Public understanding of cigarette smoke constituents: three US surveys

Abstract

Introduction The Tobacco Control Act requires public disclosure of information about toxic constituents in cigarette smoke. To inform these efforts, we studied public understanding of cigarette smoke constituents. Methods We conducted phone surveys with national probability samples of adolescents (n=1125) and adults (n=5014) and an internet survey with a convenience sample of adults (n=4137), all in the USA. We assessed understanding of cigarette smoke constituents in general and of 24 specific constituents. Results Respondents commonly and incorrectly believed that harmful chemicals in cigarette smoke mostly originate in additives introduced by cigarette manufacturers (43–72%). Almost all participants had heard that nicotine is in cigarette smoke, and many had also heard about carbon monoxide, ammonia, arsenic and formaldehyde. Less than one-quarter had heard of most other listed constituents being in cigarette smoke. Constituents most likely to discourage respondents from wanting to smoke were ammonia, arsenic, formaldehyde, hydrogen cyanide, lead and uranium. Respondents more often reported being discouraged by constituents that they had heard are in cigarette smoke (all p<0.05). Constituents with names that started with a number or ended in ‘ene’ or ‘ine’ were less likely to discourage people from wanting to smoke (all p<0.05). Discussion Many people were unaware that burning the cigarette is the primary source of toxic constituents in cigarette smoke. Constituents that may most discourage cigarette smoking have familiar names, like arsenic and formaldehyde and do not start with a number or end in ene/ine. Our findings may help campaign designers develop constituent messages that discourage smoking.

How people think about the chemicals in cigarette smoke: a systematic review

“…Cross-sectional studies in the US, UK, Australia, Mexico, and Canada using convenience and probability samples have found that the public was most aware that carbon monoxide (48–86%), nicotine (64–94%), and tar (48–86%) are in cigarette smoke (Borland & Hill, 1997; Brewer et al, 2016; Cummings et al, 2004b; Environics Research Group, 1996a, b, 2003a, b; Hammond et al, 2006; Ipsos-Eureka, 2009; Moracco et al, 2016; O'connor et al, 2006; Swayampakala et al, 2015; Wiseman et al, 2016). Fewer people were aware that cyanide (13–72%) and arsenic (6–58%) are in cigarette smoke (Brewer et al, 2016; Cummings et al, 2004b; Environics Research Group, 1996b, 2003b; Hammond et al, 2006; Moracco et al, 2016; Siahpush et al, 2006; Wiseman et al, 2016), and very few people knew that other constituents such as nitrosamines (6–25%), polonium (8–24%), and mercury (11–26%) are in cigarette smoke (Boynton et al, 2016; Brewer et al, 2016; Cummings et al, 2004b; Environics Research Group, 1996b; Siahpush et al, 2006; Swayampakala et al, 2015; Wiseman et al, 2016). One study of pregnant women in Lebanon found that 70% knew cigarette smoke contained addictive substances and carcinogens (Chaaya et al, 2004).…”

“…One study of pregnant women in Lebanon found that 70% knew cigarette smoke contained addictive substances and carcinogens (Chaaya et al, 2004). One study of a U.S. national probability sample assessed awareness of 24 cigarette smoke constituents, randomly assigning respondents to answer about a panel of four constituents (Boynton et al, 2016; Brewer et al, 2016). More than a third of participants were unaware of all of the constituents in their panel, and only 8% knew at least three of the four constituents they were asked about.…”

“…In a study with U.S. smokers, the average perceived safety for additive-free cigarettes ranged from 2.3 to 2.5 on a 0 to 4 scale with a higher score indicating greater belief that they were as dangerous as regular cigarettes (Bansal et al, 2004a). A national phone survey found that smokers said their interest in additive-free cigarettes would increase if they found out that cigarette smoke contains chemicals like lead and hydrogen cyanide (Brewer et al, 2016). An in-person survey found that Canadian students in grades 9–12 rated “additive-free” tobacco and “organic” tobacco as less harmful than regular cigarettes.…”

“…Another approach could be to better understand the simplifications that people engage in as a way to bring meaning to smoking harms. People appear to use a mental shorthand in which they equate any aspect of cigarettes with harm, for example thinking that nicotine is the main cause of the harms of smoking or that the main harms come from tobacco additives but not from burning the tobacco (Brewer et al, 2016; Moracco et al, 2016). Research on these mental shortcuts or heuristics can help the FDA and other agencies communicate about tobacco constituents in ways that match people's current mental models and address key misunderstandings.…”

How hearing about harmful chemicals affects smokers' interest in dual use of cigarettes and e-cigarettes

“…From September 2014 to May 2015, we recruited a probability sample of 5014 U.S. adults, including 1164 smokers (Boynton et al, 2016; Brewer et al, 2016). Our paper focuses on an experiment conducted with established cigarette smokers (defined as those who reported smoking “some days” or “every day” and who had smoked at least 100 cigarettes in their lifetime).…”