title: Criterion validity of measures of perceived relative harm of e-cigarettes and smokeless tobacco compared to cigarettes.
abstract: Beliefs about the relative harmfulness of one product compared to another (perceived relative harm) are central to research and regulation concerning tobacco and nicotine-containing products, but techniques for measuring such beliefs vary widely. We compared the validity of direct and indirect measures of perceived harm of e-cigarettes and smokeless tobacco (SLT) compared to cigarettes. On direct measures, participants explicitly compare the harmfulness of each product. On indirect measures, participants rate the harmfulness of each product separately, and ratings are compared. The U.S. Health Information National Trends Survey (HINTS-FDA-2015; N=3738) included direct measures of perceived harm of e-cigarettes and SLT compared to cigarettes. Indirect measures were created by comparing ratings of harm from e-cigarettes, SLT, and cigarettes on 3-point scales. Logistic regressions tested validity by assessing whether direct and indirect measures were associated with criterion variables including: ever-trying e-cigarettes, ever-trying snus, and SLT use status. Compared to the indirect measures, the direct measures of harm were more consistently associated with criterion variables. On direct measures, 26% of adults rated e-cigarettes as less harmful than cigarettes, and 11% rated SLT as less harmful than cigarettes. Direct measures appear to provide valid information about individuals' harm beliefs, which may be used to inform research and tobacco control policy. Further validation research is encouraged.
authors.affiliation: Office of Science, Center for Tobacco Products, FDA, Silver Spring, MD, USA. Electronic address: alexander.persoskie@fda.hhs.gov.
authors.forename: Alexander
authors.initials: A
authors.lastname: Persoskie
authors.affiliation: Office of Science, Center for Tobacco Products, FDA, Silver Spring, MD, USA.
authors.forename: Anh B
authors.initials: AB
authors.lastname: Nguyen
authors.affiliation: Tobacco Control Research Branch, National Cancer Institute, Rockville, MD, USA.
authors.forename: Annette R
authors.initials: AR
authors.lastname: Kaufman
authors.affiliation: Office of Science, Center for Tobacco Products, FDA, Silver Spring, MD, USA.
authors.forename: Cindy
authors.initials: C
authors.lastname: Tworek
mesh_terms: D066300:Electronic Nicotine Delivery Systems / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015203:Reproducibility of Results; D062789:Tobacco Products / Q000009:adverse effects*; D014030:Tobacco, Smokeless / Q000009:adverse effects*
keywords: Electronic cigarettes; Measures; Perceived harm; Smokeless tobacco; Tobacco; Validity