug Abuse, National Institute on Minority Health and Health Disparities or the FDA.

  • Competing interests No, there are no competing interests.

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