Understandings of the component causes of harm from cigarette smoking in Australia

Abstract

Introduction and Aims To investigate relationships between smoking‐related behaviours and knowledge of the disease risks of smoking and the causes of smoking harms, using a four‐way division of ‘component causes’: nicotine, other substances found in unburned tobacco, combustion products of tobacco and additives. Design and Methods The data were collected using an on‐line survey in Australia with 1047 participants in three groups; young non‐smokers (18 to 25), young smokers (18 to 25) and older smokers (26 and above). Results Most participants agreed that cancer and heart disease are major risks of smoking but only a quarter accurately quantified the mortality risk of lifetime daily smoking. Very few (two of 1047) correctly estimated the relative contributions of all four component causes. Post‐hoc analyses reinterpreting responses as expressions of relative concern about combustion products and nicotine showed that 29% of participants rated combustion products above nicotine. We delineated six relative concern segments, most of which had distinctive patterns of beliefs and actions. However, higher levels of concern about combustion products were only weakly positively associated with harm reducing beliefs and actions. Discussion and Conclusions Most smokers do not appear to understand the risks of smoking and their causes well enough to be able to think systematically about the courses of action open to them to reduce their health risk. To facilitate informed decision‐making, tobacco control communicators may need to better balance the dual aims of creating fear/negative affect about smoking and imparting knowledge about the health harms and their mechanisms.

‘It’s all the other stuff!’ How smokers understand (and misunderstand) chemicals in cigarettes and cigarette smoke

“…We have avoided being over-confident in prescribing solutions, as there is still more to understand about the problem. Nonetheless, our published quantitative survey research demonstrated that some of the misunderstandings discussed here are likely to be prevalent, particular those concerning harm from additives (King et al, 2019). Recent research in the United States (Bernat et al, 2017; Brewer et al, 2017) has also found these beliefs to be widespread, so it is unlikely that our findings are due to a chance selection of participants with unusual beliefs.…”

“…Recent research on public understandings of smoking-related chemicals, using both qualitative and quantitative methods (Bernat et al, 2017; Breslin et al, 2018; Brewer et al, 2017; King et al, 2018, 2019; Moracco et al, 2016; Morgan et al, 2017; Pepper et al, 2017), has yielded a consistent picture: the public has limited knowledge of the toxicants in cigarette smoke and frequently believe toxic additives are the main cause of harmful exposures.…”

“…Previous mixed methods research linked to this study found that even smokers with good general knowledge of smoking-related harms often resorted to heuristics to judge the harmfulness of specific products (King et al, 2018). The research also found only a minority of smokers correctly understood that toxicants generated by combustion account for most of smoking-related harm (King et al, 2019).…”

Effects of a Nicotine Fact Sheet on Perceived Risk of Nicotine and E-Cigarettes and Intentions to Seek Information About and Use E-Cigarettes

“…Additionally, tobacco risk communication often presents information about nicotine in tobacco products together with information about the risk of tobacco products, which can make people develop negative feelings or affect towards nicotine. Such negative affect is related to high perceived nicotine risk [27,28] and can bias processing of nicotine-related messages. In our study, this negative affect might even get reinforced due to the presence of negative information about nicotine in the fact sheet.…”

Nicotine‐related misperceptions among faculty and students at a Midwestern dental school

“…Unfortunately, communication with the public concerning risks of tobacco use generally conflates information about nicotine in tobacco products with information about the dangers of tobacco products. This exacerbates the misperception that nicotine is a known carcinogen 22 . This notion was upheld by a survey of the public about low‐nicotine cigarettes.…”