‘It brings light to what you really put into your body’: a focus group study of reactions to messages about nicotine reduction in cigarettes

Duong, Hue Trong; Loud, Emily E.; Thrasher, James F.; Henderson, Katherine; Ashley, David L.; Popova, Lucy

doi:10.1136/tobaccocontrol-2020-056312

Cited by 15 publications

(9 citation statements)

References 37 publications

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“…Achieving accurate perceptions may require messages that both communicate about the intent of reducing nicotine (to reduce addictiveness) and the harm caused by smoking regardless of nicotine content (harm misperceptions) ( Popova et al., 2019 ). A recent focus group study found that people who smoke are receptive to messages about low nicotine cigarettes increasing quitting efficacy and messages about low nicotine cigarettes being equally as harmful traditional cigarettes ( Duong et al., 2021 ). Among participants who used to smoke or who have never smoked, however, there were concerns about the messages downplaying smoking risks and potentially inspiring initiation and relapse.…”

Section: Resultsmentioning

confidence: 99%

A review of the evidence on cigarettes with reduced addictiveness potential

Donny

White

2022

International Journal of Drug Policy

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Background In May 2018, the Secretariat for the World Health Organization Framework Convention on Tobacco Control convened a meeting to discuss the potential for reducing the addictiveness of tobacco products. A central focus was to review research findings on the behavioral effects of reducing the addictiveness of cigarettes. Methods This manuscript reports the results of a review of the behavioral science literature, updated through April 2021, with special attention to both the potential benefits and unintended consequences of reducing nicotine in cigarettes. Results Available evidence suggests that reducing nicotine content in cigarettes to very low levels could benefit public health in three primary ways, by 1) decreasing uptake of regular smoking, 2) decreasing the amount people smoke, and 3) increasing the likelihood of smoking cessation. Current evidence also suggests that reducing nicotine in cigarettes may produce similar benefits across many important subpopulations of people who smoke, including those with psychiatric comorbidities, those who use other substances, those with low socioeconomic status, young people, people who smoke infrequently and people who prefer menthol cigarettes. Cigarette nicotine reduction could also lead to some undesirable outcomes, such as experiencing withdrawal, product manipulation, an illicit market, and harm misperceptions; strategies that may mitigate each are discussed. Conclusion Overall, behavioral research suggests product standards that limit the nicotine content of combusted tobacco products could render cigarettes and similar products less addictive. The availability of legal, non-combusted products that effectively substitute for cigarettes and the dissemination of public health campaigns that clarify misperceptions about the relationship between nicotine, tobacco and disease may facilitate the extent to which a nicotine reduction policy reduces smoking.

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Section: Resultsmentioning

confidence: 99%

A review of the evidence on cigarettes with reduced addictiveness potential

Donny

White

2022

International Journal of Drug Policy

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“… 43 Recent research indicates the need for absolute and comparative risk communication around nicotine and nicotine-containing products to be well-designed, evidence-based and preferably tailored to a specific target audience (eg, smokers) to avoid unintended consequences such as uptake among non-smokers. 44–46 Pack inserts may be an efficient and effective way to educate smokers about the health harms of nicotine-containing products such as NRT. 47 Offering a trial of NRT to all smokers including those who are reluctant to use NRT may help dispel any safety concerns they may have about NRT.…”

Section: Discussionmentioning

confidence: 99%

Do Smokers’ Perceptions of the Harmfulness of Nicotine Replacement Therapy and Nicotine Vaping Products as Compared to Cigarettes Influence Their Use as an Aid for Smoking Cessation? Findings from the ITC Four Country Smoking and Vaping Surveys

