Perceptions of Harm and Addiction of Snus: A Mixed Methods Study

Introduction: Changes in public attitudes toward smoking have led to reductions in cigarette consumption in the US. To revitalize their brand image, prevent smokers from quitting tobacco, and retain their profits, tobacco companies have diversified their products and have expanded to smokeless tobacco options. Companies marketing in the U.S. are prohibited from making claims that these products pose less risk or are less addictive than cigarettes. However, advertisements for emerging products seem to make such claims implicitly. This purpose of this study is to examine beliefs (i.e., harm, addiction), related to print advertisements. This was examined in the context of an emerging tobacco product, snus, using a mixed-methods design combining eye-tracking methodology with structured interviews.

Methods: A community convenience sample (N = 22) of young adult male smokers ages 18-29 years were recruited. Upon arriving at the laboratory, participants completed a baseline questionnaire containing items on smoking history, snus use and beliefs, and demographics. Tobii Studio TX300 was used to display five snus advertisements (branding removed, images randomized) for 20 seconds each and to track eye movements. After each advertisement, participants responded to questions about perceived harm and addictiveness. Quantitative analyses were conducted to examine the eye tracking results (e.g. fixation duration), harm and addictiveness perceptions, and the associations between them. Participants then engaged in one-on-one semi-structured interviews. Interviews were transcribed and qualitative analyses were conducted using QSR International NVivo10 Software.

Results: On average, participants’ total fixation duration on the warning labels across all five advertisement was 1.60 (SD=0.86) seconds and time to first fixation was 6.14 (SD=2.56) seconds. Linear regression analyses were conducted to predict 1) harm and 2) addiction beliefs from the eye tracking results for each advertisement controlling for baseline harm and addiction beliefs. Addiction beliefs were significantly related to attention (as measured by eye tracking) and harm beliefs were not. Interview themes that emerged included tobacco product and health risk comparisons, advertisement appeal to youth, snus use frequency, and deceptiveness of advertisements. Participant’s behavioral willingness to use snus was variable. 

 Conclusions: Understanding how smokers perceive and understand products after viewing advertisements may inform regulations regarding implicit claims about product harm and addictiveness. Our results may guide public health efforts to educate smokers on the risks of emerging products. These insights may also inform the development of tobacco control interventions and policies in the US.