Effect of warning labels and “endorsements” on perceived risk of alternative tobacco products among non-smokers

Background: Perceived risk is central to initiation and cessation of tobacco, and warning labels on cigarettes promote cessation and effectively communicate risk, but research on smokeless tobacco and electronic cigarette warning labels is nascent. Tobacco companies have proposed alternative smokeless tobacco warning labels that endorse smokeless tobacco as safer than cigarettes.

Methods: Online experiment with a national sample of 455 adult non-users of tobacco randomized to view print advertisements for snus, e-cigarettes, and moist snuff with either warning labels (current warning label, graphic warning label), or endorsements (“FDA-approved” or the label proposed by one of the large tobacco companies “Warning: No tobacco product is safe, but this product presents substantially lower risks to health than cigarettes”), or control. Perceived harm of each product was measured at pretest and post-test.

Results: Warning labels increased perceived harm of e-cigarettes. Endorsements decreased perceived harm of moist snuff and snus, and the large tobacco company proposed endorsement had an effect similar to the prohibited “FDA Approved” endorsement.   Almost 16% of non-users were interested in a free sample of an alternative tobacco product, mostly e-cigarettes (the most requested brand was blu, even if blu was not the brand of e-cigarette ad shown in the experiment). Those interested in a free sample had significantly lower perceived harm of all tobacco products than those not interested in a free sample.

Conclusions: Regulatory agencies should not allow endorsements of alternative tobacco products and should implement graphic warning labels for smokeless tobacco products and warning labels for e-cigarettes.