Yong

Gravely

Borland

et al. 2022

Nicotine &Amp; Tobacco Research

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Aim This study examined whether smokers’ harm perceptions of nicotine replacement therapy (NRT) and nicotine vaping products (NVPs) relative to cigarettes predicted their subsequent use as smoking cessation aids during their last quit attempt (LQA). Methods We analyzed data from 1,315 current daily smokers (10+ cigarettes per day) who were recruited at Wave 1 (2016), and who reported making a quit attempt by Wave 2 (2018) of the International Tobacco Control Four Country Smoking and Vaping Surveys in Australia, Canada, England, and the US. We used multinomial logistic regression models to examine prospective associations between harm perceptions of a) NRT and b) NVPs and their use at LQA, controlling for socio-demographic and other potential confounders. Results Smokers who perceive that a) NRT and b) NVPs are much less harmful than cigarettes were more likely to subsequently use the respective product as an aid than using no aid or other aids during LQA (adjusted relative risk ratio [aRRR]=3.79, 95%CI=2.16-6.66; and aRRR=2.11, 95%CI=1.29-3.45, respectively) compared to smokers who perceive these products as equally or more harmful. Additionally, those who perceive NVPs as much less harmful than cigarettes were less likely to use NRT as a quit aid (aRRR=0.34, 95%CI=0.20-0.60). No country variations for these associations were found. Conclusion This study found that smokers’ perceptions of the harmfulness of a) NRT and b) NVPs relative to cigarettes predicted the respective product use when trying to quit smoking. Corrective education targeting misperceptions of nicotine products’ relative harmfulness may facilitate their use for smoking cessation. IMPLICATIONS What this study adds:Nicotine replacement therapy and nicotine vaping products are two commonly used smoking cessation aids. This study demonstrates that misperceptions of the harms of nicotine products relative to cigarettes influence their use for smoking cessation. Believing that nicotine vaping products are much less harmful than cigarette smoking may lead some smokers to prefer these products over nicotine replacement therapy to aid smoking cessation. Education targeting misperceptions of nicotine products’ harmfulness relative to cigarettes may enable smokers to make informed choices about which are appropriate to aid smoking cessation.

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“…Despite different core themes, all messages provided general information about the FDA policy, including that the nicotine content of all cigarettes would be reduced. Message reactions are reported elsewhere [27]; in this paper we include only the discussion concerning nicotine and addiction that participants raised in response to the messages.…”

Section: Methodsmentioning

confidence: 99%

Addicted to smoking or addicted to nicotine? A focus group study on perceptions of nicotine and addiction among US adult current smokers, former smokers, non‐smokers and dual users of cigarettes and e‐cigarettes

et al. 2021

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Background and Aims In 2017, the US Food and Drug Administration (FDA) proposed to reduce nicotine in cigarettes to minimally or non‐addictive levels. This study qualitatively explored perceptions of nicotine and addiction, both independently and in response to messages communicating about nicotine reduction. Design Qualitative study using focus groups. Participants described their perceptions of nicotine and addiction and their responses to messages about the nicotine reduction. Setting Atlanta, GA and San Francisco, CA, USA. Semi‐structured focus groups were conducted virtually in Spring 2020. Participants Exclusive smokers (n = 27), dual users (of cigarettes and electronic cigarettes) (n = 25), former smokers (n = 32) and young adult non‐smokers (n = 31). Measurement Inductive thematic analysis of transcripts was conducted, and results were compared across smoking status groups. Findings Participants across all smoking status groups associated nicotine with tobacco products, but consistently misperceived that nicotine caused disease. Perceptions of addiction were largely negative and varied by smoking status. Experienced smokers (exclusive smokers, former smokers and dual users) differentiated tobacco use from other addictions and minimized their own experiences of addiction. Perceptions of addiction across experienced smokers included not only the chemical properties of nicotine, but also the behavioral aspects of tobacco use, including oral fixation, having a smoking routine and response to internal and external cues. In response to messages, many believed that removing the nicotine would not make cigarettes less addictive because of the multi‐factorial nature of smoking addiction that includes non‐pharmacological cues. Conclusions Perceptions of nicotine and addiction among non‐smokers, former smokers, exclusive smokers and dual users of cigarettes and e‐cigarettes vary based on smoking status, but there is a common tendency to believe that nicotine is addictive, that addiction results from more than just nicotine, and that very low nicotine cigarettes will not necessarily reduce the addictiveness of cigarettes.

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‘It brings light to what you really put into your body’: a focus group study of reactions to messages about nicotine reduction in cigarettes

Cited by 15 publications

References 37 publications

A review of the evidence on cigarettes with reduced addictiveness potential

A review of the evidence on cigarettes with reduced addictiveness potential

Do Smokers’ Perceptions of the Harmfulness of Nicotine Replacement Therapy and Nicotine Vaping Products as Compared to Cigarettes Influence Their Use as an Aid for Smoking Cessation? Findings from the ITC Four Country Smoking and Vaping Surveys

Addicted to smoking or addicted to nicotine? A focus group study on perceptions of nicotine and addiction among US adult current smokers, former smokers, non‐smokers and dual users of cigarettes and e‐cigarettes

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