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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (31 March 2021) | Viewed by 41461

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Special Issue Editors

Dr. Olivia A. Wackowski

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Guest Editor

Deptment Health Behavior, Society and Policy, Rutgers School of Public Health, Center for Tobacco Studies, Rutgers Biomedical Health Sciences, 303 George Street, New Brunswick, NJ 08901, USA
Interests: tobacco control; tobacco regulatory science; risk perceptions & health communication; tobacco product marketing; communication and perceptions

Dr. Jennifer Pearson

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Assistant Guest Editor

School of Community Health Sciences, University of Nevada, Reno, NV 89557, USA
Interests: tobacco regulatory science; e-cigarettes; tobacco products

Dr. Michelle Jeong

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Assistant Guest Editor

Deptment Health Behavior, Society and Policy, Rutgers School of Public Health, Center for Tobacco Studies, Rutgers Biomedical Health Sciences, 303 George Street, New Brunswick, NJ 08901, USA
Interests: tobacco regulatory science; tobacco control; health communication; tobacco marketing; e-cigarettes

Special Issue Information

Dear Colleagues,

We are organizing a Special Issue on “Perceptions of Tobacco and Nicotine Products” in the International Journal of Environmental Research and Public Health, a peer-reviewed scientific journal that publishes articles and communications in the interdisciplinary area of environmental health sciences and public health. For detailed information on the journal, we refer you to https://www.mdpi.com/journal/ijerph.

Health behavior theories suggest that individuals’ perceptions and beliefs about tobacco and nicotine products can play an important role in their use of these products. While perceptions about some tobacco and nicotine products may be relatively constant over time, others may be changing and/or evolving, potentially in response to new product regulations, innovations, information, and communications (e.g., e-cigarettes and EVALI). Perceptions of newer products may influence whether or not people initiate or switch to these products. For example, adult smokers may or may not use other nicotine products to try to reduce or quit smoking cigarettes based on their perceptions of such products, and youth’s perceptions of newer products may also influence whether they initiate their use. Tobacco and nicotine product perceptions can also be the targets of public health interventions (e.g., educational and communication campaigns, warning labels), necessitating a proper understanding of how the public perceives tobacco and nicotine products. Research about product perceptions among unique population subgroups is also important. For example, the type of recommendations health care providers may provide patients asking about e-cigarettes may depend on their beliefs about e-cigarettes’ relative safety and cessation efficacy. For these various reasons, this special issue invites original research articles presenting quantitative and/or qualitative data about tobacco and nicotine product perceptions. This may include articles describing:

Perceptions about new tobacco and nicotine products (e.g., heat-not-burn products, capsule cigarettes, low or reduced nicotine cigarettes, tobacco-free nicotine pouches).
Changes in product perceptions over time
Product perceptions among special population groups (e.g., health care providers)
Methods for measuring product perceptions (e.g., measuring risk and harm perceptions)
Comparative perceptions among products
Associations between product perceptions and use

Conflicts of interest/funding:

Authors should note that IJERPH will not consider for publication papers reporting work that is funded, in whole or in part, by a tobacco company or tobacco industry organization or affiliate or papers written by authors who accept tobacco industry or affiliate funding. Other sources of funding, particularly from e-cigarette- or pharmaceutical-related interests should be fully disclosed. The full policy is available here https://www.mdpi.com/1660-4601/15/12/2831/htm

Dr. Olivia A. Wackowski
Dr. Jennifer Pearson
Dr. Michelle Jeong
Guest Editors

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Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

product perceptions
tobacco products
nicotine products
attitudes and beliefs
risk perceptions

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Published Papers (11 papers)

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15 pages, 706 KiB

Open AccessArticle

Will E-Cigarette Modified Risk Messages with a Nicotine Warning Polarize Smokers’ Beliefs about the Efficacy of Switching Completely to E-Cigarettes in Reducing Smoking-Related Risks?

