Comparing direct and indirect assessments of perceptions of reduced risk for a modified-risk tobacco product
Manufacturers seeking to make claims about modified-risk tobacco products (MRTPs) must assess consumers' perceptions of absolute and relative risks for that product. We cross-validate data from two methods: (a) indirect assessments based on the difference between absolute risk ratings for the MRTP and cigarettes; and, (b) direct assessments comparing the MRTP to cigarettes. We also examine indirect assessments of consumers who, on direct assessment, indicate they don't know the risk of the MRTP relative to cigarettes. US adult current, former and never tobacco users (n=18,234) recruited from online research panels were shown advertisements stating that smokers who switch completely to Camel Snus (CS) could reduce their risk of lung cancer and respiratory disease. Respondents rated the absolute risks of CS and cigarettes, separately, on a 1-7 scale, and directly compared the risks of CS versus cigarettes for each disease. For lung cancer, the mean difference in absolute ratings for CS and cigarettes was -0.4±0.02 for those who indicated no difference in risk, based on direct assessment; -2.1±0.02 for those who indicated a lower risk for CS; -3.4±0.04 for those who indicated CS presented no risk at all; and, -1.0±0.04 for those who responded "don’t know." Results were similar for respiratory disease. The tight correlation between direct and indirect modes of assessing perceived risk indicates reliability and validity for both methods. That respondents who indicated "don't know" in the direct assessment provided absolute ratings intermediate between 'same as smoking' and 'less risk' indicates their perceptions are very conservative; they do not believe CS is completely safe. The findings confirm the validity of these approaches for assessing perceived risks of MRTPs.