Sabeeh A. Baig

Sabeeh A Baig, PhD; Bayesian inference: Parameter estimation for inference in small samples, Nicotine & Tobacco Research, , ntab221, https://doi.org/10.1093/ntr

Sabeeh A Baig, PhD; Bayesian inference: Evaluating replication attempts with Bayes factors, Nicotine & Tobacco Research, , ntab219, https://doi.org/10.1093/ntr/

Tobacco risk perceptions impact behavior. Our 2018 systematic review of tobacco risk perception measures found no measures of smokeless tobacco (ST) risk perceptions with demonstrated validity and complete consistency with tobacco researcher recommendations (e.g. specifying use frequency). This study develops such measures to assess seven specific risk perceptions of market-leading ST products: absolute health and addiction risks, health and addiction risks relative to cigarettes, pregnancy health risks relative to cigarettes, health risks relative to nicotine replacement therapy, and health risks relative to tobacco cessation. We fielded 64 items assessing risk perceptions associated with tobacco in an online survey experiment (N = 2754) that tested effects of exposing participants to a modified risk claim on a leading ST product. Through reliability and validity analyses, we reduced this to 35 items representing seven constructs. Exploratory factor analyses indicated single-factor solutions for all but two constructs: absolute health risk and health risk relative to cigarettes, which were each represented by two-factors (respiratory and oral risks). Participants perceived respiratory risks differently than oral risks: a modified risk claim reduced ST relative respiratory risk perceptions but increased ST perceived oral risks. Absolute and relative risk perceptions were each represented by two factors that behaved differently, underscoring the utility of assessing respiratory and oral risk perceptions separately. These measures of seven risk perception constructs demonstrated some validity and can be used to assess perceptions of ST risk in future research, such as postmarket surveillance of tobacco products authorized for marketing by FDA. This study develops and validates publicly available measures of seven smokeless tobacco risk perception constructs: absolute health and addiction risks, health and addiction risks relative to cigarettes, pregnancy health risks relative to cigarettes, health risks relative to nicotine replacement therapy, and health risks relative to tobacco cessation. This study suggests that for both absolute and relative risk perceptions, risks of respiratory and oral health effects should be assessed separately, because these risk perceptions may be impacted differently by modified risk claims, and are differentially related to smokeless tobacco beliefs, use intentions, and current use.

Tobacco risk perceptions are important predictors of behavior and are impacted by tobacco communications. Our systematic literature review (completed in 2018) found there were no measures of e-cigarette risk perceptions that were completely consistent with tobacco researcher recommendations (eg, specifying use frequency) and had demonstrated validity and reliability. The current study develops measures to assess specific risk perceptions, including absolute risks and risks compared with cigarettes, nicotine replacement therapy, and all nicotine cessation. We generated a list of tobacco health effects based on our previous systematic review of tobacco risk perception measures. Based on health effects prioritized by regulatory science experts, we developed 63 items to assess seven types of e-cigarette risk perceptions: absolute health and addiction risks, health and addiction risks relative to cigarettes, pregnancy health risks relative to cigarettes, health risks relative to nicotine replacement therapy, and health risks relative to all nicotine cessation. We fielded these items in an online survey (N = 1642). Through reliability and validity analyses, we reduced this pool to 21 items, including many single-item measures. Supporting the measures’ validity, each measure was negatively associated with current e-cigarette use, e-cigarette intentions, and skepticism about e-cigarette harms; and positively associated with perceiving e-cigarettes as equally or more harmful than cigarettes and intentions to quit e-cigarettes. This study developed and validated brief measures of several types of e-cigarette risk perceptions. Surprisingly, we found that for many types of risk perceptions, multi-item measures were redundant and these perceptions were well-represented by single-item measures. This study developed measures of seven types of e-cigarette health risk perceptions, including absolute health and addiction risk, and risk relative to cigarettes, nicotine replacement therapy, and cessation. We reduced 63 items to 21 to measure all of these constructs. These measures follow tobacco researcher recommendations, were developed using a rigorous measures development process, and demonstrated some aspects of reliability and validity. Because these measures are publicly available, they can be used by public health and industry researchers.

Monumental advances in computing power in recent decades have contributed to the rising popularity of Bayesian methods among applied researchers. This series of commentaries seeks to raise awareness among nicotine and tobacco researchers of Bayesian methods for analyzing experimental data. The current commentary introduces statistical inference via Bayes factors and demonstrates how they can be used to present evidence in favor of both alternative and null hypotheses.

Evidence for the health harms of e-cigarettes is growing, yet little is known about which harms may be most impactful in health messaging. Our study sought to identify which harms tobacco product users were aware of and which most discouraged them from wanting to vape. Participants were a convenience sample of 1,872 U.S. adult e-cigarette-only users, cigarette-only smokers, and dual users recruited in August 2018. In an online survey, participants evaluated 40 e-cigarette harms from seven categories: chemical exposures, device explosions, addiction, cardiovascular harm, respiratory harm, e-liquid toxicity, and other harms. Outcomes were awareness of the harms (“check all that apply”) and the extent to which the harms discouraged vaping (5-point scale; (1) “not at all” to (5) “very much”). Awareness of most e-cigarette harms was modest, being highest for harms in the device explosions category of harms (44%) and lowest for the e-liquid toxicity category (16%). The harms with the highest mean discouragement from wanting to vape were the respiratory harm (M = 3.82) and exposure to chemicals (M = 3.68) categories. Harms in the addiction category were the least discouraging (M = 2.83) compared with other harms (all p < .001). Findings were similar for e-cigarette-only users, cigarette-only smokers, and dual users. Addiction was the least motivating e-cigarette harm, a notable finding given that the current FDA e-cigarette health warning communicates only about nicotine addiction. The next generation of e-cigarette health warnings and communication campaigns should highlight other harms, especially respiratory harms and the chemical exposures that may lead to health consequences. E-cigarette health harms related to respiratory effects, chemical exposures, and other health areas most discouraged vaping among tobacco users. In contrast, health harms about addiction least discouraged use. Several countries have begun implementing e-cigarette health warnings, including the United States, and many others are considering adopting similar policies. To increase impact, future warnings and other health communication efforts should communicate about health harms beyond addiction, such as the effects of e-cigarette use on respiratory health. Such efforts should communicate that e-cigarette use is risky and may pose less overall risk to human health than smoking, according to current evidence.