by Bo Yang, Juliana L. Barbati and Yunjin Choi

Int. J. Environ. Res. Public Health 2021, 18(11), 6094; https://doi.org/10.3390/ijerph18116094 - 5 Jun 2021

Viewed by 3026

Abstract

In the U.S., e-cigarette companies can apply for permission to use reduced or modified risk messages (MRMs) in their marketing materials. Because e-cigarette marketing materials should have a nicotine addictiveness warning, MRMs and a nicotine warning could appear together—resulting in a conflicting message. When reading a conflicting message, individuals assimilate evidence supporting their pre-existing beliefs and eventually develop stronger beliefs, diverging more from those with different pre-existing beliefs (i.e., polarization). This study examined if exposure to e-cigarette MRMs with a nicotine warning polarizes smokers’ initially opposing beliefs about the efficacy of switching completely to e-cigarettes in reducing smoking-related risks, and if this polarization depends on individuals’ need for closure. An online experiment randomized 761 U.S. adult smokers to either three MRMs with a nicotine warning or three control messages. People reported their perceived efficacy of switching completely to e-cigarettes at pre- and posttest and need for closure at pretest. Linear regression showed no polarization effects. Nonetheless, need for closure and pretest efficacy beliefs influenced message response: MRMs with a nicotine warning only enhanced efficacy beliefs of smokers with low pretest efficacy beliefs and low need for closure. Evaluation of e-cigarette mixed communication should consider individuals’ motivational and cognitive differences. Full article

(This article belongs to the Special Issue Perceptions of Tobacco and Nicotine Products)

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13 pages, 1268 KiB

Open AccessArticle

Australian Smokers’ Sensory Experiences and Beliefs Associated with Menthol and Non-Menthol Cigarettes

by Serafino Mancuso, Emily Brennan, Kimberley Dunstone, Amanda Vittiglia, Sarah Durkin, James F. Thrasher, Janet Hoek and Melanie Wakefield

Int. J. Environ. Res. Public Health 2021, 18(11), 5501; https://doi.org/10.3390/ijerph18115501 - 21 May 2021

Cited by 2 | Viewed by 2722

Abstract

Many current smokers incorrectly believe that menthol cigarettes are less harmful, likely due to the biological and sensory effects of menthol, which can lead smokers to have favourable sensory experiences. In this study, we measured the extent to which Australian smokers associate certain sensory experiences with smoking menthol and non-menthol cigarettes, and their beliefs about how damaging and enjoyable they find cigarettes with each of these sensory experiences. A sample of 999 Australian 18–69-year-old weekly smokers was recruited from a non-probability online panel; this study focuses on the 245 respondents who currently smoked menthol cigarettes at least once per week. Current menthol smokers were four to nine times more likely to experience menthol rather than non-menthol cigarettes as having favourable sensory experiences, including feeling smooth, being soothing on the throat, fresh-tasting and clean-feeling. Menthol smokers perceived cigarettes with these favourable sensations as less damaging and more enjoyable than cigarettes with the opposite more aversive sensory experience. Efforts to correct these misperceptions about risk will likely require messages that provide new information to help smokers understand that these sensations do not indicate a lower level of risk. Banning menthol in tobacco products—as has recently been done in some nations—would also be a timely and justified strategy for protecting consumers. Full article

(This article belongs to the Special Issue Perceptions of Tobacco and Nicotine Products)

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22 pages, 980 KiB

Open AccessArticle

Risk Perceptions of Low Nicotine Cigarettes and Alternative Nicotine Products across Priority Smoking Populations

by Rachel L. Denlinger-Apte, Lauren R. Pacek, Jennifer Cornacchione Ross, Maansi Bansal-Travers, Eric C. Donny, Dorothy K. Hatsukami and Dana Mowls Carroll

Int. J. Environ. Res. Public Health 2021, 18(10), 5311; https://doi.org/10.3390/ijerph18105311 - 17 May 2021

