83_FR_54565 83 FR 54356 - Agency Information Collection Activities; Submission for Office of Management and Budget Review; Comment Request; Investigation of Consumer Perceptions of Expressed Modified Risk Claims

83 FR 54356 - Agency Information Collection Activities; Submission for Office of Management and Budget Review; Comment Request; Investigation of Consumer Perceptions of Expressed Modified Risk Claims

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Food and Drug Administration

Federal Register Volume 83, Issue 209 (October 29, 2018)

Page Range54356-54359
FR Document2018-23523

The Food and Drug Administration (FDA, Agency, or we) is announcing that a proposed collection of information has been submitted to the Office of Management and Budget (OMB) for review and clearance under the Paperwork Reduction Act of 1995.

Federal Register, Volume 83 Issue 209 (Monday, October 29, 2018)
[Federal Register Volume 83, Number 209 (Monday, October 29, 2018)]
[Notices]
[Pages 54356-54359]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2018-23523]


-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Food and Drug Administration

[Docket No. FDA-2018-N-0821]


Agency Information Collection Activities; Submission for Office 
of Management and Budget Review; Comment Request; Investigation of 
Consumer Perceptions of Expressed Modified Risk Claims

AGENCY: Food and Drug Administration, HHS.

ACTION: Notice.

-----------------------------------------------------------------------

SUMMARY: The Food and Drug Administration (FDA, Agency, or we) is 
announcing that a proposed collection of information has been submitted 
to the Office of Management and Budget (OMB) for review and clearance 
under the Paperwork Reduction Act of 1995.

DATES: Fax written comments on the collection of information by 
November 28, 2018.

ADDRESSES: To ensure that comments on the information collection are 
received, OMB recommends that written comments be faxed to the Office 
of Information and Regulatory Affairs, OMB, Attn: FDA Desk Officer, 
Fax: 202-395-7285, or emailed to [email protected]. All 
comments should be identified with the OMB control number 0910-NEW and 
title ``Investigation of Consumer Perceptions of Expressed Modified 
Risk Claims.'' Also include the FDA docket number found in brackets in 
the heading of this document.

FOR FURTHER INFORMATION CONTACT: Amber Sanford, Office of Operations, 
Food and Drug Administration, Three White Flint North, 10A-12M, 11601 
Landsdown St., North Bethesda, MD 20852, 301-796-8867, 
[email protected].

SUPPLEMENTARY INFORMATION: In compliance with 44 U.S.C. 3507, FDA has 
submitted the following proposed collection of information to OMB for 
review and clearance.

Investigation of Consumer Perceptions of Expressed Modified Risk Claims

OMB Control Number 0910--NEW

I. Background

    FDA's Center for Tobacco Products proposes to conduct a study to 
develop generalizable scientific knowledge to help inform its 
implementation of section 911 of the Federal Food, Drug, and Cosmetic 
Act (FD&C Act) (21 U.S.C. 387k), wherein FDA will be evaluating 
information submitted to the Agency about how consumers understand and 
perceive modified risk tobacco products (MRTPs). Section 911 of the 
FD&C Act authorizes FDA to grant orders to persons to allow the 
marketing of MRTPs. The term ``modified risk tobacco product'' means 
any tobacco product that is sold or distributed for use to reduce harm 
or the risk of tobacco-related disease associated with commercially 
marketed tobacco products. FDA can issue a risk modification order 
under section 911(g)(1) of the FD&C Act authorizing the marketing of an 
MRTP only if the Agency determines that the product, as it is used by 
consumers, will significantly reduce harm and the risk of tobacco-
related disease to individual tobacco users and benefit the health of 
the population as a whole, taking into account both users of tobacco 
products and persons who do not currently use tobacco products (section 
911(g)(1) of the FD&C Act). Alternatively, with respect to tobacco 
products that may not be commercially marketed under section 911(g)(1) 
of the FD&C Act, FDA may issue an exposure modification order under 
section 911(g)(2) of the FD&C Act authorizing the marketing of an MRTP 
if the Agency determines that the standard in section 911(g)(2) of the 
FD&C Act is met, including, among other requirements, that: Any aspect 
of the label, labeling, or advertising that would cause the product to 
be an MRTP

[[Page 54357]]

