Harm perception among Swedish daily smokers regarding nicotine, NRT-products and Swedish Snus

Abstract

BackgroundIn Sweden NRT-products and Snus, are easily available and used as smoking cessation aids. However, most quit attempts are made without any cessation aids. The limited use of these products as cessation aids may be influenced by the way smokers perceive the harmfulness of NRT-products and Snus compared to smoking. The present study examines these perceptions and their association with perceptions of the harmfulness of nicotine itself.MethodsThe study is based on the Swedish part of a two-nation web-based survey of daily smokers in Sweden (n = 1016) and Norway (n = 1000). Questionnaire items addressed perceptions of NRT-products' and Snus' harmfulness and nicotine's part of the health risks of smoking. Data analyses included cross-tabulations and logistic regressions.ResultsA majority, 59% of the answers to the question about harmfulness of NRT-products, and 75% of the answers about harmfulness of Snus, were inconsistent with the scientific evidence by demonstrating exaggerated perceptions of harmfulness. The strongest predictor of consistent answers was the perception of the harmfulness of nicotine. There were also significant associations with own experience of successful use of the products in question. Overall the perceptions of the harmfulness of nicotine were considerably exaggerated. This pattern was more pronounced among women than men. Prevailing misperceptions may be related to the way that different tobacco and nicotine products are presented in the media and other publicly available information sources.ConclusionsPublic information about smoking and health should be expanded to include objective and unambiguous information regarding nicotine's part in the harmfulness of smoking and the harmfulness of different nicotine-containing products compared to smoking.This is essential in order to preclude that misperceptions regarding these matters could discourage smokers from adopting effective cessation practices with use of nicotine-containing aids.

How do consumers perceive differences in risk across nicotine products? A review of relative risk perceptions across smokeless tobacco, e-cigarettes, nicotine replacement therapy and combustible cigarettes

“…and 21 31 33 42 46 74–76 Although in approximately one-third of samples (35%), a majority of respondents viewed NRT as less harmful than CCs, these findings should be interpreted with caution, given that in half of the samples (50%), there was insufficient information to ascertain whether a majority of respondents held a particular RRP. Sampling strategy had an effect on the results, whereby in a large minority of probability-based samples (40%), a majority of respondents perceived NRT and CCs as equally harmful, while in almost one-half (47%) of non-probability-based samples, a majority of respondents perceived NRT as less harmful than CCs.…”

“…i As shown in table 2, measures of RRPs were highly variable and exhibited many characteristics. Although a majority of measures (n=41) operationalised risk as an overall concept of harm,22 and 23 24A 24B 27–30 31b 32 35 37 39 40 42a 43–46 50 51a 51b 52 54 57–63 65–73 75–76 some were based on distinct dimensions of risk,77 such as perceived severity,20 and 21 41 55 64 perceived susceptibility,29 31a 33–34 36 38 42b 47–49 53 55–56 64 74 and perceived likelihood 20 . and 21 In addition, several used aids to help guide respondents, such as an awareness prompt (n=9),22 and 23 30 24A 24B 49 50 54 56 58 or visual aids, such as product images (n=2).…”

“…A majority of measures were direct in nature (n=50),20 and 21 , 22 and 23 24A 24B 28–30 31a 31b 32–33 35 37–40 42a 42b 43–50 51a 52–63 65–68 70–76 requiring respondents to make a direct comparison of the products, whereas seven measures were indirect,27 34 36 41 51b 64 69 in which the responses to separate questions were compared. Among the direct measures (n=50), question stems were either open (n=36),20 and 21 , 22 and 23 24A 24B 28–30 31a 32–33 35 39–40 43–49 51a 52–61 63 65 67 71 72 or closed (n=14) 31b 37–38 42a 42b 50 62 66 68 70 73–76.…”

Perceptions of relative risk of disease and addiction from cigarettes and snus.

“…Widespread high risk perceptions were also found in an earlier survey conducted on behalf of the Norwegian Medical Association, where 70 per cent of adult respondents thought snus use was an important cause of cancer, and 43 per cent thought it was an important cause of heart disease (Opinion, 2002). A Swedish study showed that a majority of daily smokers had exaggerated ideas of the harmfulness of both snus and NRT (nicotine replacement therapy) (Wikmans & Ramström, 2010).…”

Commentary on Lund et al. (2011): Consolidating the evidence on effectiveness of snus for smoking cessation - implications for public health

“…Studies from Sweden and the United States have demonstrated that misbeliefs regarding snus and other nicotine products are very common [15,16]. This is likely to discourage many smokers from adopting effective cessation practices with use of nicotine-containing aids in 'real-life' attempts to quit smoking.…”