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Am J Health Behav. 2019 Mar 1;43(2):266-278. doi: 10.5993/AJHB.43.2.4.

Multi-item Measures of Tobacco Health Perceptions: A Review.

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Food and Drug Administration, Center for Tobacco Products, Office of Science, Silver Spring, MD;, Email:
Food and Drug Administration, Center for Tobacco Products, Office of Science, Silver Spring, MD.


Objective: In this paper, we review multi-item measures of tobacco risk perceptions and health beliefs, describe the measures' content and quality, and identify measure development opportunities. Methods: We identified 110 articles that included measures assessing perceptions of tobacco's health effects by combining multiple items into a score. We coded measures' provenance (newly developed vs built on prior measures), content, consistency with risk-perception researcher recommendations (eg, specifying use conditions), samples used, and reliability and validity. Results: Most measures were newly developed or built on the Smoking Consequences Questionnaire. Few measures assessed perceptions of non-cigarette products, and some health harms rarely were assessed. Few measures specified product use conditions. Over half of studies assessed reliability, which was typically high. Most assessed validity by comparing scores by use status, finding mixed results. Conclusions: Several measures of cigarette risk perceptions included a range of health effects and demonstrated reliability and validity, though they had other shortcomings (eg, they did not specify conditions of use). Researchers could help address gaps in measuring tobacco health perceptions by developing quality consensus measures for non-cigarette products, assessing a range of perceived health effects, assessing perceptions relative to other products, specifying use conditions, and showing multiple types of validity in diverse subpopulations.


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