Effects of a Reduced Risk Claim on Adolescents' Smokeless Tobacco Perceptions and Willingness to Use

Purpose: United States Smokeless Tobacco Company LLC submitted a modified risk tobacco product application to the US Food and Drug Administration, proposing a claim that switching to Copenhagen snuff fine cut from cigarettes reduces lung cancer risk. This claim could affect adolescents' smokeless tobacco perceptions and its use.Methods: Students (N = 592; mean age: 15.3 years; 46% male; 32% nonHispanic White; 8% smokeless tobacco ever-users) at seven California high schools were randomized within a survey to view a Copenhagen snuff image, either with or without the proposed reduced risk claim. Par-ticipants were then asked about the harm of smokeless tobacco and their willingness to try Copenhagen snuff if a friend offered. Postimage harm rating and willingness were compared be-tween image groups overall, stratified by past 30-day tobacco use (87% of tobacco users were e-cigarette users), and adjusted for participant characteristics using multivariable regression.Results: Participants who viewed the claim were less likely to perceive smokeless tobacco to cause "a lot" of harm (56% vs. 64%; p = .03), including after statistical adjustment (risk ratio [RR]: 0.84; 95% confidence interval [CI]: 0.75, 0.94), and with a numerically stronger effect among tobacco users (RR: 0.65; 95% CI: 0.48, 0.86). The claim did not increase willingness overall (17% vs. 20%; p = .41) but did increase willingness among tobacco users (RR: 1.67; 95% CI: 1.05, 2.67).Discussion: Brief exposure to a reduced-risk claim decreased adolescents' smokeless tobacco harm perceptions and increased willingness to try among tobacco users. The Food and Drug Adminis-tration order permitting this claim could increase some adolescents' susceptibility to smokeless tobacco, particularly those already using other tobacco products like e-cigarettes. (c) 2023 Society for Adolescent Health and Medicine. All rights reserved.