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

Rachel L Denlinger-Apte,Jennifer Cornacchione Ross,Dorothy K Hatsukami,Dana Mowls Carroll,Eric C Donny,Maansi Bansal-Travers,Lauren R Pacek

doi:10.3390/ijerph18105311

Abstract

Background: As the U.S. Food and Drug Administration considers a low nicotine product standard for cigarettes, it is important to examine how people who smoke, especially individuals from priority populations disproportionately affected by smoking, perceive low nicotine content (LNC) cigarettes and their relative risk perceptions of alternative nicotine delivery system (ANDS) products, including e-cigarettes and snus, and medicinal nicotine. Methods: Data are from Wave 4 (2016–2017) of the adult Population Assessment of Tobacco Use and Health (PATH) Study. We examined respondents’ absolute risk perceptions about nicotine, LNC cigarettes, ANDS products and medicinal nicotine; their relative risk perceptions of LNC cigarettes and ANDS products compared to conventional cigarettes; and their relative risk perceptions of medicinal nicotine compared to ANDS products. Results: The majority of respondents across priority smoking populations indicated snus, e-cigarettes, and LNC cigarettes were ‘about the same’ level of harmfulness or addictiveness as conventional cigarettes. The majority of respondents indicated e-cigarettes to be ‘about the same’ harmfulness as medicinal nicotine. Conclusions: Our study indicates that adults who smoke cigarettes generally have misperceptions about the harms of nicotine and the relative risks of ANDS products and such misperceptions exist regardless of their racial/ethnic identity, sexual orientation, and gender identity.

Highlights

The nicotine-focused framework developed by Food and Drug Administration (FDA) regulators relies on the concept that a continuum of harm exists for nicotine and tobacco products—with products such as nicotine replacement therapy representing the least harmful products on this continuum and combusted cigarettes representing the most harmful—and that moving people away from using the most harmful products is essential for improving public health outcomes [2,3]
Perceptions of low nicotine cigarettes and non-combustible tobacco products relative to regular cigarettes: we examined the following questions: “In your opinion, do you think cigarettes with lower amounts of nicotine are less harmful, about the same, or more harmful to a person’s health than regular cigarettes?”, “In your opinion, do you think that cigarettes with lower amounts of nicotine are less addictive, about the same, or more addictive than regular cigarettes?”, “Is using [e-cigarettes or other electronic nicotine products/snus] less harmful, about the same, or more harmful than smoking cigarettes?”
Snus, e-cigarettes, and nicotine, the vast majority of participants perceived these products to be in the range of ‘somewhat harmful’ to ‘extremely harmful’ (Figure 1A)

Summary

Introduction

The nicotine-focused framework developed by FDA regulators relies on the concept that a continuum of harm exists for nicotine and tobacco products—with products such as nicotine replacement therapy representing the least harmful products on this continuum and combusted cigarettes representing the most harmful—and that moving people away from using the most harmful products is essential for improving public health outcomes [2,3]. This framework is founded in the evidence that nicotine, while responsible for the highly addictive nature of commercial tobacco products, is not directly. Conclusions: Our study indicates that adults who smoke cigarettes generally have misperceptions about the harms of nicotine and the relative risks of ANDS products and such misperceptions exist regardless of their racial/ethnic identity, sexual orientation, and gender identity

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