title: Associations of Proposed Relative-Risk Warning Labels for Snus With Perceptions and Behavioral Intentions Among Tobacco Users and Nonusers.
abstract: BACKGROUND
  The US Food and Drug Administration can require changes in warning statements for modified risk tobacco products. We report an independent analysis of a consumer perception survey sponsored by Swedish Match as part of a Modified Risk Tobacco Product application to change warning labels for Swedish snus products.
  
  
  METHODS
  The survey exposed each of 4324 daily exclusive cigarette smokers, 1033 daily smokeless tobacco users, 1205 daily other tobacco users, 726 former users, and 5915 triers/never users to one of four current warnings and two proposed relative-risk labels (No tobacco product is safe, but this product presents lower risks to health than cigarettes, or No tobacco product is safe, but this product presents substantially lower risks to health than cigarettes) for snus. Descriptive and logistic regression analyses examined four outcomes: believability, harmfulness, motivation to use, and intention to buy snus.
  
  
  RESULTS
  Compared with the current not-safe-alternative warning, adult tobacco users who viewed the proposed labels perceived them as less believable, perceived snus as less harmful and were more likely to use and buy snus. The proposed labels had no impact on former smokers' likelihood to use and buy snus; triers/never users viewing the substantially lower risk label were more likely to buy snus.
  
  
  CONCLUSIONS
  Tobacco users viewing the proposed labels perceived snus as less harmful than cigarettes and may be more likely to use and buy snus. If labeling changes lead to increased snus use and cigarette reduction or abstinence, public health may benefit. If the opposite occurs, public health could suffer.
authors.affiliation: Department of Medicine, School of Medicine, University of Louisville, Louisville, KY; James Graham Brown Cancer Center, University of Louisville, Louisville, KY; brad.rodu@louisville.edu.
authors.forename: Brad
authors.initials: B
authors.lastname: Rodu
authors.affiliation: James Graham Brown Cancer Center, University of Louisville, Louisville, KY;
authors.forename: Nantaporn
authors.initials: N
authors.lastname: Plurphanswat
authors.affiliation: Center for Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT;
authors.forename: John R
authors.initials: JR
authors.lastname: Hughes
authors.affiliation: Fagerström Consulting, Vaxholm, Sweden.
authors.forename: Karl
authors.initials: K
authors.lastname: Fagerström
mesh_terms: D000293:Adolescent; D000328:Adult; D000329:Advertising; D016739:Behavior, Addictive; D005260:Female; D040261:Harm Reduction; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D040541:Marketing / Q000379:methods*; D008875:Middle Aged; D009042:Motivation; D011356:Product Labeling; D011634:Public Health; D012306:Risk; D016540:Smoking Cessation / Q000379:methods*; D014029:Tobacco Use Disorder / Q000453:epidemiology* / Q000517:prevention & control; D014030:Tobacco, Smokeless / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D014486:United States Food and Drug Administration; D055815:Young Adult