Reducing Nicotine Without Misleading the Public: Descriptions of Cigarette Nicotine Level and Accuracy of Perceptions About Nicotine Content, Addictiveness, and Risk

Abstract

Significance The public incorrectly believes very low nicotine content (VLNC) cigarettes are less carcinogenic than current cigarettes, a belief associated with lower motivation to quit under a VLNC standard. We examined how different descriptions of the nicotine level in VLNC cigarettes affect the accuracy of the public’s perceptions about nicotine content, addictiveness, and cancer risk. Methods Participants were a national convenience sample of 1353 US adults (22% smokers). In an online experiment, we randomized participants to a VLNC description using (1) concise language; (2) a percentage; (3) an interpretation; (4) a percentage and interpretation; (5) a percentage and a pictograph; or (6) a percentage, interpretation, and pictograph; or to a control description using (7) FDA's “minimally or nonaddictive” phrasing. We assessed accuracy of perceived nicotine content, addictiveness, and cancer risk compared to current cigarettes. Results Compared to control, the percentage description resulted in more accurate perceptions about nicotine content (76% vs. 49% accuracy) and addictiveness (44% vs. 34%), but less accurate perceptions about cancer risk (56% vs. 68%; all ps < .05). Adding interpretation or pictographs to the percentage description did not increase accuracy. The concise language description reduced accuracy of perceived nicotine content and addictiveness but increased accuracy of cancer risk (all ps < .05). Conclusions Stating that 95% of nicotine would be removed more accurately conveyed the nicotine content and addictiveness of VLNC cigarettes. However, descriptions that better conveyed nicotine content and addictiveness misled people about cancer risk. Implications Implementation of a VLNC standard should include plans for a communication campaign that conveys that VLNC cigarettes will be less addictive but equally toxic to smoke. Stating the percent reduction in nicotine is likely to more clearly communicate reduced addictiveness but may also exacerbate risk misperceptions. VLNC communication requires further study to ensure the public accurately understands a VLNC standard.

Risk Perceptions of Low Nicotine Cigarettes and Alternative Nicotine Products across Priority Smoking Populations

“…Another possible reason for the observed disconnect is that the nicotine level of LNC cigarettes was never quantified in the survey measure. Recent studies have shown that stating “95% of the nicotine would be removed”, which reflects levels of nicotine in LNC cigarettes versus conventional cigarettes, results in more accurate perceptions of the addictiveness of LNC cigarettes [ 79 ]. Another observed misperception is that over 60% of respondents indicated that it is the nicotine in cigarettes causing cancer, which is consistent with prior studies including one among U.S. physicians [ 31 , 32 , 80 ].…”

Reactions to graphic and text health warnings for cigarettes, sugar-sweetened beverages, and alcohol: An online randomized experiment of US adults

“…After viewing the warnings and responding to survey items, participants completed two additional experiments (30,31) and answered demographic items. Participants received $2.20 for completing the survey.…”

Effects of Framing Nicotine Reduction in Cigarettes on Anticipated Tobacco Product Use Intentions and Risk Perceptions Among US Adult Smokers

“…Another recent study examined how different ways of describing nicotine reduction in cigarettes affect perceptions of VLNCs. 14 The description ranged from very simple to very detailed by adding numerical reduction (removal of “95% of the nicotine”), a pictograph, and the words “nearly nicotine-free” alone and in combination. The study found that descriptions including the numeric information (95%) were more effective at conveying to smokers and non-smokers that VLNCs contain less nicotine and are less addictive than current cigarettes (which are correct beliefs) but also fostered perceptions that VLNCs are less harmful to smoke (incorrect belief).…”

“…So far, very little research has examined different ways to describe nicotine reduction in cigarettes and how those might influence smokers’ perceptions and behavior. 11,13,14 Most of this extant research has been conducted in the context of experimental studies where smokers were given VNLCs and told that these cigarettes contained either “very low nicotine” or “average nicotine.” 13 More participants were interested in quitting when being informed the only cigarettes for purchase in the future were “very low nicotine” cigarettes rather than “average nicotine” cigarettes. 11 However, these studies did not measure other behavioral intentions, such as likelihood of switching or dual use, nor did they assess the framing of the nicotine reduction.…”