“My First Thought was Croutons”: Perceptions of Cigarettes and Cigarette Smoke Constituents Among Adult Smokers and Nonsmokers

Abstract

Introduction: Understanding what people think about harmful and potentially harmful constituents in cigarettes and cigarette smoke has new urgency given legislation requiring US Food and Drug Administration (FDA) to disclose constituent information. Our study sought to obtain qualitative information on what people think about these constituents and the language they use to talk about them. Methods: We conducted six focus groups in 2014 with 40 adults in North Carolina. Open-ended questions focused on cigarette and cigarette smoke constituents in general and on the 18 constituents on the FDA's abbreviated list. We coded the transcripts for emergent themes, and all four coders discussed themes until we reached consensus. Results: Participants knew that cigarette smoke contains chemicals but did not know how many chemicals nor what those chemicals are, beyond tar and nicotine. Dangers of constituents mentioned included "chemicals, " physical disease, and addiction. Participants incorrectly believed harmful constituents came primarily from tobacco companies' additives. For unfamiliar constituents, people tried to make associations based on similar-sounding words. Recognizable constituents that participants associated with health harms most discouraged them from wanting to smoke. Most participants wanted to know health harms associated with constituents and what else the chemicals were in. Conclusions: Participants showed enthusiasm for learning more information about constituents, and also showed substantial misunderstandings about the source of harmful constituents. Our findings contribute to the limited body of research on adults' knowledge and perceptions of cigarette smoke constituents and can aid the FDA as it plans to disclose constituent information to the public. Implications: Our study provides information about adults' understanding of cigarette smoke constituents and what adults would like to know about these constituents. This information can help communication campaigns describe cigarette smoke constituents in a way that discourages people from wanting to smoke.

Public understanding of cigarette smoke constituents: three US surveys

“…It could also be that endings that sounded like ‘ide’ benefit from associations with highly discouraging constituent names like formaldehyde. This insight follows from some of our previous qualitative research, indicating that unfamiliar constituents lead people to find similar sounding words to establish meaning 20. These speculations on the mechanism driving constituent name effects require further study.…”

“…Constituent names that started with a number elicited less discouragement, perhaps because these names seemed technical, which may have prevented participants from creating meaning 20. Constituent names ending with text that sounded like ‘ene’ were also less discouraging.…”

“…In our prior qualitative research, familiar-sounding constituents appeared to elicit concern, while unfamiliar constituent names led people to search for meaning by using any available clues, including making associations to other words that sound or look similar 19 20. We hypothesised that constituent names that are more familiar to people or have less technical sounding names (ie, no numerical prefix, shorter) would elicit more discouragement from wanting to smoke.…”

Reactance to Health Warnings Scale: Development and Validation

“…To develop the items, we relied on previously published measures (5, 27, 28), qualitative studies that captured the natural language people use when talking about reactance (29, 30), and feedback from tobacco and reactance researchers on both item wording and whether our items reflected the dimensions we were intending to measure.…”

Effective Formats for Communicating Risks from Cigarette Smoke Chemicals

“…3 When asked what chemicals are in cigarettes, most people can name only nicotine, carbon monoxide, and “tar.” 4–9 The public has an interest in knowing more about the chemicals in cigarette smoke, 10–12 and some studies suggest that learning about the chemicals may increase quit intentions. 3 Some experts argue the public has a fundamental right to know what they are consuming when they smoke, just as they currently know what ingredients are in food.…”