Abstract
BackgroundGraphic warning labels are a tobacco control best practice that is mandated in the US for cigarettes under the 2009 Family Smoking Prevention and Tobacco Control Act. However, smokeless tobacco products are not required to carry graphic warning labels, and as of September 2014, electronic cigarettes in the US carry no warning labels and are aggressively marketed, including with “reduced harm” or “FDA Approved” messages.MethodsIn this online experiment, 483 US adult non-users of tobacco were randomized to view print advertisements for moist snuff, snus, and e-cigarettes with either warning labels (current warning label, graphic warning label) or “endorsements” (a “lower risk” label proposed by a tobacco company, an “FDA Approved” label) or control (tobacco advertisement with no label, advertisement for a non-tobacco consumer products). Main outcome measures included changes in perceived harm, positive attitudes towards, openness to using, and interest in a free sample of moist snuff, snus, and e-cigarettes.ResultsThe graphic warning label increased perceived harm of moist snuff and e-cigarettes. “Lower risk” and “FDA Approved” labels decreased perceived harm of moist snuff and snus respectively. Current warning label and graphic warning label significantly lowered positive attitudes towards e-cigarettes. In this sample of non-users of tobacco, 15% were interested in a free sample of alternative tobacco products (predominantly e-cigarettes). Proportion of participants interested in a free sample did not differ significantly across the conditions, but those interested in a free sample had significantly lower perceptions of harm of corresponding tobacco products.ConclusionsRegulatory agencies should not allow “lower risk” warning labels, which have similar effects to the “FDA Approved” label, which is prohibited, and should consider implementing graphic warning labels for smokeless tobacco products and e-cigarettes.
Highlights
Graphic warning labels are a tobacco control best practice that is mandated in the US for cigarettes under the 2009 Family Smoking Prevention and Tobacco Control Act
The proposed US graphic warning labels would cover top 50% of both front and back of cigarette packages, which is consistent with WHO Framework Convention on Tobacco Control (FCTC) recommendation of 50% or more of the principal display areas [12], but is less than the recently revised European Commission’s Tobacco Product Directive (65% of the front and back of the cigarette pack) [13]
Snus is ground tobacco placed in a porous pouch to be placed between lip and gum to allow nicotine absorption; snus sold in the US is modeled after a traditional Swedish product which typically is manufactured so that it contains fewer tobaccospecific nitrosamines than other forms of chewing tobacco [18]
Summary
Graphic warning labels are a tobacco control best practice that is mandated in the US for cigarettes under the 2009 Family Smoking Prevention and Tobacco Control Act. The proposed US graphic warning labels would cover top 50% of both front and back of cigarette packages, which is consistent with WHO FCTC recommendation of 50% or more of the principal display areas [12], but is less than the recently revised European Commission’s Tobacco Product Directive (65% of the front and back of the cigarette pack) [13]. New warning labels may be developed for tobacco products other than cigarettes. Tobacco and e-cigarette companies have been aggressively developing and promoting new alternative tobacco products, such as electronic cigarettes (e-cigarettes), snus, and dissolvable tobacco products [14,15,16,17]. E-cigarettes are electronic devices generally consisting of a battery connected to a heater, a mouthpiece, and a chamber containing a solution of propylene glycol and other chemicals, frequently including nicotine. Snus is ground tobacco placed in a porous pouch to be placed between lip and gum to allow nicotine absorption; snus sold in the US is modeled after a traditional Swedish product which typically is manufactured so that it contains fewer tobaccospecific nitrosamines (carcinogens) than other forms of chewing tobacco [18]
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