Reduced nicotine content cigarette advertising: How false beliefs and subjective ratings affect smoking behavior

Abstract

Introduction Tobacco advertising can create false beliefs about health harms that are reinforced by product design features. Reduced nicotine content (RNC) cigarettes may reduce harm, but research has not addressed advertising influences. This study examined RNC cigarette advertising effects on false harm beliefs, and how these beliefs – along with initial subjective ratings of RNC cigarettes – affect subsequent smoking behaviors. We further explored whether subjective ratings moderate associations between false beliefs and behavior. Methods Seventy-seven daily, non-treatment-seeking smokers (66.2% male) participated in the first 15 days of a randomized, controlled, open-label RNC cigarette trial. Participants viewed an RNC cigarette advertisement at baseline before completing a 5-day period of preferred brand cigarette use, followed by a 10-day period of RNC cigarette use (0.6 mg nicotine yield). Participants provided pre- and post-advertisement beliefs, and subjective ratings and smoking behaviors for cigarettes smoked during laboratory visits. Results Viewing the advertisement increased beliefs that RNC cigarettes contain less nicotine and are healthier than regular cigarettes (p’s < 0.001 and 0.011), and decreased the belief that they are less likely to cause cancer (p = 0.046). Neither false beliefs nor subjective ratings directly affected smoking behaviors. Significant interactions of strength and taste ratings with beliefs (p’s < 0.001), however, indicated that among smokers with less negative initial subjective ratings, greater false beliefs were associated with greater RNC cigarette consumption. Conclusions Smokers may misconstrue RNC cigarettes as less harmful than regular cigarettes. These beliefs, in conjunction with favorable subjective ratings, may increase product use.

Misperceptions of Nicotine and Nicotine Reduction: The Importance of Public Education to Maximize the Benefits of a Nicotine Reduction Standard

“…Two studies have examined associations between reduced nicotine cigarette risk perceptions and smoking behaviors. 9,11 Product perceptions were not directly associated with smoking behaviors in either study, although Mercincavage and colleagues found that greater false beliefs about reduced nicotine cigarettes were correlated with higher daily cigarette consumption among smokers who provided more favorable subjective ratings of the cigarettes. 11 Thus, there is limited data available to address how perceived health risks may influence initiation or long-term use of VLNC cigarettes or cessation.…”

Effects of immediate versus gradual nicotine reduction in cigarettes on biomarkers of biological effects

“…If nicotine in cigarettes were to become regulated, it would be imperative to educate the consumer that this product standard is not associated with a significant reduction in cigarette harm. Smokers tend to report misperceptions of the harms of cigarettes that are significantly reduced in levels of nicotine . These misperceptions are due largely to the erroneous belief that nicotine causes cancer or heart disease and, therefore, if nicotine is reduced in a product, then it would be safer.…”

Examining Risk Perceptions Among Daily Smokers Naïve to Reduced Nicotine Content Cigarettes

“…Thus, our data extend this literature by examining multiple risk perceptions among an RNC-naïve sample. We hypothesized that, consistent with studies of previously commercially-available 15 and investigational 6,16 RNC cigarettes, smokers would misperceive RNC cigarettes as less harmful. Consistent with industry research, 19 we also hypothesized that age and gender would predict RNC cigarette risk perceptions, such that older and female smokers would be more likely to hold these misperceptions.…”

“…Indeed, the investigational RNC cigarette manufacturer used by recent trials has applied to the FDA to market its cigarettes as modified risk tobacco products. 14 Misperceptions about RNC cigarette risks may discourage cessation or promote increased product use, 15 negating potential benefits of mandated nicotine reduction.…”