Role of outcome expectancies among smokeless tobacco users: A qualitative approach

Objective: To understand the role of expectancies of smokeless tobacco (ST) use among adult users.

Background: Expectancies, the anticipated effects of a behavior, have been found to strongly influence behavioral decisions. Studies suggest that positive expected outcomes (e.g., stress reduction, physical enjoyment) are stronger predictors of tobacco use than negative expected outcomes (e.g., health consequences, unkempt image). While the outcome expectancies of smoking associated with cigarette use have been studied, the relationship needs to be further examined for ST use.

Methods: Semi-structured in-depth interviews were conducted with male ST users (n=11) who participated in a randomized, single-blind, cross-over pilot study of two smokeless, spitless, tobacco products. The interviews captured participants' views and experiences with ST. One trained study staff member performed each interview to avoid inter-interviewer bias. MAXQDA was used to code emergent themes and analyze data.

Results: Interviewees' expectancy beliefs about ST were influenced by convenience (ability to use in public areas), ability to conceal use, safety (lower perceived health risk than cigarettes), physical satisfaction, craving relief, social desirability, peer and familial use, participation in team sports, and negative consequences.

Conclusions: In this sample, convenience and safety were the most commonly cited outcome expectancies of using ST. Increasing public smoking bans and promotion of ST as potentially reduced-harm product highlights the need for research on ST. The results of this study will provide guidance in instrument-development to be applied to a survey of ST users.