is limited to an explicit or implicit representation that the tobacco 
product or its smoke does not contain or is free of a substance or 
contains a reduced level of a substance, or presents a reduced exposure 
to a substance in tobacco smoke; the order would be appropriate to 
promote the public health; the issuance of the order is expected to 
benefit the population as a whole, taking into account both users and 
nonusers of tobacco products; and the existing evidence demonstrates 
that a measurable and substantial reduction in morbidity and mortality 
among individual tobacco users is reasonably likely to be shown in 
subsequent studies (section 911(g)(2) of the FD&C Act). In addition, 
section 911 of the FD&C Act requires that any advertising or labeling 
concerning modified risk products enable the public to comprehend the 
information concerning modified risk and to understand the relative 
significance of such information in the context of total health and in 
relation to all the diseases and health-related conditions associated 
with the use of tobacco products (section 911(h)(1) of the FD&C Act). 
The proposed research will inform the Agency's efforts to implement the 
provisions of the FD&C Act related to MRTPs.
    FDA proposes conducting a study to assist in determining 
appropriate methods for gathering information about how consumers 
perceive and understand modified risk information. The study would 
develop and validate measures of consumer perceptions of health risk 
from using tobacco products. Moreover, the study would test how 
participants' responses on these measures are affected by viewing 
modified risk labeling or advertising, participants' characteristics 
such as prior beliefs about the harmfulness of tobacco products, 
current use of tobacco products, and sociodemographic characteristics. 
Finally, the study would examine factors that may influence the 
effectiveness of debriefing at the end of a consumer perception study 
to ensure that people read and recall key information about the study. 
This research is significant because it will validate methods that can 
be used in studies of the impact of labels, labeling, and advertising 
on consumer perceptions and understanding of the risks of product use.
    Measures of consumer health risk perception will be developed and 
validated by conducting a study on two product types: Moist snuff 
smokeless tobacco products and electronic cigarette (e-cigarette) 
products. For each product type, we will assess individual-level 
factors that may moderate the impact of modified risk information on 
consumer responses. Potential moderating factors under study include: 
Beliefs (prior to viewing the modified risk information) about the 
harmfulness of tobacco products, and the strength with which those 
beliefs are held; current tobacco use behaviors; and sociodemographic 
characteristics including age and educational attainment. For each 
product type, participants will be randomized to view one of two 
conditions: Tobacco product labeling and advertising that either does 
or does not contain modified risk claims about a product. The labeling 
will consist of a product package. The advertising will consist of a 
print advertisement. The study will assess participants' perceptions of 
various health risks from using the product, as well as their 
perceptions of health risk from using the product compared to smoking 
cigarettes, using nicotine replacement therapies, and quitting all 
tobacco and nicotine products. The study will also assess participants' 
intentions to use the product and their level of doubt about whether 
tobacco products are harmful to users' health. Measures of intentions 
and doubt will be used to help assess the validity of the measures of 
health risk perception.
    In the Federal Register of May 21, 2018 (83 FR 23464), FDA 
published a 60-day notice requesting public comment on the proposed 
collection of information. FDA received four comments that were PRA 
related. Within those submissions, FDA received multiple comments which 
the Agency has addressed.
    (Comment) Three of the comments were supportive of the usefulness 
and importance of the proposed data collection. These comments stated 
that validated measures of consumers' health risk perceptions could be 
useful for FDA, researchers in the field, and industry--in particular, 
sponsors of modified risk tobacco product applications (MRTPAs). One of 
these comments expressed hope that the proposed study would be part of 
a more general effort by FDA to establish methods and standards for 
evaluating other aspects of MRTPAs.
    (Response) FDA agrees with these comments to the extent they relate 
to this study.
    (Comment) One of the comments was unsupportive of the proposed data 
collection, stating that it should not be undertaken for two reasons. 
The comment stated that the data are unneeded because U.S. consumers 
already understand the negative health effects of tobacco use and will 
not use a tobacco product if they are concerned about their health.
    (Response) The proposed data collection focuses on consumer 
perceptions of modified risk tobacco products, which are products that 
are sold or distributed for use to reduce harm or the risk of tobacco-
related diseases associated with commercially marketed tobacco 
products.
    (Comment) A comment stated that the proposed data collection should 
not be undertaken because it would waste taxpayers' money.
    (Response) FDA believes this study will provide information 
important to its implementation of The Family Smoking Prevention and 
Tobacco Control Act. FDA also notes that the study is not funded by 
taxpayers' money, but rather by industry user fees paid by regulated 
tobacco companies.
    (Comment) One comment suggested that the proposed data collection 
should be guided by a theoretical approach.
    (Response) The main objective of the data collection--developing 
and validating measures of consumer perceptions of tobacco health 
risks--is intentionally atheoretical. We intend for this aspect of the 
research to be data-driven rather than theory-driven. To accomplish 
this, we have created a large pool of risk perception items by 
aggregating items from all of the multi-item measures we could find in 
the published tobacco literature, putting them into the main categories 
of tobacco health effects that have been identified in prior health 
reviews, changing the wording of the items to put them in a common 
format, eliminating redundant or poorly worded items by consulting 
expert colleagues in medicine, epidemiology, and social science, and 
adding items to fill remaining gaps in terms of the main categories of 
tobacco health effects. When analyzing data from this proposed data 
collection, we plan to use factor analysis to identify the main 
dimensions underlying how U.S. consumers perceive tobacco product 
risks. Thus, overall, the goal of the proposed measurement development 
research is to comprehensively assess risk perceptions without 
overlaying our own preconceptions about how people may perceive these 
risks.
    (Comment) One comment stated that the findings from our proposed 
analyses of moderation effects--in particular, the moderating effects 
of prior beliefs and the certainty with which those beliefs are held--
should be considered exploratory, given that these effects are not well 
established in prior literature. Relatedly, another comment pointed out 
that the findings from these moderation

[[Page 54358]]

