http://hints.cancer.gov

briefs

NUMBER 17

Smokers’ Attitudes 

Toward Potential

“Reduced-Exposure”

Tobacco Products (PREPs)

The tobacco industry has in recent years introduced a

proliferation of potential reduced-exposure tobacco

products (PREPs), marketing such products as alternatives

to conventional cigarettes and sometimes claiming they are

less harmful or less addictive. PREPs include modified

tobacco cigarettes, cigarette-like products, and

oral/smokeless tobacco products. Public health experts

have raised concern about the marketing of PREPs, noting

that these products pose substantial challenges for tobacco

control efforts because smokers may perceive the products

as an alternative to quitting or as a “less harmful”

alternative to conventional cigarettes.

Many studies have documented public misperceptions

about “light” cigarettes and have demonstrated that

smokers may switch to these brands expecting a health

benefit. Research on PREPs follows a similar pattern,

documenting that smokers are interested in trying PREPs

and perceive them to have lower health risks, even when

advertising does not make explicit health claims. Combined

data from HINTS 2003 and 2005 show that 54% of current

smokers report that they would be “very” or “somewhat”

interested in trying a cigarette advertised as less harmful.

The U.S. Food and Drug Administration (FDA) was recently

granted authority to regulate tobacco, including the

authority to develop regulations governing claims for

“modified risk” products.The 2009 legislation also banned

use of the terms “light,” “low,” and “mild” in cigarette

labeling and advertising.

In this HINTS Brief, we explore smokers’ attitudes toward

PREPs and suggest opportunities for public education.

0

20

40

60

80

100

Interested in PREPs

Health Information National Trends Survey (HINTS) 2003, 2005

Not Interested in PREPs

Interest in PREPs and Consideration of

Quitting Smoking

51.7% 59.5% 48.3% 40.5%

• Considering Quiting Smoking

• Not Considering Quiting Smoking

Quick Facts

• Smoking is the leading cause of preventable death in 

the United States, causing one in five deaths each year

from cancer, cardiovascular and pulmonary disease, and

other causes.

• Chewing tobacco and snuff contain 28 carcinogens and

cause oral and pancreatic cancers.

• Epidemiologic and other scientific data demonstrate that

changes in cigarette design since the 1950s, including the

introduction of “light” cigarettes, have not decreased the

risks of smoking.

• There is insufficient evidence that new “reducedexposure” tobacco products provide benefits to

smokers’ health.

Study Finds Smokers Interested in PREPs Despite Lack of Health Benefit

Heavy smokers and “health conscious” smokers vulnerable to misleading claims

In a 2009 research study using data from HINTS 2003 and Of particular concern is that heavy smokers (those who

2005, investigators found that there is substantial awareness smoke 20 or more cigarettes per day) who are not

of PREPs among U.S. adults, although use of these products planning to quit, and smokers who categorize themselves

remains relatively low. Furthermore, results from this study as “health conscious,” may be especially receptive to PREPs

suggest that there is a substantial level of interest among marketing strategies and may view PREPs as an alternative

current smokers in cigarettes marketed with claims of to quitting smoking. One-half of HINTS respondents who

reduced exposure or harm. had tried a PREP reported doing so to reduce harm or

assist in quitting.

In this HINTS Brief, we explore smokers' attitudes toward potential “reduced-exposure” tobacco products, or PREPs.
Adult Smokers’ Interest in PREPs: Differences by Gender,

Race/Ethnicity, and Smoking Behavior

Although use of PREPs remains low in the United States, there is substantial interest among smokers in products that

purport to be less hazardous to health. Interest in PREPs differs by gender, race/ethnicity, and smoking behavior.

Gender Race/Ethnicity Smoking Behavior

Female smokers (59%) are more likely A higher proportion of non-Hispanic Daily smokers (58%) are substantially

to be interested in PREPs than male whites (57%) report interest in PREPs more likely to be interested in PREPs

smokers (50%). than Hispanics (46%) and African than those who smoke only on some

Americans (40%).Those classified as days (41.6%). Moreover, smokers who

“other race” (e.g., Native Americans, are not currently considering quitting

Asians, and those not reporting a (59.5%) show more interest in 

race/ethnicity) show an overall higher PREPs than smokers who want to

level of interest in PREPs (63%). quit (51.7%).

How Can This Inform Your Work?

HINTS data show that there is substantial interest in • Educating tobacco users that quitting tobacco

PREPs among smokers and that the majority of those completely is the only proven way to reduce the risk of

who have tried PREPs have done so to reduce harm or tobacco-related illness and disease

assist in their efforts to quit. Health communication • Raising awareness about FDA-approved medicines to

practitioners can strive to reverse this trend by: help tobacco users quit (nicotine gum, inhalers,

• Spreading the word that PREPs are not a good lozenges, nasal sprays, and patches; bupropion SR pills,

alternative to quitting smoking or chewing tobacco, nor varenicline pills)

are they a “safer” alternative to these behaviors • Encouraging smokers to visit http://smokefree.gov for

help with quitting

About HINTS

http://hints.cancer.gov

The National Cancer Institute (NCI) fielded the first Health Information National Trends Survey (HINTS) in 2002 and 2003, surveying

6,369 Americans. Subsequent surveys followed in 2005 (5,586 Americans surveyed) and 2008 (7,674 Americans surveyed). HINTS was

created to monitor changes in the rapidly evolving field of health communication.The survey data can be used to understand how

adults 18 years and older use different communication channels to obtain health information for themselves and their loved ones, and

to create more effective health communication strategies across populations.

HINTS Briefs provide a snapshot of noteworthy research findings.They introduce population-level estimates for specific questions in

the survey and summarize significant research findings that are a result of analyzing how certain demographic characteristics influence

specific outcomes. Many Briefs summarize research findings from recent peer-reviewed journal articles using HINTS data.

For More Information on Cancer

• Call the NCI Cancer Information Service at 1-800-4-CANCER

• Visit http://cancer.gov

• Order NCI publications at https://cissecure.nci.nih.gov/ncipubs/

References Used in This HINTS Brief

Parascandola M,Augustson E, O’Connell ME, Marcus S. Consumer awareness

and attitudes related to new potential reduced-exposure tobacco product

brands. Nicotine & Tobacco Research. July 2009. 11(7):886-895.

November 2010