Nicotine Risk Misperception Among US Physicians

Steinberg, Michael B.; Bover-Manderski, Michelle T.; Wackowski, Olivia A; Singh, Binu; Strasser, Andrew A.; Delnevo, Cristine D.

doi:10.1007/s11606-020-06172-8

Cited by 19 publications

(21 citation statements)

References 5 publications

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“…Recent studies have shown that stating “95% of the nicotine would be removed”, which reflects levels of nicotine in LNC cigarettes versus conventional cigarettes, results in more accurate perceptions of the addictiveness of LNC cigarettes [ 79 ]. Another observed misperception is that over 60% of respondents indicated that it is the nicotine in cigarettes causing cancer, which is consistent with prior studies including one among U.S. physicians [ 31 , 32 , 80 ]. Again, such findings point to the need for educating the public about the harms of nicotine and LNC cigarettes prior to implementing a low nicotine product standard for cigarettes.…”

Section: Discussionsupporting

confidence: 81%

Risk Perceptions of Low Nicotine Cigarettes and Alternative Nicotine Products across Priority Smoking Populations

Denlinger-Apte

Pacek

Ross

et al. 2021

IJERPH

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Background: As the U.S. Food and Drug Administration considers a low nicotine product standard for cigarettes, it is important to examine how people who smoke, especially individuals from priority populations disproportionately affected by smoking, perceive low nicotine content (LNC) cigarettes and their relative risk perceptions of alternative nicotine delivery system (ANDS) products, including e-cigarettes and snus, and medicinal nicotine. Methods: Data are from Wave 4 (2016–2017) of the adult Population Assessment of Tobacco Use and Health (PATH) Study. We examined respondents’ absolute risk perceptions about nicotine, LNC cigarettes, ANDS products and medicinal nicotine; their relative risk perceptions of LNC cigarettes and ANDS products compared to conventional cigarettes; and their relative risk perceptions of medicinal nicotine compared to ANDS products. Results: The majority of respondents across priority smoking populations indicated snus, e-cigarettes, and LNC cigarettes were ‘about the same’ level of harmfulness or addictiveness as conventional cigarettes. The majority of respondents indicated e-cigarettes to be ‘about the same’ harmfulness as medicinal nicotine. Conclusions: Our study indicates that adults who smoke cigarettes generally have misperceptions about the harms of nicotine and the relative risks of ANDS products and such misperceptions exist regardless of their racial/ethnic identity, sexual orientation, and gender identity.

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Section: Discussionsupporting

confidence: 81%

Risk Perceptions of Low Nicotine Cigarettes and Alternative Nicotine Products across Priority Smoking Populations

Denlinger-Apte

Pacek

Ross

et al. 2021

IJERPH

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“…For clinicians, a white paper will spell out the treatment considerations of ENDS use drawn from both the cardiovascular and respiratory outcomes from the reviews. As most physicians and health care providers hold erroneous beliefs about the health effects of nicotine itself [51][52][53], the white paper will include a section on nicotine. The white paper will be translated into as many languages as possible and sent to medical associations, distributed at conferences, and published on a website for downloading.…”

Section: Discussionmentioning

confidence: 99%

Respiratory and Cardiovascular Health Effects of e-Cigarette Substitution: Protocol for Two Living Systematic Reviews

et al. 2021

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Background Despite the clear risks of tobacco use, millions of people continue to smoke. Electronic nicotine delivery systems (ENDS), commonly called e-cigarettes, have been proposed as a substitute for those who are unwilling or unable to quit. Current systematic and narrative reviews on the health effects of ENDS use, particularly respiratory and cardiovascular effects, have come to differing conclusions. Objective We conducted two systematic reviews to critically assess and synthesize available human studies on the respiratory and cardiovascular health effects of ENDS substitution for people who smoke. The primary goal is to provide clinicians with evidence on the health effects of ENDS substitution to inform their treatment recommendations and plans. The twin goal of the reviews is to promote health literacy in ENDS users with facts on the health effects of ENDS. Methods These two reviews will be living systematic reviews. The systematic reviews will be initiated through a baseline review. Studies will be evaluated using the JBI quality assessment tools and a checklist of biases drawn from the Centre for Evidence Based Medicine Catalogue of Bias. A narrative synthesis is planned because of the heterogeneity of data. A search for recently published studies will be conducted every 3 months, and an updated review will be published every 6 months for the duration of the project or possibly longer. Results The baseline and updated reviews will be published in a peer-reviewed journal. The findings of the reviews will be reported in a white paper for clinicians and a fact sheet for people who use ENDS. Conclusions The substitution of ENDS for cigarettes is one way to potentially reduce the risks of smoking. Clinicians and their patients need to understand the potential benefits and possible risks of substituting ENDS for cigarettes. Our living systematic reviews seek to highlight the best and most up-to-date evidence in this highly contentious and fast-moving field of research. Trial Registration PROSPERO CRD42021239094; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=239094 International Registered Report Identifier (IRRID) DERR1-10.2196/29084