analyses may only apply to moist snuff smokeless tobacco and e-
cigarette products, given that these are the product types under study 
in this proposed data collection.
    (Response) FDA agrees that the findings of these analyses will be 
novel in the tobacco literature, and we plan to encourage others to 
replicate and extend our findings. However, we also note that the 
measures used in this part of the study were adapted from measures 
developed and used previously in the attitude certainty literature, and 
the hypotheses about the potential moderating effects of belief 
certainty were developed based on prior studies of attitude certainty 
(Refs. 1 and 2). Thus, there is related literature that will help us 
interpret our findings on this topic.
    (Comment) A comment encouraged FDA to consider how to account for 
participants' prior beliefs when the tobacco product under study has 
not been previously marketed in the United States and is therefore 
unknown to U.S. consumers.
    (Response) Our hypothesis would be that consumers may tend to be 
less certain about their beliefs about such unknown products, and 
therefore their beliefs about such products may be more susceptible to 
influence by modified risk information--but this is a hypothesis that 
has not been empirically tested. We agree that our findings from the 
proposed analyses of the moderating effects of prior beliefs will 
benefit from replication and extension by others.
    (Comment) One comment suggested that we should consider making four 
changes to the proposed data collection methodology. First, this 
comment suggested modifying the study design to change it from a 
between-subjects design (i.e., in which participants are randomized to 
conditions and complete a posttest) to a mixed factorial design (i.e., 
in which participants complete a pretest, are randomized to conditions, 
and then complete a posttest). The comment stated that this modified 
design, described as a pretest-posttest-control-group design, would 
allow us to control for pretest scores, which would ``explicitly 
minimize the potential threat to internal validity, namely, selection 
bias.''
    (Response) There are advantages and disadvantages to this 
alternative design type. Whereas the pretest-posttest-control-group 
design may help determine whether there is anything unusual about the 
sample that would reduce its representativeness of the target 
population (i.e., caused by biased selection), using this design would 
require participants to respond to the key measures twice within a 
short period of time. This would significantly lengthen the study, 
which is currently estimated to take approximately 20 minutes, and may 
influence how participants respond on the posttest (e.g., because of 
boredom or frustration with repetitive items, testing effects, or 
demand characteristics). Instead, we propose to use the original, 
between-subjects design and to conduct analyses to examine the 
sociodemographic and other characteristics of the sample to understand 
its representativeness of the U.S. population and to test the success 
of the randomization procedure.
    (Comment) A comment suggested that we should consider using a newly 
developed measure of participants' intentions to use tobacco products 
rather than the currently proposed intention items. The comment noted 
that the currently proposed items are based on prior research but 
stated that the new measure was developed and validated following 
procedures in FDA's (2009) guidance on patient-reported outcome 
measures.
    (Response) We appreciate this comment and support the continued 
development and validation of intention measures. However, at this 
time, we cannot use this newly developed measure because the research 
supporting its use has not yet been published in a peer-reviewed 
journal.
    (Comment) A comment suggested that this proposed data collection 
should assess many more of participants' pre-existing beliefs and 
attitudes. As examples, the comment suggested assessing participants' 
skepticism and perceived truthfulness of modified risk claims, stating 
that this would allow us to more fully capture the key constructs that 
explain why some people are more likely than others to recall and 
comprehend the claims.
    (Response) As with the recommendations above, we appreciate this 
suggestion but propose not to assess these additional constructs in 
this data collection because of concerns about participant burden. The 
proposed data collection is not intended to comprehensively assess 
influences on consumer responses to modified risk claims. Rather, it is 
intended to achieve several specific goals such as developing measures 
and testing novel potential moderators of the effects of modified risk 
information. The constructs proposed in this comment have been studied 
in prior research, as have additional constructs such as brand loyalty 
(November 19, 2014 (79 FR 68888)). Assessing such constructs may be 
informative but is not required to achieve the goals of the current 
proposed data collection.
    (Comment) To assist with this project's measurement validation 
aims, this comment recommended that the study should collect two types 
of evidence discussed in an FDA guidance on patient-reported outcome 
measures (FDA, 2009): Evidence of the measures' content validity, such 
as open-ended input from appropriate populations, and evidence of 
reliability, other aspects of validity, and sensitivity to detect 
change.
    (Response) The proposed data collection is consistent with both 
these recommendations. As described above, to achieve content validity, 
we developed our initial pool of items to be as comprehensive as 
possible, consulting multi-item measures used previously in the tobacco 
literature, literature on the objective health effects of tobacco use, 
and expert colleagues. Additionally, we cognitively tested our pool of 
items in individual, qualitative interviews with tobacco users and non-
users to evaluate their understanding of the items and beliefs about 
product risks. These interviews included open-ended questions, as 
recommended. Moreover, the proposed data collection is designed to test 
the performance of our measures on the criteria discussed in the 
comment, including internal consistency reliability, other aspects of 
validity (e.g., known groups, convergent, and discriminant validity), 
and sensitivity to detect changes (i.e., based on responsiveness to 
viewing advertisements with vs. without modified risk information). 
Other performance measures such as test-retest reliability must await 
further study.
    (Comment) Lastly, one comment requested that we clarify how the 
proposed data collection will assist in measuring consumers' 
understanding of modified risk information, in addition to their 
perceptions of health risk.
    (Response) In our conceptualization, risk perceptions are a 
component of consumer understanding, which also includes other 
components. The goal of the present study is to develop and validate 
measures of understanding insofar as this construct includes people's 
perceptions of absolute and relative health risks of using tobacco 
products.
    FDA estimates the burden of this collection of information as 
follows:

[[Page 54359]]



                                                     Table 1--Estimated Annual Reporting Burden \1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                               Number of
                 Activity                      Number of     responses per   Total annual           Average  burden per  response           Total hours
                                              respondents     respondent       responses
--------------------------------------------------------------------------------------------------------------------------------------------------------
Invitation: Young Adults (Ages 18-25).....          29,000               1          29,000  0.02 (1 minute).............................             580
Invitation: Adults (Ages 26+).............          29,000               1          29,000  0.02 (1 minute).............................             580
Consent and Screener: Young Adults (Ages            11,000               1          11,000  0.10 (6 minutes)............................           1,100
 18-25).
Consent and Screener: Adults (Ages 26+)...          16,500               1          16,500  0.10 (6 minutes)............................           1,650
Study: Young Adults (Ages 18-25)..........           3,300               1           3,300  0.33 (20 minutes)...........................           1,089
                                           -------------------------------------------------------------------------------------------------------------
Study: Adults (Ages 26+)..................           3,300               1           3,300  0.33 (20 minutes)...........................           1,089
    Total.................................  ..............  ..............  ..............  ............................................           6,088
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ There are no capital costs or operating and maintenance costs associated with this collection of information.

    FDA's burden estimate is based on prior experience with research 
that is similar to this proposed study. Approximately 58,000 people 
will receive a study invitation, estimated to take 1 minute to read 
(approximately 0.02 hour), for a total of 1,160 hours for invitations. 
Approximately 27,500 people will complete the informed consent and 
screener to determine eligibility for participation in the study, 
estimated to take 6 minutes (0.10 hour), for a total of 2,750 hours for 
informed consent and screening activities. Approximately 6,600 people 
will complete the full study, estimated to take 20 minutes 
(approximately 0.33 hour), for a total of 2,178 hours for study 
completion activities. The estimated total hour burden of the 
collection of information is 6,088 hours.

II. References

    The following references marked with an asterisk (*) are on display 
at the Dockets Management Staff (HFA-305), Food and Drug 
Administration, 5630 Fishers Lane, Rm. 1061, Rockville, MD 20852) and 
are available for viewing by interested persons between 9 a.m. and 4 
p.m., Monday through Friday; they also are available electronically at 
https://www.regulations.gov. References without asterisks are not on 
public display at https://www.regulations.gov because they have 
copyright restriction. Some may be available at the website address, if 
listed. References without asterisks are available for viewing only at 
the Dockets Management Staff. FDA has verified the website addresses, 
as of the date this document publishes in the Federal Register, but 
websites are subject to change over time.

1. Tormala, Z.L. and D.D. Rucker, ``Attitude Certainty: A Review of 
Past Findings and Emerging Perspectives.'' Social and Personality 
Psychology Compass, 1:469-492, 2007. doi:10.1111/j.1751-
9004.2007.00025.x.
2. Tormala, Z.L. and D.D. Rucker, ``Attitude Certainty: Antecedents, 
Consequences, and New Directions.'' Consumer Psychology Review, 
1:72-89, 2018. doi:10.1002/arcp.1004.*


    Dated: October 23, 2018.
Leslie Kux,
Associate Commissioner for Policy.
[FR Doc. 2018-23523 Filed 10-26-18; 8:45 am]
 BILLING CODE 4164-01-P



                                              54356                        Federal Register / Vol. 83, No. 209 / Monday, October 29, 2018 / Notices

                                              Withdrawal of approval of an                            under § 314.150(c) is without prejudice
                                              application or abbreviated application                  to refiling.

