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1. Introduction
The Tobacco Control Act and the deeming rule give the Food and Drug Administration (FDA) a broad authority to regulate all tobacco products, including their manufacture, marketing, and distribution [1,2]. Under this authority, the FDA’s Center for Tobacco Products (CTP) examines and makes determinations on new tobacco products that seek market authorization, conducts rigorous compliance and enforcement programs to ensure that tobacco industry and others (e.g., distributors, retailers) follow the law, educates the public about the dangers of tobacco products, and funds and conducts research to support and establish regulations concerning tobacco products that are appropriate for the protection of the public health [1].
To achieve its mission, the FDA’s CTP is responsible for informing the public and various stakeholders (e.g., tobacco companies, manufacturers, distributers, retailers, and advocacy groups) about the FDA’s authority over tobacco products. Public perceptions of FDA are likely to influence the public’s and stakeholder’s attitudes towards the agency and its tobacco regulations [3]. Perceptions of FDA’s credibility as a tobacco regulator (i.e., its expertise, trustworthiness, and accountability in this role) may also determine receptivity to, and persuasion by, FDA communications about the harms of tobacco products [4]. Research in the United States (US), however, shows moderate levels of trust in government agencies, including those that were tasked to implement tobacco control measures [5,6]. One study found that federal agencies, such as FDA, the Centers for Disease Control (CDC), and the National Institutes of Health (NIH) emerged third (42%) in ratings of trust in online health information resources after personal doctor (59%), and medical universities (48%) [6]. In a 2015 Pew Research Center Poll, only 51% and 71% of the US population reported that they view the FDA and CDC favorably [7]. A more recent study by Kowitt et al., (2017) found that only 43% of US adults reported trust in the federal government and that trust in FDA was moderate (62%) but lower than trust in the CDC (65%) [5]. Research also shows low public awareness of FDA’s tobacco regulatory and communication roles [8,9,10,11].
Historically, public opinion about tobacco use has been shaped by promotional and marketing activities of the tobacco industry, which included decades of obscuring the truth about the addictiveness of nicotine and the negative health consequences...