OBJECTIVES: The policy of tobacco harm reduction – making less harmful products available to smokers who would otherwise continue smoking – is recognized as an important strategy for reducing smoking-related harm. Predicting use behavior is an important component of product risk assessment, risk perception being a possible factor driving tobacco product uptake and use. The objective of this study was to develop a new self-report measure that quantifies perceived risks of tobacco and nicotine-containing products using Rasch Measurement Methods (RMMs).

METHODS: The Perceived Risk Instrument (PRI) was constructed from focus groups in three countries, literature review and expert opinion. Cognitive debriefing interviews were conducted in four countries to inform the content of the instrument and to support the cultural adaptation. The pilot PRI was then field-tested in two stages based on large cross-national web-surveys. Subsequently, The PRI was implemented in cross-sectional studies to get an understanding of the perceived risk profile of different tobacco products for both adult smokers as well as never and former smokers.

RESULTS: RMMs supported the formation of an 18-item Perceived Health Risk scale and a 7-item Perceived Addiction Risk scale. Both scales showed small measurement error, correct functioning of the rating scale, and measurement invariance across types of tobacco products, populations with different smoking status and different countries, providing thus the basis for valid comparisons. Construct validity was further supported by significant differences in perceived risks between adult smokers and never smokers. Products (i.e., cigarettes, electronic cigarettes, heat-not-burn product, and nicotine replacement therapy) could also be discriminated on the perceived risk continuum.

CONCLUSIONS: The PRI is a psychometrically robust instrument that may be used in clinical and population-based studies; for different types of tobacco and nicotine-containing products; and for different smoking status groups.