                                                 Application No.                                       Drug                                                             Applicant

                                              NDA 009165 ..........    Delatestryl (testosterone enanthate) Injection, 200 milli-              Endo Pharmaceuticals, Inc., 1400 Atwater Dr., Malvern, PA
                                                                         grams (mg)/milliliter (mL).                                             19355.
                                              NDA 010417 ..........    Xylocaine (lidocaine hydrochloride (HCl)) 4% Topical Solu-              Fresenius Kabi, USA, LLC, Three Corporate Dr., Lake Zu-
                                                                         tion/Sterile Injection.                                                 rich, IL 60047.
                                              NDA 016297 ..........    Xylocaine (1.5% lidocaine HCl with dextrose 7.5%) Spinal                Do.
                                                                         Injection, 2 mL ampules.
                                              NDA 016724 ..........    Norinyl 1+80 (mestranol and norethindrone) 21-Day Tablets,              GD Searle LLC, a subsidiary of Pfizer Inc., 235 East 42nd
                                                                         0.08 mg/1 mg.                                                           St., New York, NY 10017.
                                              NDA 016725 ..........    Norinyl 1+80 (mestranol and norethindrone) 28-Day Tablets,              Do.
                                                                         0.08 mg/1 mg.
                                              NDA 019217 ..........    Sodium Chloride 0.9% Injection USP in Plastic Container, 9              ICU Medical, Inc., 600 N. Field Dr., Lake Forest, IL 60045.
                                                                         mg/mL.
                                              NDA 019222 ..........    Dextrose 5% Injection USP in Plastic Container, 50 mg/mL                Do.
                                              NDA 203098 ..........    Testosterone Gel, 2.5 mg/1.25 grams (g), 25 mg/2.5 g, 50                Perrigo Co., U.S. Agent for Perrigo Israel Pharmaceuticals
                                                                         mg/5 g.                                                                 Ltd., 3490 Quebec Ave. North, Minneapolis, MN 55427.
                                              NDA 204031 ..........    Xartemis XR (oxycodone HCl and acetaminophen) Ex-                       Mallinckrodt Inc., 675 McDonnell Blvd., Hazelwood, MO
                                                                         tended-Release Tablets, 7.5 mg/325 mg.                                  63042.
                                              NDA 205777 ..........    Targiniq ER (naloxone HCl and oxycodone HCl) Extended-                  Purdue Pharma, LP, One Stamford Forum, Stamford, CT
                                                                         Release Tablets, 5 mg/10 mg, 10 mg/20 mg, and 20 mg/                    06901–3431.
                                                                         40 mg.



                                                 Therefore, approval of the                           announcing that a proposed collection                 generalizable scientific knowledge to
                                              applications listed in the table, and all               of information has been submitted to the              help inform its implementation of
                                              amendments and supplements thereto,                     Office of Management and Budget                       section 911 of the Federal Food, Drug,
                                              is hereby withdrawn as of November 28,                  (OMB) for review and clearance under                  and Cosmetic Act (FD&C Act) (21 U.S.C.
                                              2018. Introduction or delivery for                      the Paperwork Reduction Act of 1995.                  387k), wherein FDA will be evaluating
                                              introduction into interstate commerce of                DATES: Fax written comments on the                    information submitted to the Agency
                                              products without approved new drug                      collection of information by November                 about how consumers understand and
                                              applications violates section 301(a) and                28, 2018.                                             perceive modified risk tobacco products
                                              (d) of the Federal Food, Drug, and                      ADDRESSES: To ensure that comments on                 (MRTPs). Section 911 of the FD&C Act
                                              Cosmetic Act (21 U.S.C. 331(a) and (d)).                the information collection are received,              authorizes FDA to grant orders to
                                              Drug products that are listed in the table              OMB recommends that written                           persons to allow the marketing of
                                              that are in inventory on November 28,                   comments be faxed to the Office of                    MRTPs. The term ‘‘modified risk
                                              2018 may continue to be dispensed                       Information and Regulatory Affairs,                   tobacco product’’ means any tobacco
                                              until the inventories have been depleted                OMB, Attn: FDA Desk Officer, Fax: 202–                product that is sold or distributed for
                                              or the drug products have reached their                 395–7285, or emailed to oira_                         use to reduce harm or the risk of
                                              expiration dates or otherwise become                    submission@omb.eop.gov. All                           tobacco-related disease associated with
                                              violative, whichever occurs first.                      comments should be identified with the                commercially marketed tobacco
                                                Dated: October 23, 2018.                              OMB control number 0910–NEW and                       products. FDA can issue a risk
                                              Leslie Kux,                                             title ‘‘Investigation of Consumer                     modification order under section
                                              Associate Commissioner for Policy.
                                                                                                      Perceptions of Expressed Modified Risk                911(g)(1) of the FD&C Act authorizing
                                                                                                      Claims.’’ Also include the FDA docket                 the marketing of an MRTP only if the
                                              [FR Doc. 2018–23528 Filed 10–26–18; 8:45 am]
                                                                                                      number found in brackets in the                       Agency determines that the product, as
                                              BILLING CODE 4164–01–P
                                                                                                      heading of this document.                             it is used by consumers, will
                                                                                                      FOR FURTHER INFORMATION CONTACT:                      significantly reduce harm and the risk of
                                              DEPARTMENT OF HEALTH AND                                Amber Sanford, Office of Operations,                  tobacco-related disease to individual
                                              HUMAN SERVICES                                          Food and Drug Administration, Three                   tobacco users and benefit the health of
                                                                                                      White Flint North, 10A–12M, 11601                     the population as a whole, taking into
                                              Food and Drug Administration                            Landsdown St., North Bethesda, MD                     account both users of tobacco products
                                                                                                      20852, 301–796–8867, PRAStaff@                        and persons who do not currently use
                                              [Docket No. FDA–2018–N–0821]                            fda.hhs.gov.                                          tobacco products (section 911(g)(1) of
                                                                                                      SUPPLEMENTARY INFORMATION: In                         the FD&C Act). Alternatively, with
                                              Agency Information Collection
                                                                                                      compliance with 44 U.S.C. 3507, FDA                   respect to tobacco products that may not
                                              Activities; Submission for Office of
                                                                                                      has submitted the following proposed                  be commercially marketed under
                                              Management and Budget Review;
                                                                                                      collection of information to OMB for                  section 911(g)(1) of the FD&C Act, FDA
                                              Comment Request; Investigation of
                                                                                                      review and clearance.                                 may issue an exposure modification
                                              Consumer Perceptions of Expressed
                                                                                                                                                            order under section 911(g)(2) of the
amozie on DSK3GDR082PROD with NOTICES1




