Latent Classes of Nicotine Beliefs Correlate with Perceived Susceptibility and Severity of Nicotine and Tobacco Products in US Young Adults

Abstract

Background Pervasive misperceptions about nicotine may influence uptake of quit smoking aids and the impact of policies addressing nicotine as a tobacco product constituent. Methods Latent class analyses were conducted using four items on nicotine beliefs asked of 4037 adults aged 18–40 in wave 9 (February–March 2016) of the Truth Initiative Young Adult Cohort Study. Confirmatory factor analyses identified three factors from 12 items: nicotine susceptibility (NSUS), nicotine severity (NSEV), and tobacco severity (TSEV). Analyses assessed correlations between latent classes, sociodemographics, and nicotine/tobacco factor scores. Results A four-class model of nicotine beliefs was the best fit, with the largest class believing that nicotine plays a major part in smoking risks (class 1, n = 2070; 52%). Class 2 shared that belief but also responded “Don’t know” to addiction questions (class 2, n = 382; 11%). Fewer belonged in class 3, who reported that nicotine plays a small part in health risks (n = 1277; 30%), and class 4, who perceived nicotine as not cancer causing (n = 308; 7%). Latent class membership was correlated with sociodemographics, peer smoking, and past 30-day tobacco use. Classes 1 and 2 had similar NSUS scores and classes 3 and 4 had similar NSEV and TSEV scores. Discussion Differences in the perceptions of nicotine and tobacco-related harms can be partially explained by clustering of underlying nicotine beliefs. These classes of beliefs are correlated with sociodemographic predictors of smoking. These findings may help to identify specific beliefs or groups to be targeted by public education efforts on nicotine. Implications The current study supports that underlying nicotine beliefs are associated with perceived harms of specific nicotine and tobacco products (relative to cigarettes), with greater false beliefs about nicotine correlated with greater perceived susceptibility to nicotine addiction. Two important inferences emerge from this study: first, that education to address nicotine beliefs may also reframe perceptions of the harms of nicotine and tobacco products; and second, that this type of education may differentially impact perceptions of the harms of nicotine products (e.g., nicotine replacement therapy and e-cigarettes) and tobacco products (e.g., cigars, smokeless, and hookah).

Prospective associations between nicotine beliefs and tobacco-related susceptibility, curiosity, and use in U.S. adults

“…Four items addressing nicotine beliefs at Wave 9 were included in latent class models; detail on these analyses have been published elsewhere (Villanti et al, 2019a). Three items assessed nicotine's role in causing disease (i.e., "Nicotine is a cause of cancer"; "According to you, how large a part of the health risks of cigarette smoking comes from the nicotine itself?…”

“…Our previous work in U.S. adults aged 18-40 identified that people cluster into four latent classes based on their beliefs about nicotine: those who believe that nicotine causes cancer and plays a large part in smoking risks (Class 1); those who share the belief about nicotine's large part in causing smoking health harms, but were differentiated from Class 1 by "don't know" responses to nicotine's addictiveness and role in cancer (Class 2); those who believe that nicotine plays no role or a small part in health risks (Class 3); and those who believe that nicotine plays no role or a small part in health risks and that none or a very small part of cancer is caused by nicotine (Class 4; Villanti et al, 2019a). The goal of the current study was to examine whether these latent classes were associated with susceptibility and curiosity to use tobacco and tobacco use behavior.…”

Nicotine Standards in the United States

“…These beliefs are associated with perceived harm of nicotine and tobacco products and correlated with sociodemographic predictors of smoking. 20 These findings may help us to identify specific beliefs or groups to be targeted by public education efforts on nicotine.…”

“…These authors recommend key elements of public education efforts to correct misperceptions of nicotine in order to maximize the potential benefits of a nicotine reduction standard. An empirical analysis 20 models latent classes of nicotine beliefs among US young adults and identifies four classes of beliefs, with the largest class believing that nicotine plays a major role in smoking risk. These beliefs are associated with perceived harm of nicotine and tobacco products and correlated with sociodemographic predictors of smoking.…”

Misperceptions of Nicotine and Nicotine Reduction: The Importance of Public Education to Maximize the Benefits of a Nicotine Reduction Standard

“…4,5 There are strong correlations between nicotine beliefs and the perceived harms of nicotine and tobacco products. 6 Given these common misperceptions about nicotine, a low nicotine product standard has potential to further confuse consumers about tobacco product risks in the absence of public education efforts.…”