Perceptions of Nicotine Reduction Policy in the United States: A Qualitative Study

Abstract

Introduction Several countries are considering a reduced nicotine policy that would make cigarettes minimally or non-addictive. This qualitative study documents reactions to the policy that should be addressed by future communication efforts. Methods In 2020, we recruited participants in Atlanta, GA and San Francisco, CA (27 people who exclusively smoke, 25 who dual use cigarettes and e-cigarettes, 32 who formerly smoked, and 31 young adults who do not smoke). We held 16 focus groups: 2 focus groups for each smoking status in each city. Participants viewed messages about very low nicotine content cigarettes (VLNCs) and were asked about their reactions to each message and their overall response to the reduced nicotine policy. Results While responses to the policy were predominantly positive, focus group discussion also revealed concerns, questions, and misunderstandings (referred to here collectively as “perceptions”) that may need to be addressed if a reduced nicotine policy is enacted. Participants expressed perceptions related to the policy intent, including that the FDA has ulterior motives, adoption/ implementation, including that nicotine would have to be replaced with other chemicals if removed or that the policy would be unfeasible to implement, and effectiveness, including concern that VLNCs would still be addictive or the policy would backfire. Conclusions Addressing perceptions about reduced nicotine policy intent, adoption/implementation, and effectiveness could be key in creating public support and political motivation to move forward with such a policy. Countries contemplating adopting such a policy should consider pairing it with communications that address these perceptions. IMPLICATIONS This study is one of very few to use qualitative methods to explore potentially problematic perceptions about nicotine reduction policy among US adults. Results illuminated new policy-specific concerns, questions and misunderstandings about the reduced nicotine policy intent, adoption/implementation, and effectiveness. Identifying, studying, and addressing relevant perceptions may play a key role in generating support in countries contemplating such a policy.

Messaging about very low nicotine cigarettes (VLNCs) to influence policy attitudes, harm perceptions and smoking motivations: a discrete choice experiment

“…16 Some people who smoke even believe that nicotine reduction will substantially increase smoking among current smokers via compensatory behaviours (ie, smoking more to get the same levels of nicotine as from regular cigarettes), cause relapse among former smokers and encourage non-smokers to try cigarettes. 15 Misperceptions about VLNCs and reduced nicotine policy may be diminished through messaging. Both empirical and theoretical literature indicate that effective messages can influence motivations to try novel behaviours, including smoking, and therefore may enhance the policy's effect on quitting behaviour 25 26 while conveying the harmfulness of VLNCs and bolstering attitudes towards policies.…”

“…21 22 Public perceptions of the FDA's scientific accuracy and integrity may influence how the policy is construed, or even the level of opposition against such a policy. 15 VLNC communication strategies may be strengthened by integrating source information. Prior research has shown that the public is generally uninformed about the role of the FDA in tobacco regulation 34 but that those who smoke, despite scepticism, still find the FDA to be generally trustworthy.…”

“…12 Maximising the positive impact of a reduced nicotine policy may depend on public acceptance and understanding of very low nicotine cigarettes (VLNCs), as prior research has raised concerns about the public reaction to such a policy. [13][14][15][16] Although a reduced nicotine policy confers multiple benefits, including reductions in smoking behaviour…”

“…Maximising the positive impact of a reduced nicotine policy may depend on public acceptance and understanding of very low nicotine cigarettes (VLNCs), as prior research has raised concerns about the public reaction to such a policy 13–16. Although a reduced nicotine policy confers multiple benefits, including reductions in smoking behaviour and substantially reduced mortality among the public,9 17–19 numerous misperceptions persist among the public about the harmfulness, addictiveness and likely behavioural consequences of VLNCs,20 and these could reduce the full potential of the policy.…”

“…Qualitative research has also shown that some people who smoke are confused about nicotine’s role in addiction and believe that nicotine reduction will not reduce the addictiveness of cigarettes 16. Some people who smoke even believe that nicotine reduction will substantially increase smoking among current smokers via compensatory behaviours (ie, smoking more to get the same levels of nicotine as from regular cigarettes), cause relapse among former smokers and encourage non-smokers to try cigarettes 15…”