                                              Modified Risk Claims                                    Investigation of Consumer Perceptions                 FD&C Act authorizing the marketing of
                                              AGENCY:    Food and Drug Administration,                of Expressed Modified Risk Claims                     an MRTP if the Agency determines that
                                              HHS.                                                    OMB Control Number 0910—NEW                           the standard in section 911(g)(2) of the
                                              ACTION:   Notice.                                                                                             FD&C Act is met, including, among
                                                                                                      I. Background                                         other requirements, that: Any aspect of
                                              SUMMARY: The Food and Drug                                 FDA’s Center for Tobacco Products                  the label, labeling, or advertising that
                                              Administration (FDA, Agency, or we) is                  proposes to conduct a study to develop                would cause the product to be an MRTP


                                         VerDate Sep<11>2014   17:48 Oct 26, 2018   Jkt 247001   PO 00000   Frm 00049   Fmt 4703   Sfmt 4703   E:\FR\FM\29OCN1.SGM   29OCN1


                                                                           Federal Register / Vol. 83, No. 209 / Monday, October 29, 2018 / Notices                                          54357

                                              is limited to an explicit or implicit                   impact of modified risk information on                a tobacco product if they are concerned
                                              representation that the tobacco product                 consumer responses. Potential                         about their health.
                                              or its smoke does not contain or is free                moderating factors under study include:                  (Response) The proposed data
                                              of a substance or contains a reduced                    Beliefs (prior to viewing the modified                collection focuses on consumer
                                              level of a substance, or presents a                     risk information) about the harmfulness               perceptions of modified risk tobacco
                                              reduced exposure to a substance in                      of tobacco products, and the strength                 products, which are products that are
                                              tobacco smoke; the order would be                       with which those beliefs are held;                    sold or distributed for use to reduce
                                              appropriate to promote the public                       current tobacco use behaviors; and                    harm or the risk of tobacco-related
                                              health; the issuance of the order is                    sociodemographic characteristics                      diseases associated with commercially
                                              expected to benefit the population as a                 including age and educational                         marketed tobacco products.
                                              whole, taking into account both users                   attainment. For each product type,                       (Comment) A comment stated that the
                                              and nonusers of tobacco products; and                   participants will be randomized to view               proposed data collection should not be
                                              the existing evidence demonstrates that                 one of two conditions: Tobacco product                undertaken because it would waste
                                              a measurable and substantial reduction                  labeling and advertising that either does             taxpayers’ money.
                                              in morbidity and mortality among                        or does not contain modified risk claims                 (Response) FDA believes this study
                                              individual tobacco users is reasonably                  about a product. The labeling will                    will provide information important to
                                              likely to be shown in subsequent studies                consist of a product package. The                     its implementation of The Family
                                              (section 911(g)(2) of the FD&C Act). In                 advertising will consist of a print                   Smoking Prevention and Tobacco
                                              addition, section 911 of the FD&C Act                   advertisement. The study will assess                  Control Act. FDA also notes that the
                                              requires that any advertising or labeling               participants’ perceptions of various                  study is not funded by taxpayers’
                                              concerning modified risk products                       health risks from using the product, as               money, but rather by industry user fees
                                              enable the public to comprehend the                     well as their perceptions of health risk              paid by regulated tobacco companies.
                                              information concerning modified risk                                                                             (Comment) One comment suggested
                                                                                                      from using the product compared to
                                              and to understand the relative                                                                                that the proposed data collection should
                                                                                                      smoking cigarettes, using nicotine
                                              significance of such information in the                                                                       be guided by a theoretical approach.
                                                                                                      replacement therapies, and quitting all                  (Response) The main objective of the
                                              context of total health and in relation to              tobacco and nicotine products. The
                                              all the diseases and health-related                                                                           data collection—developing and
                                                                                                      study will also assess participants’                  validating measures of consumer
                                              conditions associated with the use of                   intentions to use the product and their
                                              tobacco products (section 911(h)(1) of                                                                        perceptions of tobacco health risks—is
                                                                                                      level of doubt about whether tobacco                  intentionally atheoretical. We intend for
                                              the FD&C Act). The proposed research                    products are harmful to users’ health.
                                              will inform the Agency’s efforts to                                                                           this aspect of the research to be data-
                                                                                                      Measures of intentions and doubt will                 driven rather than theory-driven. To
                                              implement the provisions of the FD&C                    be used to help assess the validity of the
                                              Act related to MRTPs.                                                                                         accomplish this, we have created a large
                                                                                                      measures of health risk perception.                   pool of risk perception items by
                                                 FDA proposes conducting a study to                      In the Federal Register of May 21,
                                              assist in determining appropriate                                                                             aggregating items from all of the multi-
                                                                                                      2018 (83 FR 23464), FDA published a                   item measures we could find in the
                                              methods for gathering information about
                                                                                                      60-day notice requesting public                       published tobacco literature, putting
                                              how consumers perceive and
                                                                                                      comment on the proposed collection of                 them into the main categories of tobacco
                                              understand modified risk information.
                                                                                                      information. FDA received four                        health effects that have been identified
                                              The study would develop and validate
                                                                                                      comments that were PRA related.                       in prior health reviews, changing the
                                              measures of consumer perceptions of
                                                                                                      Within those submissions, FDA                         wording of the items to put them in a
                                              health risk from using tobacco products.
                                                                                                      received multiple comments which the                  common format, eliminating redundant
                                              Moreover, the study would test how
                                                                                                      Agency has addressed.                                 or poorly worded items by consulting
                                              participants’ responses on these
                                              measures are affected by viewing                           (Comment) Three of the comments                    expert colleagues in medicine,
                                              modified risk labeling or advertising,                  were supportive of the usefulness and                 epidemiology, and social science, and
                                              participants’ characteristics such as                   importance of the proposed data                       adding items to fill remaining gaps in
                                              prior beliefs about the harmfulness of                  collection. These comments stated that                terms of the main categories of tobacco
                                              tobacco products, current use of tobacco                validated measures of consumers’ health               health effects. When analyzing data
                                              products, and sociodemographic                          risk perceptions could be useful for                  from this proposed data collection, we
                                              characteristics. Finally, the study would               FDA, researchers in the field, and                    plan to use factor analysis to identify
                                              examine factors that may influence the                  industry—in particular, sponsors of                   the main dimensions underlying how
                                              effectiveness of debriefing at the end of               modified risk tobacco product                         U.S. consumers perceive tobacco
                                              a consumer perception study to ensure                   applications (MRTPAs). One of these                   product risks. Thus, overall, the goal of
                                              that people read and recall key                         comments expressed hope that the                      the proposed measurement
                                              information about the study. This                       proposed study would be part of a more                development research is to
                                              research is significant because it will                 general effort by FDA to establish                    comprehensively assess risk perceptions
                                              validate methods that can be used in                    methods and standards for evaluating                  without overlaying our own
                                              studies of the impact of labels, labeling,              other aspects of MRTPAs.                              preconceptions about how people may
                                              and advertising on consumer                                (Response) FDA agrees with these                   perceive these risks.
                                              perceptions and understanding of the                    comments to the extent they relate to                    (Comment) One comment stated that
                                              risks of product use.                                   this study.                                           the findings from our proposed analyses
                                                 Measures of consumer health risk                        (Comment) One of the comments was                  of moderation effects—in particular, the
amozie on DSK3GDR082PROD with NOTICES1




