Department of Health Studies and Gerontology, University of Waterloo, 200 University Ave. W, Waterloo, Ontario, Canada N2L 3G1.
Nicotine Tob Res. 2011 May;13(5):373-83. doi: 10.1093/ntr/ntr013. Epub 2011 Feb 28.
Although the health risks from smokeless tobacco (ST) are lower than cigarettes, it remains unclear how smokers might use ST products, including as a substitute, a cessation aid, or concurrently with cigarette use, if at all. Additionally, there is little evidence examining the impact of health warning labels (HWL) on ST use and perceptions.
The current study investigated perceptions of ST products with and without HWL and a relative health risk (RHR) message. The study consisted of a full-factorial "between-subjects" experiment in which 3 HWL and a RHR message were systematically varied. Canadian smokers aged 18-30 years (N = 611) completed an online survey where they viewed four brands of ST packages altered according to the experimental conditions.
Approximately half of the smokers indicated that they were willing to try ST as a substitute and to help quit smoking. More than one quarter (28%) of smokers were unaware that using ST is less harmful than smoking. Pictorial HWL increased false beliefs about the RHR of ST and decreased smokers' willingness to try ST, whereas text warnings did not. Adding a RHR message communicating the lower risk of ST compared with cigarettes increased willingness to try ST when added to text HWL but decreased willingness to try ST even further when added to pictorial HWL.
The findings indicate relatively high levels of appeal for ST among young adult Canadian cigarette smokers. Pictorial HWL reduced the appeal of ST products and increased perceived risks, including the false belief that ST is equally harmful as cigarettes. Further research could consider evaluating designs of HWL on ST products that better balance absolute and RHR.
尽管无烟烟草（ST）的健康风险低于香烟，但目前尚不清楚吸烟者如何使用 ST 产品，包括将其作为替代品、戒烟辅助工具，或者是否与香烟同时使用。此外，几乎没有证据可以检验健康警示标签（HWL）对 ST 使用和认知的影响。
本研究调查了带有和不带有 HWL 以及相对健康风险（RHR）信息的 ST 产品的认知。该研究采用完全因子“组间”实验设计，系统地改变了 3 个 HWL 和一个 RHR 信息。年龄在 18-30 岁的加拿大吸烟者（N=611）完成了一项在线调查，他们查看了根据实验条件修改后的四种 ST 包装品牌。
大约一半的吸烟者表示愿意尝试 ST 作为替代品并帮助戒烟。超过四分之一（28%）的吸烟者不知道使用 ST 的危害比吸烟小。图片 HWL 增加了对 ST 的相对健康风险的错误认知，降低了吸烟者尝试 ST 的意愿，而文字警告则没有。当添加传达 ST 风险低于香烟的 RHR 信息时，文字 HWL 增加了尝试 ST 的意愿，但当添加到图片 HWL 时，尝试 ST 的意愿进一步降低。
研究结果表明，年轻的加拿大成年香烟吸烟者对 ST 的吸引力相对较高。图片 HWL 降低了 ST 产品的吸引力，并增加了感知风险，包括 ST 与香烟同样有害的错误信念。进一步的研究可以考虑评估 ST 产品的 HWL 设计，以更好地平衡绝对风险和 RHR。
