Development and Assessment of Nicotine Continuum of Risk Education on Tobacco Use Among Lower Income Adults - Adults with lower income are at increased risk of heavy smoking, face reduced cessation success, and bear a heavy burden of smoking-attributable morbidity and mortality. For adults who are not yet ready or able to quit smoking, switching to a lower harm, non-combustible nicotine product could reduce exposure to smoke from combustible cigarettes. However, smokers who are not yet ready or willing to quit nicotine use completely are less likely to switch products without understanding that the health risks of nicotine-containing products are not identical but lie along a continuum of risk (COR), where combustible products are most harmful and noncombustible products less harmful. Studies have identified a general lack of knowledge about the relative risks of nicotine-containing products across the population, and evidence suggests that low-income adults may be least knowledgeable. There is still a lack of evidence about COR perceptions among low-income smokers, the effectiveness of educational messages designed to boost COR knowledge, and whether increasing COR knowledge may impact intentions to switch products and reduce combustible product use. This proposal aims to 1) use qualitative methods to assess COR perceptions among low-income smokers, 2) design and test candidate COR educational messages, and 3) investigate the effects of exposure to COR educational messages on COR knowledge, intentions to switch from combustible to noncombustible products, and reductions in combustible product use among low-income smokers. A comprehensive training plan will ensure successful execution of these aims, with four overall goals for the PI during the training period: 1) proficiency in qualitative research methodology, 2) acquire expertise in clinical trial administration, leadership, and methodology, 3) acquire expertise in advanced statistical methods to evaluate the effects of interventions, and 4) develop expertise in designing, optimizing, and testing health communications. Training will be guided by a team of expert mentors with complementary areas of expertise and current, strong collaborative relationships with one another. This research and training will also be supported by the strong training environment at Virginia Commonwealth University, and prepare the PI to successfully lead independent studies focused on reducing the harms of tobacco and other substance use. Modified Specific Aims People with lower income and/or lower educational attainment have more difficulty quitting smoking and high rates of smoking-related morbidity and mortality. While “no tobacco product is safe”, the FDA’s Center for Tobacco products (CTP) recognizes that tobacco products lie along a continuum of risk (COR), with combusted cigarettes being the most harmful to health. Low-income smokers are less likely to accurately perceive the relative health risks of combusted versus non-combusted products than other smokers and are more likely to incorrectly attribute much of the health harm associated with smoking to nicotine. Further, low-income adults who smoke are less likely to use medicinal nicotine or alternative, non-combusted nicotine products, such as electronic cigarettes (e-cigarettes). While educational campaigns about health risks posed by nicotine and tobacco products have been developed, none have focused on low-income adults, who have higher prevalence of smoking. They also have not delivered comprehensive COR information, nor examined whether increasing COR knowledge will result in behavior change among low-income adults. It is essential to specifically assess COR message effectiveness among low-income adults, not only because of their increased risk of tobacco-related disease, but because they face different tobacco marketing environments and advertising than higher-income adults. Studies have examined the effectiveness of general population smoking cessation campaigns, finding that such campaigns may be less effective among low-income adults,