                                              perception will be developed and                        unsupportive of the proposed data                     moderating effects of prior beliefs and
                                              validated by conducting a study on two                  collection, stating that it should not be             the certainty with which those beliefs
                                              product types: Moist snuff smokeless                    undertaken for two reasons. The                       are held—should be considered
                                              tobacco products and electronic                         comment stated that the data are                      exploratory, given that these effects are
                                              cigarette (e-cigarette) products. For each              unneeded because U.S. consumers                       not well established in prior literature.
                                              product type, we will assess individual-                already understand the negative health                Relatedly, another comment pointed out
                                              level factors that may moderate the                     effects of tobacco use and will not use               that the findings from these moderation


                                         VerDate Sep<11>2014   17:48 Oct 26, 2018   Jkt 247001   PO 00000   Frm 00050   Fmt 4703   Sfmt 4703   E:\FR\FM\29OCN1.SGM   29OCN1


                                              54358                        Federal Register / Vol. 83, No. 209 / Monday, October 29, 2018 / Notices

                                              analyses may only apply to moist snuff                  selection), using this design would                   brand loyalty (November 19, 2014 (79
                                              smokeless tobacco and e-cigarette                       require participants to respond to the                FR 68888)). Assessing such constructs
                                              products, given that these are the                      key measures twice within a short                     may be informative but is not required
                                              product types under study in this                       period of time. This would significantly              to achieve the goals of the current
                                              proposed data collection.                               lengthen the study, which is currently                proposed data collection.
                                                 (Response) FDA agrees that the                       estimated to take approximately 20                       (Comment) To assist with this
                                              findings of these analyses will be novel                minutes, and may influence how                        project’s measurement validation aims,
                                              in the tobacco literature, and we plan to               participants respond on the posttest                  this comment recommended that the
                                              encourage others to replicate and extend                (e.g., because of boredom or frustration              study should collect two types of
                                              our findings. However, we also note that                with repetitive items, testing effects, or            evidence discussed in an FDA guidance
                                              the measures used in this part of the                   demand characteristics). Instead, we                  on patient-reported outcome measures
                                              study were adapted from measures                        propose to use the original, between-                 (FDA, 2009): Evidence of the measures’
                                              developed and used previously in the                    subjects design and to conduct analyses               content validity, such as open-ended
                                              attitude certainty literature, and the                  to examine the sociodemographic and                   input from appropriate populations, and
                                              hypotheses about the potential                          other characteristics of the sample to                evidence of reliability, other aspects of
                                              moderating effects of belief certainty                  understand its representativeness of the              validity, and sensitivity to detect
                                              were developed based on prior studies                   U.S. population and to test the success               change.
                                              of attitude certainty (Refs. 1 and 2).                  of the randomization procedure.                          (Response) The proposed data
                                              Thus, there is related literature that will                (Comment) A comment suggested that                 collection is consistent with both these
                                              help us interpret our findings on this                  we should consider using a newly                      recommendations. As described above,
                                              topic.                                                  developed measure of participants’                    to achieve content validity, we
                                                 (Comment) A comment encouraged                       intentions to use tobacco products                    developed our initial pool of items to be
                                              FDA to consider how to account for                      rather than the currently proposed                    as comprehensive as possible,
                                              participants’ prior beliefs when the                    intention items. The comment noted                    consulting multi-item measures used
                                              tobacco product under study has not                     that the currently proposed items are                 previously in the tobacco literature,
                                              been previously marketed in the United                  based on prior research but stated that               literature on the objective health effects
                                              States and is therefore unknown to U.S.                 the new measure was developed and                     of tobacco use, and expert colleagues.
                                              consumers.                                              validated following procedures in FDA’s               Additionally, we cognitively tested our
                                                 (Response) Our hypothesis would be                   (2009) guidance on patient-reported                   pool of items in individual, qualitative
                                              that consumers may tend to be less                      outcome measures.                                     interviews with tobacco users and non-
                                              certain about their beliefs about such                     (Response) We appreciate this                      users to evaluate their understanding of
                                              unknown products, and therefore their                   comment and support the continued                     the items and beliefs about product
                                              beliefs about such products may be                      development and validation of intention               risks. These interviews included open-
                                              more susceptible to influence by                        measures. However, at this time, we                   ended questions, as recommended.
                                              modified risk information—but this is a                 cannot use this newly developed                       Moreover, the proposed data collection
                                              hypothesis that has not been empirically                measure because the research                          is designed to test the performance of
                                              tested. We agree that our findings from                 supporting its use has not yet been                   our measures on the criteria discussed
                                              the proposed analyses of the moderating                 published in a peer-reviewed journal.                 in the comment, including internal
                                              effects of prior beliefs will benefit from                 (Comment) A comment suggested that
                                                                                                                                                            consistency reliability, other aspects of
                                              replication and extension by others.                    this proposed data collection should
                                                                                                                                                            validity (e.g., known groups,
                                                 (Comment) One comment suggested                      assess many more of participants’ pre-
                                                                                                                                                            convergent, and discriminant validity),
                                              that we should consider making four                     existing beliefs and attitudes. As
                                                                                                                                                            and sensitivity to detect changes (i.e.,
                                              changes to the proposed data collection                 examples, the comment suggested
                                                                                                                                                            based on responsiveness to viewing
                                              methodology. First, this comment                        assessing participants’ skepticism and
                                                                                                                                                            advertisements with vs. without
                                              suggested modifying the study design to                 perceived truthfulness of modified risk
                                                                                                                                                            modified risk information). Other
                                              change it from a between-subjects                       claims, stating that this would allow us
                                                                                                                                                            performance measures such as test-
                                              design (i.e., in which participants are                 to more fully capture the key constructs
                                                                                                                                                            retest reliability must await further
                                              randomized to conditions and complete                   that explain why some people are more
                                                                                                                                                            study.
                                              a posttest) to a mixed factorial design                 likely than others to recall and
                                              (i.e., in which participants complete a                 comprehend the claims.                                   (Comment) Lastly, one comment
                                              pretest, are randomized to conditions,                     (Response) As with the                             requested that we clarify how the
                                              and then complete a posttest). The                      recommendations above, we appreciate                  proposed data collection will assist in
                                              comment stated that this modified                       this suggestion but propose not to assess             measuring consumers’ understanding of
                                              design, described as a pretest-posttest-                these additional constructs in this data              modified risk information, in addition
                                              control-group design, would allow us to                 collection because of concerns about                  to their perceptions of health risk.
                                              control for pretest scores, which would                 participant burden. The proposed data                    (Response) In our conceptualization,
                                              ‘‘explicitly minimize the potential threat              collection is not intended to                         risk perceptions are a component of
                                              to internal validity, namely, selection                 comprehensively assess influences on                  consumer understanding, which also
                                              bias.’’                                                 consumer responses to modified risk                   includes other components. The goal of
                                                 (Response) There are advantages and                  claims. Rather, it is intended to achieve             the present study is to develop and
                                              disadvantages to this alternative design                several specific goals such as                        validate measures of understanding
                                                                                                                                                            insofar as this construct includes
amozie on DSK3GDR082PROD with NOTICES1