Cited by 11 | Viewed by 5244

Abstract

Background: As the U.S. Food and Drug Administration considers a low nicotine product standard for cigarettes, it is important to examine how people who smoke, especially individuals from priority populations disproportionately affected by smoking, perceive low nicotine content (LNC) cigarettes and their relative risk perceptions of alternative nicotine delivery system (ANDS) products, including e-cigarettes and snus, and medicinal nicotine. Methods: Data are from Wave 4 (2016–2017) of the adult Population Assessment of Tobacco Use and Health (PATH) Study. We examined respondents’ absolute risk perceptions about nicotine, LNC cigarettes, ANDS products and medicinal nicotine; their relative risk perceptions of LNC cigarettes and ANDS products compared to conventional cigarettes; and their relative risk perceptions of medicinal nicotine compared to ANDS products. Results: The majority of respondents across priority smoking populations indicated snus, e-cigarettes, and LNC cigarettes were ‘about the same’ level of harmfulness or addictiveness as conventional cigarettes. The majority of respondents indicated e-cigarettes to be ‘about the same’ harmfulness as medicinal nicotine. Conclusions: Our study indicates that adults who smoke cigarettes generally have misperceptions about the harms of nicotine and the relative risks of ANDS products and such misperceptions exist regardless of their racial/ethnic identity, sexual orientation, and gender identity. Full article

(This article belongs to the Special Issue Perceptions of Tobacco and Nicotine Products)

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12 pages, 4062 KiB

Open AccessArticle

The Effect of Cigarillo Packaging Characteristics on Young Adult Perceptions and Intentions: An Experimental Study

by Cristine D. Delnevo, Michelle Jeong, Ollie Ganz, Daniel P. Giovenco and Erin Miller Lo

Int. J. Environ. Res. Public Health 2021, 18(8), 4330; https://doi.org/10.3390/ijerph18084330 - 19 Apr 2021

Cited by 11 | Viewed by 3179

Abstract

Research demonstrates that characteristics of cigarette packaging influence consumer product perceptions, yet the current literature on the impact of cigar packaging is limited. This study aims to examine how different cigarillo packaging features influence young adult cigar smokers’ perceptions. In 2016, we recruited past-year cigar users aged 18–34 from Amazon Mechanical Turk (N = 1260). We utilized a 2 × 2 × 3 × 2 between-subjects factorial design, randomly assigning participants to view one of 24 images of a cigarillo package that varied by brand (Black & Mild vs. Swisher Sweets), brand name (full vs. abbreviated), color (brown vs. green vs. purple), and price promotion (present vs. absent). Participants rated the product on several perceptions and purchase intentions, and they reported on cigar use and demographics. Overall, color and brand name influenced perceptions, but effects varied by brand. For Swisher Sweets, only price promotions influenced perceptions (e.g., taste, use for marijuana); for Black & Mild, all packaging features influenced perceptions (e.g., harshness, tobacco quality), and price promotions increased purchase intentions. Our findings also raise questions that product features may interact with one another, with certain features, such as color, overpowering other attributes. More research is needed to understand the impact of other packaging features, such as warning labels, on product perceptions across a variety of brands. Full article

(This article belongs to the Special Issue Perceptions of Tobacco and Nicotine Products)

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18 pages, 330 KiB

Open AccessArticle

Harm Perceptions and Beliefs about Potential Modified Risk Tobacco Products

by Jennifer C. Morgan and Joseph N. Cappella

Int. J. Environ. Res. Public Health 2021, 18(2), 576; https://doi.org/10.3390/ijerph18020576 - 12 Jan 2021

