PREPs Surveillance: Summary of Cognitive Interviews and Recommendations for PREPs Surveillance Measures

A review of existing research on population awareness of potentially reduced exposure tobacco products (PREPs) as well as results of cognitive interviews suggest that awareness of PREPs is quite low at this time, except in active test-markets. In order to monitor changes in awareness and perceptions of, and receptivity to these products over time, we have proposed using a set of questions as well as coding conventions that appear to result in reasonably accurate estimates of awareness of a particular group of products. The recommended items, which performed will in cognitive interviews, are presented in Appendix D of this report. It must be acknowledged that this report is limited by the need to restrict the number of respondents and by the fact that those included were of relatively high socio-economic status. Prior to any large scale use of these survey items, we recommend that further pre-tests be done using other survey modes (telephone and self-administered), and that an effort be made to include respondents with lower levels of education, and with greater cultural diversity

PREPs Surveillance: Summary of Existing Survey Measures and Recommendations for Ongoing Efforts

Over the past decade or more, tobacco companies have introduced cigarettes with lower content of some toxins than regular and light cigarettes. These new cigarettes, referred to as a class as Potential Reduced Exposure Products (PREPs), have typically been introduced into test markets, not nationwide, which means they are not yet widely known or recognized by name or description by most consumers. However, the introduction of these products is of great concern to public health advocates, who do not believe that enough research, particularly long term research, has been done to know whether or not the PREPs, even if proven to have reduced toxins, actually present a reduced health risk. The fear in the public health community is that smokers who might have been motivated to quit may reverse those quit plans if they perceive an alternative, safer smoking option exists with the PREPs. Likewise, there is concern that former smokers could be tempted back to smoking and non-smokers could be tempted to initiate smoking if they too perceive that PREPs present lower health risks than other cigarettes. Having faced a similar situation with the introduction of “light” cigarettes – i.e. new product, insufficient research about its health implications -- public health officials are feeling cautious about PREPs and have called for development of a science to evaluate PREPs, as well as ongoing surveillance. In order to obtain as complete a set of existing measures as possible, we reviewed published literature on consumer reactions to PREPs and solicited input about ongoing studies from members of the project advisory group, members of the Harm Reduction Network, and other members of the tobacco research community. Appendix A is a list of studies we have included in the summary of current data on the subject of PREPs surveillance. Appendix B is the full listing of PREPs-related questions for each included study

Massachusetts Adult Tobacco Survey: Tobacco Use and Attitudes After Seven Years of The Massachusetts Tobacco Control Program, Technical Report & Tables 1993 — 2000

The Massachusetts Tobacco Control Program was launched in October of 1993. At that time, the Center for Survey Research conducted the Massachusetts Tobacco Survey (MTS), a comprehensive survey of adults and teens living in Massachusetts. The purpose of the survey was to collect baseline data on the prevalence of tobacco use among adults and teens in the Commonwealth and on issues related to the likelihood of smoking cessation or initiation. The survey also assessed the prevalence of restrictive smoking policies, and attitudes about tobacco control measures. The baseline data serve as a standard against which the impact of various programs sponsored by the Department of Public Health can be assessed. Technical details about the MTS and reports of the results are available from the Massachusetts Department of Public Health. In January, 1995 the Department of Public Health contracted with the Center for Survey Research to carry out a second survey monitoring tobacco use and related attitudes and behaviors among adults in the Commonwealth. This second survey, known as the Massachusetts Adult Tobacco Survey (MATS), has been carried out monthly since March of 1995. Data are aggregated at the end of each calendar year. MATS is similar to the MTS in that initial screening interviews are carried out with a household member who provides demographic and smoking status information about other adults in the household. One member of the household is then randomly selected for extended interview. The annual sample for this survey is smaller than that used for the MTS and does not include teens. It also differs from the MTS in that smokers were not over-sampled, nor were members of minority groups. The sample was geographically stratified as was the MTS. (More details on the sampling design are presented in Chapter I.) Technical Reports are available for the 1993 MTS survey, and for the 1995 through 1999 MATS surveys. Please refer to those reports for descriptions of the respective surveys and a more general discussion of the use of the telephone survey for data collection. This report presents methodological details of the 2000 MATS. It contains an appendix of tables of major results for data collected each year. Nontechnical reports describing the major results are available from the Massachusetts Department of Public Health

Snus use and rejection in the USA

OBJECTIVE: To determine whether snus might become a strategy for reducing the harm associated with cigarette smoking in the USA as appears to be the case in Sweden, we examined receptivity to snus use in two cities with the greatest exposure to the major brands. METHODS: A dual frame, telephone survey and a brief mail survey were conducted in 2011 and 2012 in Indianapolis, Indiana and Dallas/Fort Worth Texas. Over 5000 adults completed surveys. Trial, ever use, current use and reasons for using or quitting snus after trial were measured. RESULTS: Among male smokers, 29.9% had ever tried snus (CI 22.7 to 38.1) and 4.2% were current users (CI 1.6 to 10.7). Among female smokers, 8.5% ever tried snus (CI 4.4 to 15.7) and current use was unknown. Current use was virtually absent among former smokers and never smokers. A major predictor of any level of snus use was current use of conventional smokeless tobacco. Those who tried and gave up snus cited curiosity (41.3%) and the fact that it was available at low or no cost (30%) as reasons for trial; reasons for not continuing included preferring another form of tobacco (75.1%) and disliking the mouth feel (34.6%). Almost all current snus users indicated that they were trying to cut down on cigarettes, but few (3.9%) were using it to quit smoking entirely. CONCLUSIONS: The low rate of adoption of snus suggests that neither the hopes nor the fears surrounding this new product are likely to be realised in the USA with the current marketing patterns

Surveillance indicators for potential reduced exposure products (PREPs): developing survey items to measure awareness

<p>Abstract</p> <p>Background</p> <p>Over the past decade, tobacco companies have introduced cigarettes and smokeless tobacco products (known as Potential Reduced Exposure Products, PREPs) with purportedly lower levels of some toxins than conventional cigarettes and smokeless products. It is essential that public health agencies monitor awareness, interest, use, and perceptions of these products so that their impact on population health can be detected at the earliest stages.</p> <p>Methods</p> <p>This paper reviews and critiques existing strategies for measuring <it>awareness </it>of PREPs from 16 published and unpublished studies. From these measures, we developed new surveillance items and subjected them to two rounds of cognitive testing, a common and accepted method for evaluating questionnaire wording.</p> <p>Results</p> <p>Our review suggests that high levels of awareness of PREPs reported in some studies are likely to be inaccurate. Two likely sources of inaccuracy in awareness measures were identified: 1) the tendency of respondents to misclassify "no additive" and "natural" cigarettes as PREPs and 2) the tendency of respondents to mistakenly report awareness as a result of confusion between PREPs brands and similarly named familiar products, for example, Eclipse chewing gum and Accord automobiles.</p> <p>Conclusion</p> <p>After evaluating new measures with cognitive interviews, we conclude that as of winter 2006, awareness of reduced exposure products among U.S. smokers was likely to be between 1% and 8%, with the higher estimates for some products occurring in test markets. Recommended measurement strategies for future surveys are presented.</p