                                              type. Whereas the pretest-posttest-                     developing measures and testing novel
                                              control-group design may help                           potential moderators of the effects of                people’s perceptions of absolute and
                                              determine whether there is anything                     modified risk information. The                        relative health risks of using tobacco
                                              unusual about the sample that would                     constructs proposed in this comment                   products.
                                              reduce its representativeness of the                    have been studied in prior research, as                  FDA estimates the burden of this
                                              target population (i.e., caused by biased               have additional constructs such as                    collection of information as follows:




                                         VerDate Sep<11>2014   17:48 Oct 26, 2018   Jkt 247001   PO 00000   Frm 00051   Fmt 4703   Sfmt 4703   E:\FR\FM\29OCN1.SGM   29OCN1


                                                                                   Federal Register / Vol. 83, No. 209 / Monday, October 29, 2018 / Notices                                                                                               54359

                                                                                                          TABLE 1—ESTIMATED ANNUAL REPORTING BURDEN 1
                                                                                                                                                      Number of                                                         Average
                                                                                                                            Number of                                            Total annual
                                                                            Activity                                                                responses per                                                     burden per                      Total hours
                                                                                                                           respondents                                            responses
                                                                                                                                                      respondent                                                       response

                                              Invitation: Young Adults (Ages 18–25) ...............                                  29,000                              1                   29,000        0.02 (1 minute) ..............                      580
                                              Invitation: Adults (Ages 26+) ...............................                          29,000                              1                   29,000        0.02 (1 minute) ..............                      580
                                              Consent and Screener: Young Adults (Ages 18–                                           11,000                              1                   11,000        0.10 (6 minutes) .............                    1,100
                                                25).
                                              Consent and Screener: Adults (Ages 26+) .........                                      16,500                              1                   16,500        0.10 (6 minutes) .............                    1,650
                                              Study: Young Adults (Ages 18–25) .....................                                  3,300                              1                    3,300        0.33 (20 minutes) ...........                     1,089

                                              Study: Adults (Ages 26+) ....................................                             3,300                             1                    3,300       0.33 (20 minutes) ...........                     1,089
                                                  Total .............................................................    ........................   ........................    ........................   ........................................          6,088
                                                 1 There    are no capital costs or operating and maintenance costs associated with this collection of information.