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“…In a follow-up to our prior research that observed misperceptions about the health effects of nicotine among a national sample of US physicians [ 9 ], we sought to assess the impact of question wording on estimates of physician perceptions about nicotine using a randomized split-sample survey experiment. Indeed, question version was significantly associated with “strongly agreeing” that nicotine directly contributes to development of birth defects, CVD, cancer, and COPD, even after adjusting for age, sex, and medical specialty.…”

Section: Discussionmentioning

confidence: 99%

“…The survey included domains about demographic characteristics, treatment practices, and knowledge/perceptions about tobacco and electronic nicotine products (e.g., e-cigarettes). Participants were randomly assigned to receive one of two versions of a question matrix about health effects of nicotine: Version 1 (from our previous survey [ 9 ], “Please indicate the extent to which you agree or disagree that nicotine directly contributes to the development of the following health problems by selecting your choice” and Version 2, “Please indicate the extent to which you agree or disagree that nicotine on its own directly contributes to the development of the following health problems by selecting your choice.” Both versions then presented response options “Strongly Agree,” “Agree,” “Disagree,” and “Strongly Disagree” corresponding to each of five health outcomes: birth defects, cardiovascular disease, cancer, depression, and COPD (See online supplement, Figure S1 ).…”

Section: Methodsmentioning

confidence: 99%

“…For example, a 2007 study found that 60% of nurses incorrectly perceived nicotine as carcinogenic [ 8 ]. Indeed, our own national survey of US physicians in 2018 found that a majority of doctors ‘strongly agreed’ that “nicotine directly contributes” to the development of CVD, COPD, and cancer [ 9 ]. Additionally, we found that misperceptions regarding nicotine’s role differed by physician specialty, with pulmonologists generally being least likely to hold nicotine misperceptions while family physicians were more likely than most other specialists to hold nicotine misperceptions.…”

Section: Introductionmentioning

confidence: 99%

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Persistent Misperceptions about Nicotine among US Physicians: Results from a Randomized Survey Experiment

Bover-Manderski

Steinberg

Wackowski

et al. 2021

IJERPH

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We conducted a survey experiment among US physicians to evaluate whether question wording impacted perceptions about the health effects of nicotine. 926 physicians were randomized to receive one of two versions of a question matrix that asked about the “extent to which they agree or disagree that ‘nicotine’ (Version 1) or ‘nicotine, on its own,’ (Version 2) directly contributes to” birth defects, cardiovascular disease (CVD), cancer, depression, and chronic obstructive pulmonary disease (COPD). We evaluated whether question condition predicted strong agreement and/or agreement with each statement, and assessed demographic correlates of each outcome while adjusting for question version. Physicians who received Version 2 were less likely to “strongly agree” that nicotine directly caused birth defects (Prevalence Ratio (PR) 0.84, 95% CI 0.72–0.98), CVD (PR 0.89, 95% CI 0.84–0.95), cancer (PR 0.81, 95% CI 0.75–0.87), and COPD (PR 0.78, 95% CI 0.72–0.84). Females were more likely to “strongly agree” that nicotine directly contributes to birth defects and cancer, and family physicians were most likely to “strongly agree” that nicotine directly contributes to CVD, cancer, and COPD. Question wording is important when measuring physicians’ beliefs about nicotine; however, even after accounting for question version, misperceptions about the direct health effects of nicotine were common and varied by sex and specialty.

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Nicotine Risk Misperception Among US Physicians

Cited by 19 publications

References 5 publications

Risk Perceptions of Low Nicotine Cigarettes and Alternative Nicotine Products across Priority Smoking Populations

Risk Perceptions of Low Nicotine Cigarettes and Alternative Nicotine Products across Priority Smoking Populations

Respiratory and Cardiovascular Health Effects of e-Cigarette Substitution: Protocol for Two Living Systematic Reviews

Persistent Misperceptions about Nicotine among US Physicians: Results from a Randomized Survey Experiment

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