Cited by 12 | Viewed by 3577

Abstract

Under US law, tobacco products may be authorized to claim lower exposure to chemicals, or lower risk of health harms. We sought to examine the harm perceptions and beliefs about potential modified risk tobacco products (MRTPs). We recruited 864 adult current and former smokers in August 2019. Participants read a paragraph describing the potential for the FDA to authorize MRTPs and a brief description of MRTPs. The most endorsed beliefs for each product were that they contained nicotine and that they were risky. Believing that e-cigarettes can help smokers quit smoking, that they tasted good, and looked cool were associated with greater odds of intending to try e-cigarettes after controlling for demographic and use factors. For snus, the beliefs that the product was not addictive and tasted good were associated with increased odds of intending to try snus. The beliefs that heated tobacco would taste good and would be a good quit aid was associated with increased odds of intentions to try heated tobacco products. Understanding what the public believes about products currently or potentially authorized to be marketed as modified risk tobacco products can inform communication efforts. Full article

(This article belongs to the Special Issue Perceptions of Tobacco and Nicotine Products)

17 pages, 336 KiB

Open AccessArticle

What Motivates Smokers to Switch to ENDS? A Qualitative Study of Perceptions and Use

by Abigail T. Evans, Katherine C. Henderson, Anna Geier, Scott R. Weaver, Claire Adams Spears, David L. Ashley, Meredith Fritz, Lisa John and Terry F. Pechacek

Int. J. Environ. Res. Public Health 2020, 17(23), 8865; https://doi.org/10.3390/ijerph17238865 - 28 Nov 2020

Cited by 14 | Viewed by 4129

Abstract

Switching completely from cigarettes to electronic nicotine delivery systems (ENDS) may reduce health risks for addicted smokers. This paper provides information about perceptions and other factors that may influence smokers’ ENDS use and substitution for cigarettes. We conducted 12 online focus groups (N = 61) among smokers who had never tried using ENDS (Never Users, N = 11), currently used both cigarettes and ENDS (Dual Users, N = 21), used but discontinued ENDS (Rejectors, N = 14), and switched completely to ENDS use (Switchers, N = 15). Thematic analysis was used to interpret the transcripts. Participants described initial interest in trying ENDS in hopes of quitting smoking and because of convenience (i.e., due to rules, regulations, or social norms). Risk perceptions and higher prices relative to cigarettes were reported as disadvantages of ENDS that discouraged initiation. Dual Users and Rejectors reported product problems (e.g., products breaking) and dissatisfaction (i.e., inability to satisfy cravings for cigarettes) as factors that lowered their substitutability for cigarettes or led to discontinuing ENDS use. Switchers indicated that satisfaction, lack of product problems, and perceived safety facilitated successfully switching from cigarette smoking to exclusive ENDS use. However, Switchers reported trying many products before they found ones that satisfied their needs. We recommend that policymakers consider the potential impact of tobacco control policies on smokers’ motivation and ability to switch completely from cigarettes to ENDS. Full article

(This article belongs to the Special Issue Perceptions of Tobacco and Nicotine Products)

9 pages, 1398 KiB

Open AccessArticle

Comparison between Gradual Reduced Nicotine Content and Usual Nicotine Content Groups on Subjective Cigarette Ratings in a Randomized Double-Blind Trial

by Wenxue Lin, Nicolle M. Krebs, Junjia Zhu, Jonathan Foulds, Kimberly Horn and Joshua E. Muscat

Int. J. Environ. Res. Public Health 2020, 17(19), 7047; https://doi.org/10.3390/ijerph17197047 - 26 Sep 2020

Cited by 10 | Viewed by 5366

Abstract

In 2018, the United States Food and Drug Administration (FDA) issued an advanced notice of proposed rulemaking to reduce nicotine in tobacco products to produce a minimally addictive or nonaddictive effect, but there was a research gap in the subjective responses of reduced-nicotine-content cigarettes. We compared the responses of the modified cigarette evaluation questionnaire (mCEQ) and cigarette-liking scale (CLS) between the gradually reduced nicotine content (RNC) group and the usual nicotine content (UNC) group. Linear mixed-effects models for repeated measures were used to analyze and compare the change over time for the mCEQ and CLS across the two treatment groups (RNC and UNC). We found that the change over time for the mCEQ and CLS was significant between the RNC and the UNC treatment groups at the beginning of visit 6 with 1.4 mg nicotine/cigarette. At visits 8 and 9, the RNC group reported significantly lower satisfaction scores compared to UNC. Subscale analysis showed that smoking satisfaction decreased in RNC while other measures, such as cigarette enjoyment, did not change. Understanding the impact of nicotine reduction on cigarette subjective responses through evaluation and liking scales would provide valuable information to the FDA on nicotine reduction policies for cigarettes. Full article