                                                 FDA’s burden estimate is based on                                           and New Directions.’’ Consumer                                         AdvisoryCommittees/AboutAdvisory
                                              prior experience with research that is                                         Psychology Review, 1:72–89, 2018.                                      Committees/ucm408555.htm.
                                              similar to this proposed study.                                                doi:10.1002/arcp.1004.*
                                                                                                                                                                                                    FOR FURTHER INFORMATION CONTACT:
                                              Approximately 58,000 people will                                            Dated: October 23, 2018.                                                  Patricio Garcia, Center for Devices and
                                              receive a study invitation, estimated to                                                                                                              Radiological Health, Food and Drug
                                                                                                                        Leslie Kux,
                                              take 1 minute to read (approximately                                                                                                                  Administration, 10903 New Hampshire
                                              0.02 hour), for a total of 1,160 hours for                                Associate Commissioner for Policy.
                                                                                                                                                                                                    Ave., Bldg. 66, Rm. G610, Silver Spring,
                                              invitations. Approximately 27,500                                         [FR Doc. 2018–23523 Filed 10–26–18; 8:45 am]
                                                                                                                                                                                                    MD 20993–0002, patricio.garcia@
                                              people will complete the informed                                         BILLING CODE 4164–01–P
                                                                                                                                                                                                    fda.hhs.gov, 301–796–6875, or FDA
                                              consent and screener to determine                                                                                                                     Advisory Committee Information Line,
                                              eligibility for participation in the study,                                                                                                           1–800–741–8138 (301–443–0572 in the
                                              estimated to take 6 minutes (0.10 hour),                                  DEPARTMENT OF HEALTH AND
                                                                                                                                                                                                    Washington, DC area). A notice in the
                                              for a total of 2,750 hours for informed                                   HUMAN SERVICES
                                                                                                                                                                                                    Federal Register about last minute
                                              consent and screening activities.                                         Food and Drug Administration                                                modifications that impact a previously
                                              Approximately 6,600 people will                                                                                                                       announced advisory committee meeting
                                              complete the full study, estimated to                                     [Docket No. FDA–2018–N–1726]                                                cannot always be published quickly
                                              take 20 minutes (approximately 0.33                                                                                                                   enough to provide timely notice.
                                              hour), for a total of 2,178 hours for study                               Circulatory System Devices Panel of
                                                                                                                                                                                                    Therefore, you should always check the
                                              completion activities. The estimated                                      the Medical Devices Advisory
                                                                                                                                                                                                    Agency’s website at https://
                                              total hour burden of the collection of                                    Committee; Notice of Meeting
                                                                                                                                                                                                    www.fda.gov/AdvisoryCommittees/
                                              information is 6,088 hours.                                               AGENCY:       Food and Drug Administration,                                 default.htm and scroll down to the
                                              II. References                                                            HHS.                                                                        appropriate advisory committee meeting
                                                                                                                        ACTION:      Notice.                                                        link, or call the advisory committee
                                                 The following references marked with                                                                                                               information line to learn about possible
                                              an asterisk (*) are on display at the                                     SUMMARY:   The Food and Drug                                                modifications before coming to the
                                              Dockets Management Staff (HFA–305),                                       Administration (FDA) announces a                                            meeting.
                                              Food and Drug Administration, 5630                                        forthcoming public advisory committee
                                              Fishers Lane, Rm. 1061, Rockville, MD                                                                                                                 SUPPLEMENTARY INFORMATION:
                                                                                                                        meeting of the Circulatory System                                             Agenda: On December 4, 2018, the
                                              20852) and are available for viewing by                                   Devices Panel of the Medical Devices
                                              interested persons between 9 a.m. and 4                                                                                                               committee will discuss, make
                                                                                                                        Advisory Committee. The general                                             recommendations, and vote on
                                              p.m., Monday through Friday; they also                                    function of the committee is to provide
                                              are available electronically at https://                                                                                                              information regarding the premarket
                                                                                                                        advice and recommendations to the                                           application (PMA) for the OPTIMIZER
                                              www.regulations.gov. References                                           Agency on FDA’s regulatory issues. The
                                              without asterisks are not on public                                                                                                                   SMART Implantable Pulse Generator
                                                                                                                        meeting will be open to the public.                                         device, sponsored by Impulse Dynamics
                                              display at https://www.regulations.gov                                    DATES: The meeting will be held on
                                              because they have copyright restriction.                                                                                                              (USA), Inc. This first-of-a-kind device is
                                                                                                                        December 4 and 5, 2018, from 8 a.m. to                                      indicated to provide cardiac
                                              Some may be available at the website                                      6 p.m.
                                              address, if listed. References without                                                                                                                contractility modulation for class III
                                                                                                                        ADDRESSES: Hilton Washington DC                                             heart failure patients who are not
                                              asterisks are available for viewing only
                                              at the Dockets Management Staff. FDA                                      North/Gaithersburg, Salons A, B, C, and                                     responding to optimal medical therapy.
                                              has verified the website addresses, as of                                 D, 620 Perry Pkwy., Gaithersburg, MD                                          On December 5, 2018, the committee
                                              the date this document publishes in the                                   20877. The hotel telephone number is                                        will discuss and make
                                              Federal Register, but websites are                                        301–977–8900; additional information                                        recommendations regarding issues
                                              subject to change over time.                                              available online at: https://                                               relating to the emergence of medical
                                                                                                                        www3.hilton.com/en/hotels/maryland/                                         devices, which aim to treat
amozie on DSK3GDR082PROD with NOTICES1




                                              1. Tormala, Z.L. and D.D. Rucker, ‘‘Attitude                              hilton-washington-dc-north-                                                 hypertension. Currently, clinical studies
                                                  Certainty: A Review of Past Findings and                              gaithersburg-GAIGHHF/index.html.                                            to evaluate the safety and effectiveness
                                                  Emerging Perspectives.’’ Social and
                                                  Personality Psychology Compass, 1:469–
                                                                                                                        Answers to commonly asked questions                                         of these devices are progressing. FDA
                                                  492, 2007. doi:10.1111/j.1751–                                        including information regarding special                                     requests panel input regarding the
                                                  9004.2007.00025.x.                                                    accommodations due to a disability,                                         potential indications and labeling for
                                              2. Tormala, Z.L. and D.D. Rucker, ‘‘Attitude                              visitor parking, and transportation may                                     devices intended to treat hypertension
                                                  Certainty: Antecedents, Consequences,                                 be accessed at: https://www.fda.gov/                                        and optimal study designs needed to


                                         VerDate Sep<11>2014        17:48 Oct 26, 2018       Jkt 247001      PO 00000        Frm 00052        Fmt 4703       Sfmt 4703         E:\FR\FM\29OCN1.SGM              29OCN1



Document Created: 2018-10-27 01:10:11
Document Modified: 2018-10-27 01:10:11
CategoryRegulatory Information
CollectionFederal Register
sudoc ClassAE 2.7:
GS 4.107:
AE 2.106:
PublisherOffice of the Federal Register, National Archives and Records Administration
SectionNotices
ActionNotice.
DatesFax written comments on the collection of information by November 28, 2018.
ContactAmber Sanford, Office of Operations, Food and Drug Administration, Three White Flint North, 10A-12M, 11601 Landsdown St., North Bethesda, MD 20852, 301-796-8867, [email protected]
FR Citation83 FR 54356 

2025 Federal Register | Disclaimer | Privacy Policy
USC | CFR | eCFR