Studying the Health Perceptions and Social Behaviors of Graduate Students at the Ohio State University for the Development of Effective Oral Nicotine Pouch Addictive Risk Communication

Susceptibility will be measured using the Three Item Susceptibility to Oral Nicotine Pouch Use Scale, a validated three-item measure assessing the likelihood of trying oral nicotine pouches in the future (e.g., "Would you try an ONP if offered by a friend?"). Each item will be rated on a 4 point Likert type scale with response options: Definitely yes, Probably yes, Probably not, and Definitely not. Responses will be coded from 1 (Definitely not) to 4 (Definitely yes) and averaged to create a composite susceptibility score, with possible values ranging from 1 to 4. Higher scores indicate greater susceptibility to ONP use.

Perceived harm of oral nicotine pouches will be measured using the Comparative Harm Perceptions of Oral Nicotine Pouches Scale, a three item measure assessing whether nicotine pouches are more or less harmful compared to cigarettes, e cigarettes, and coffee. Each item uses a 5 point response scale from 1 (A lot less harmful) to 5 (A lot more harmful). Responses will be averaged to create a composite comparative harm score with possible values ranging from 1 to 5. Higher scores indicate greater perceived harm of ONPs relative to the comparison product (worse outcome).

Descriptive norms will be assessed using the Six Category Descriptive Norm Perceptions of Oral Nicotine Pouch Use Scale, which measures the perceived prevalence of ONP use across four referent groups: young adults of the participant's age in the U.S., graduate students at the institution, graduate students within the participant's program, and the participant's friends. Each item employs a six-category response scale: None (0%), Few (1% to 20%), Less than half (21% to 40%), Around half (41% to 60%), More than half but not all (61% to 80%), and Most or nearly all (81% to 100%). Responses will be coded from 1 (None, 0%) to 6 (Most or nearly all, 81% to 100%) and averaged to generate a composite descriptive norm score with potential values from 1 to 6. Higher scores reflect a higher perceived prevalence of ONP use.

Injunctive norms will be measured using the Seven Point Injunctive Norm Perceptions of Oral Nicotine Pouch Use Scale, which assesses perceived approval of ONP use across four referent groups: young adults the participant's age in the U.S., graduate students at the institution, graduate students within the participant's program, and the participant's friends. For each referent group, participants will answer: "Do they think it is a good idea to use nicotine pouches?" using a seven-point response scale: Not at all, Slightly, Somewhat, Neutral, Moderately, Quite a bit, and Very much so. Responses will be coded from 1 (Not at all) to 7 (Very much so) and averaged to create a composite injunctive norm score with possible values ranging from 1 to 7. Higher scores indicate greater perceived approval of ONP use.

Subjective norms will be assessed using the Two-Item Subjective Norm Perceptions of Oral Nicotine Pouch Use Scale. Participants will rate whether close contacts want them to use nicotine pouches and whether these contacts believe it is important to avoid using nicotine pouches, on a seven-point scale from 1 (Not at all) to 7 (Very much so). The avoid item will be reverse coded, and the items will be averaged to produce a composite subjective norm score with possible values from 1 to 7. Higher scores indicate a greater perceived encouragement to use nicotine pouches.

Personal norms will be assessed using the Four Item Personal Norms Regarding Oral Nicotine Pouch Use Scale. Participants will rate their agreement with four statements about moral obligation, personal benefit, and responsibility to avoid using nicotine pouches on a seven-point scale from 1 (Strongly Disagree) to 7 (Strongly Agree). The items will be averaged to produce a composite personal norms score, which can range from 1 to 7. Higher scores indicate stronger personal norms to avoid ONP use.

Exposure to ONP information sources will be assessed using the Self-Report Communication Channel Checklist for Oral Nicotine Pouch Information. Participants will choose all media sources from which they received information about nicotine pouches and, if social media is selected, specify which platforms they used (e.g., Facebook, YouTube, X, Reddit, Instagram, TikTok, Snapchat, Other).

Perceived severity will be measured using the Three Item Perceived Severity of Oral Nicotine Pouch Use Scale. Participants will rate agreement with three statements about the severity and harmfulness of nicotine pouch consequences on a seven point scale from 1 (Strongly Disagree) to 7 (Strongly Agree). Items will be averaged to create a composite perceived severity score with possible values ranging from 1 to 7. Higher scores indicate greater perceived severity of ONP use consequences.

Perceived impact on self efficacy will be measured using the Three Item Message Impact on Self Efficacy to Avoid Oral Nicotine Pouch Use Scale. Participants will rate agreement with three statements about message related confidence and influence on avoiding nicotine pouches on a seven point scale from 1 (Strongly Disagree) to 7 (Strongly Agree). Items will be averaged to create a composite perceived impact on self efficacy score with possible values ranging from 1 to 7. Higher scores indicate greater perceived message impact on self efficacy to avoid ONP use.

Intention to share the Oral Nicotine Pouch message on social media will be measured using the Seven-Item Intention to Share Oral Nicotine Pouch Message on Social Media Scale. Participants will rate agreement with seven statements about their interest and intention to share the message on a seven-point scale from 1 (Strongly Disagree) to 7 (Strongly Agree). Items will be averaged to create a composite sharing intention score with possible values ranging from 1 to 7. Higher scores indicate greater intention to share the ONP message on social media.

Attitudes will be measured using the Four Item Semantic Differential Attitudes Toward Oral Nicotine Pouches Scale. Participants will rate nicotine pouch use on four adjective pairs on a 1 to 5 scale, and items will be averaged (range 1 to 5). Higher scores indicate more positive attitudes toward ONP use.

Participants will report past and current use of tobacco products, including oral nicotine pouches (ONPs) and other tobacco/nicotine products. Data will include categorical indicators of ever use, past 30 day use, frequency, and product types.

Participants will provide demographic data, including age, gender, race/ethnicity, educational program, and other demographic characteristics.