(This article belongs to the Special Issue Perceptions of Tobacco and Nicotine Products)

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17 pages, 313 KiB

Open AccessArticle

Smokers’ and Young Adult Non-Smokers’ Perceptions and Perceived Impact of Snus and E-Cigarette Modified Risk Messages

by Olivia A. Wackowski, Mariam Rashid, Kathryn L. Greene, M. Jane Lewis and Richard J. O’Connor

Int. J. Environ. Res. Public Health 2020, 17(18), 6807; https://doi.org/10.3390/ijerph17186807 - 18 Sep 2020

Cited by 24 | Viewed by 3445

Abstract

Although no tobacco products are safe, tobacco companies in the United States may request regulatory authorization to make certain “modified risk tobacco product” (MRTP) claims in their marketing. However, few qualitative studies have explored consumer perceptions and understanding of comparative risk messages and wordings. We examined consumer perceptions of statements indicating reduced risks and exposure to chemicals from snus and e-cigarettes relative to smoking. We conducted 12 focus groups with adult smokers (ages 21–66) and young adult (YA) non-smokers (ages 18–25) (n = 57) in the USA in 2019. Participants shared reactions to modified risk and exposure messages and message variations. Participants largely understood claims, including language about “switching completely.” However, participants expressed desire for more message specificity, evidence, risk reduction reasons, and statistics/quantitative information. Claim believability and acceptance was also limited by existing negative product beliefs and experiences, negative media reports, and skepticism about message source. YAs did not express product interest based on message exposure. Some YAs suggested the included “smoker” language made the messages less interesting/relevant. Given existing proposals for and use of MRTP messages, additional research on their wording, framing, delivery, and effects may help inform regulatory or organizational decisions about such messages, optimize potential benefits, and mitigate unintended consequences. Full article

(This article belongs to the Special Issue Perceptions of Tobacco and Nicotine Products)

9 pages, 473 KiB

Open AccessArticle

Harm Perceptions of the JUUL E-Cigarette in a Sample of Ever Users

by Elise M. Stevens, Emily T. Hébert, Alayna P. Tackett, Eleanor L. S. Leavens and Theodore L. Wagener

Int. J. Environ. Res. Public Health 2020, 17(13), 4755; https://doi.org/10.3390/ijerph17134755 - 2 Jul 2020

Cited by 11 | Viewed by 3761

Abstract

Background: Monitoring trends and perceptions of new nicotine salt-based electronic cigarettes (ECs), like JUUL, is important to identify associations with product experimentation and use. Understanding harm perceptions of these new devices will inform prevention and intervention efforts. The current study assesses perceptions of the absolute harmfulness of JUUL use in addition to comparing it to other tobacco products. Methods: Participants (N = 839, 52% male) reporting ever use of JUUL were recruited from Amazon’s Mechanical Turk from January to March 2018. Respondents completed questionnaire items assessing demographics, co-use of non-JUUL products, JUUL use status (i.e., daily users (10.8%), non-daily users (29.4%), and triers (59.9%)), and JUUL and other tobacco products absolute harm perceptions. Results: Overall, participants rated JUUL as significantly less harmful than all other tobacco products (p < 0.001), except other ECs. Daily JUUL users rated JUUL as less harmful compared to non-daily JUUL users and JUUL triers (p < 0.05). JUUL was rated as more harmful by women compared to men (p < 0.05). Conclusions: Increased frequency of JUUL use was associated with decreased harm perceptions. JUUL was associated with reduced perceptions of absolute harm compared to most other tobacco products, except other ECs. Public health practitioners should develop public health interventions that increase harm perceptions of ECs. Full article

