use outcomes vary by age and demographics. Next, the chapter outlines the standards for studies on risk perceptions, including the questions that should be addressed through the studies, standards for the research designs, participant recruitment, measurement, and analysis.

BACKGROUND AND RATIONALE: IMPORTANCE OF RISK PERCEPTIONS

Judgments about risk, otherwise known as risk perceptions, are viewed as a fundamental element of most theoretical models of health behavior and behavioral decision making, including social cognitive theory (Bandura, 2001), the health belief model (Rosenstock, 1974), the theory of reasoned action (Fishbein and Ajzen, 1975), the theory of planned behavior (Ajzen, 1985), self-regulation theory (Kanfer, 1970), and subjective culture and interpersonal relations theory (Triandis, 1977). In general, these models argue that individuals’ perceptions about the value and likelihood of behavior-related positive and negative consequences and their vulnerability to those consequences play a key role in behavioral choices. As such, understanding individuals’ perceptions of tobacco- related products, including MRTPs, whether such perceptions change over time with the introduction of MRTPs, and whether such perceptions play a role in tobacco use behavior, is critical. The committee also acknowledges, as the 2007 Institute of Medicine (IOM) report articulated, that perceptions of risk (and benefit) may have differing implications for product use among different consumers. It is important to understand both the risk (and benefit) perceptions of the consumer and the value that is placed upon these perceptions.

In the next few sections, the committee provides an overview of the literature on tobacco-related perceptions, followed by methodological considerations to design studies to determine perceptions and behavioral implications of MRTPs.

PERCEPTIONS OF EPIDEMIOLOGIC DATA FOR TOBACCO USE

It is critical to first understand the extent to which both tobacco users and nonusers understand the actual risks of tobacco use, compared to epidemiologic data. Much of the literature comparing perceptions to actual data suggests that, on average, smokers overestimate the risks of smoking (Borland, 1997; Johnson et al., 2002; Kristiansen et al., 1983; Viscusi, 1990, 1991, 1992), while other studies show that smokers underestimate them (Arnett, 2000; Hansen and Malotte, 1986; Leventhal et al., 1987; Schoenbaum, 1997; Sutton, 1998; Virgili et al., 1991). Among adolescents and young adults (ages 18-22), Jamieson and Romer (2001) found that



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