“It can't be as bad as smoking”: Perceptions of smokeless tobacco and responses to anti-smokeless messages

Background: As major cigarette companies have entered the smokeless market, promotion and use of smokeless tobacco is growing. However, little is known about smokers' perceptions of new smokeless products and their receptivity to messages that discourage smokeless tobacco use. Methods: Seventy-five current and former smokers from across the U.S. participated in eight online focus groups in 2011 to discuss their perceptions of smokeless tobacco and to evaluate anti-smokeless message concepts. Results: Although some participants believed that smokeless tobacco was healthier than smoking, most thought smokeless was as hazardous or more hazardous than smoking. Smokers who tried but rejected smokeless reported that the taste was neither satisfying nor appealing. Perceived positive aspects of smokeless mirrored advertising claims: that it can be used anywhere, is less harmful and cleaner than cigarettes. Anti-smokeless messages featuring female spokespeople were less believable as smokeless tobacco use was viewed as a male behavior. Messages emphasizing negative health effects of smokeless use were generally well-received. Some participants believed that visceral negative imagery would increase ad effectiveness, but others labeled this “scare tactics.” Participants pointed out that emphasizing the unpleasant sensory qualities of smokeless could unintentionally encourage continued smoking, and comparing nicotine amounts in smokeless products and cigarettes might trigger interest in low-nicotine smokeless products. Conclusions: Smokers' past experience with and attitudes towards smokeless tobacco should be heeded when developing effective anti-smokeless messages so that anti-smokeless messages do not reinforce smoking.