(This article belongs to the Special Issue Perceptions of Tobacco and Nicotine Products)

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10 pages, 830 KiB

Open AccessArticle

Changing Exposure Perceptions: A Randomized Controlled Trial of an Intervention with Smoking Parents

by Vicki Myers, Shoshana Shiloh, David M. Zucker and Laura J. Rosen

Int. J. Environ. Res. Public Health 2020, 17(10), 3349; https://doi.org/10.3390/ijerph17103349 - 12 May 2020

Cited by 7 | Viewed by 2923

Abstract

Children who live with smokers are at risk of poor health, and of becoming smokers themselves. Misperceptions of the nature of tobacco smoke exposure have been demonstrated among parents, resulting in continued smoking in their children’s environment. This study aimed to change parents’ perceptions of exposure by providing information on second- and third-hand exposure and personalised information on children’s exposure [NIH registry (NCT02867241)]. One hundred and fifty-nine families with a child < 8 years and at least one smoking parent were randomized into intervention (69), control (70), and enhanced control (20) groups. Reported exposure, parental smoking details, and a child hair sample were obtained at the start of the study and 6–8 months later. Parental perceptions of exposure (PPE) were assessed via a questionnaire. The intervention consisted of motivational interviews, feedback of home air quality and child’s hair nicotine level, and information brochures. PPE were significantly higher at the study end (94.6 ± 17.6) compared to study beginning (86.5 ± 19.3) in intervention and enhanced control groups (t(72) = −3.950; p < 0.001). PPE at study end were significantly higher in the intervention group compared to the regular control group (p = 0.020). There was no significant interaction between time and group. Parallel changes in parental smoking behaviour were found. Parental perceptions of exposure were increased significantly post intervention, indicating that they can be altered. By making parents more aware of exposure and the circumstances in which it occurs, we can help parents change their smoking behaviour and better protect their children. Full article

(This article belongs to the Special Issue Perceptions of Tobacco and Nicotine Products)

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6 pages, 264 KiB

Open AccessBrief Report

Comparison of a General and Conditional Measure of E-Cigarette Harm Perceptions

by Olivia A. Wackowski and Michelle Jeong

Int. J. Environ. Res. Public Health 2020, 17(14), 5151; https://doi.org/10.3390/ijerph17145151 - 17 Jul 2020

Cited by 6 | Viewed by 2530

Abstract

Measures of tobacco product harm perceptions are important in research, given their association with tobacco use. Despite recommendations to use more specific harm and risk perception measures, limited research exists comparing different wordings. We present exploratory survey data comparing young adults’ (ages 18–29) responses to a general e-cigarette harm perception measure (“How harmful, if at all, do you think vaping/using an e-cigarette is to a user’s health?”) with a more specific conditional measure, which personalized the behavior/harm (“imagine you vaped,” “your health”) and presented a specific use condition (exclusive daily vaping) and timeframe (10 years). Data were collected in January 2019 (n = 1006). Measures were highly correlated (r = 0.76, Cronbach’s α = 0.86), and most (65%) provided consistent responses, although more participants rated e-cigarettes as very or extremely harmful using the conditional (51.6%) versus the general (43.9%) harm measure. However, significant differences in harm ratings were not observed among young adults who currently vaped. Correlations between each harm perception measure and measures of e-cigarette use intentions were similar. More specifically worded harm perception measures may result in somewhat higher e-cigarette harm ratings than general measures for some young adults. Additional research on best practices for measuring e-cigarette and other tobacco harm perceptions is warranted. Full article

(This article belongs to the Special Issue Perceptions of Tobacco and Nicotine Products)

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