title: Impact of smokeless tobacco packaging on perceptions and beliefs among youth, young adults, and adults in the U.S: findings from an internet-based cross-sectional survey.
abstract: BACKGROUND
  Research demonstrates that tobacco packaging elements (including health warning labels, descriptive characteristics, and corporate branding) are associated with knowledge of health risks and product appeal with cigarettes. Yet, little research has assessed this with smokeless tobacco (SLT) packaging. This study evaluates the association between three SLT packaging elements with knowledge of health risks and perceptions of novelty and appeal. Additionally, we assess how effects of these messages may differ across age groups, including youth (14-17 years), young adults (18-25 years), and older adults (26-65 years).
  
  
  METHODS
  1000 participants were administered a web-based survey in 2010 and shown three sets of SLT packs in random order, varied by descriptor (flavor descriptor vs. none), warning label format (graphic vs. text), and corporate branding (branded vs. plain packaging). Participants rated the packs compared with "no difference" on appeal, novelty, and risk perceptions associated with product use. Chi-square tests were used to test for significant differences in pack selections. Multinomial regression was employed to evaluate the association between effects of packaging elements and participant age.
  
  
  RESULTS
  More respondents selected the pack with the graphic warning label as the pack to make them consider the health risks associated with SLT use, attract their attention, and be least attractive to a smoker. The product with the text warning label was the product someone their age would want to be seen using and would appeal to peers. The SLT pack with the flavor descriptor was not associated with health risks associated with product use. The pack with corporate branding was selected as more appealing, to attract attention, and one they would want to be seen using; the plain pack was less attractive to smokers. Youth and young adults were more likely to indicate that pack elements affected their perceptions of appeal and risk associated with SLT products.
  
  
  CONCLUSIONS
  These results suggest that SLT pack characteristics have a measurable effect on perceptions of health risk and product appeal. Future research should assess these findings in the context of harm reduction. Specifically, research is needed to determine whether pack elements on SLT products can effectively convey risk and harm.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Adkison
authors.affiliation: Roswell Park Cancer Institute, Department of Health Behavior, Elm & Carlton Streets Buffalo, New York 14263, USA. Maansi.Travers@roswellpark.org.
authors.forename: Maansi
authors.initials: M
authors.lastname: Bansal-Travers
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Smith
authors.forename: Richard J
authors.initials: RJ
authors.lastname: O'Connor
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Hyland
mesh_terms: D000293:Adolescent; D000328:Adult; D000329:Advertising; D000368:Aged; D003258:Consumer Behavior; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010465:Perception; D011356:Product Labeling; D019064:Product Packaging; D012309:Risk-Taking; D014030:Tobacco, Smokeless; D055815:Young Adult