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‘95% less harmful’? Exploring reactions to quantitative modified risk claims for snus and e-cigarettes
  1. Olivia A Wackowski1,
  2. Richard J O'Connor2,
  3. Destiny Diaz2,
  4. Mariam Rashid1,
  5. M Jane Lewis1,
  6. Kathryn Greene3
  1. 1Center for Tobacco Studies, Rutgers The State University of New Jersey, New Brunswick, New Jersey, USA
  2. 2Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
  3. 3Department of Communication, Rutgers University, New Brunswick, New Jersey, USA
  1. Correspondence to Dr Olivia A Wackowski, Center for Tobacco Studies, Rutgers The State University of New Jersey, New Brunswick, NJ 08901-8554, USA; wackowol{at}


Objectives Studies examining perceptions of ‘modified risk tobacco product’ (MRTP) messages for e-cigarettes and smokeless tobacco have indicated consumers want statistics and quantification of harm reduction. However, limited research exists on reactions to quantitative MRTP messages.

Design We conducted 12 focus groups in the USA in 2019—6 focused on e-cigarette messages and 6 on snus messages. Eight groups were with current smokers (ages 21–66) and four with young adult (ages 18–25) non-smokers (n=57). Participants discussed messages stating that use of snus and vaping products have been estimated by scientists to be about 90% and 95% less harmful than smoking cigarettes, respectively.

Results Several participants agreed the messages strongly communicated that the products are less harmful than cigarettes, were attention getting and could be ‘convincing’. However, participants expressed scepticism about the source and accuracy of the stated figures, and some noted the claims could be misleading and attractive to young people. Comments also reflected some claim misunderstandings (eg, that e-cigarettes only pose a 5% chance of harm). Participants also agreed that stating e-cigarette risks ‘are unlikely to exceed 5% of cigarette smoking harms’ was confusing and less impactful than the ‘95% less harmful’ wording.

Conclusions Quantitative claims suggesting high levels of reduced risk when comparing e-cigarettes or smokeless tobacco/snus relative to cigarettes may be successful in gaining attention and being persuasive for some audiences, particularly, if from more credible sources. However, message developers, users and evaluators should be mindful of message limitations and aim to mitigate unintended consequences.

  • electronic nicotine delivery devices
  • harm reduction
  • non-cigarette tobacco products

Statistics from


  • Contributors OAW conceptualised the paper, led data analysis and paper writing, and obtained study funding. MR contributed to data collection, analysis and drafts of the results, and RO, KG and MJL contributed to project study design. RO, DD, KG and MJL also contributed to critical reviews and edits of manuscript drafts. All authors have read and agreed to the published version of the manuscript.

  • Funding This work was supported by the National Cancer Institute of the National Institutes of Health under Award Number R37CA222002.

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was reviewed and approved by the Rutgers University Institutional Review Board.

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

  • Data availability statement Data are available on reasonable request, including study materials (eg, focus group guide, instruments).

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