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Klosterhalfen S, Kotz D, Kastaun S. Smokers' perception of the comparative health risks of cigarettes, e-cigarettes and heated tobacco products: a survey among the German population. J Public Health (Oxf) 2024:fdae068. [PMID: 38741461 DOI: 10.1093/pubmed/fdae068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 04/04/2024] [Accepted: 04/25/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Tobacco cigarettes, e-cigarettes and heated tobacco products can pose different health risks (harm continuum). As current tobacco smokers could benefit from switching to less harmful products, we aimed to assess current smokers' perceived comparative health risks of these three products and to explore associations between risk perceptions and specific user characteristics. METHODS We analysed data from 11 waves (2019-2021; N = 5657 current tobacco smokers) of a representative, cross-sectional household survey conducted in Germany. Associations were assessed with multivariable logistic regression models. RESULTS 55.2% of smokers (95%CI = 53.8-56.5%) ranked cigarettes as the most harmful product. 36.1% of smokers (95%CI = 34.8-37.3%) perceived e-cigarettes and 33.8% (95%CI = 32.5-35.0%) heated tobacco products as more harmful than cigarettes. Misperceptions that e-cigarettes or heated tobacco products are more harmful to health than cigarettes increased over the 3-year study period and were more common among those with lower educational attainment. CONCLUSIONS Only half of current tobacco smokers in Germany perceive the comparative health risks of cigarettes adequately and such misperceptions have increased recently. As current smokers could benefit most from switching to less harmful products, educational campaigns are needed to inform this group about the health risks of tobacco smoking and the comparative health risks of the various nicotine and tobacco products along the harm continuum.
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Affiliation(s)
- Stephanie Klosterhalfen
- Addiction Research and Clinical Epidemiology Unit, Centre for Health and Society (chs), Institute of General Practice (ifam), Medical Faculty of the Heinrich-Heine-University, 40225 Duesseldorf, Germany
| | - Daniel Kotz
- Addiction Research and Clinical Epidemiology Unit, Centre for Health and Society (chs), Institute of General Practice (ifam), Medical Faculty of the Heinrich-Heine-University, 40225 Duesseldorf, Germany
- Department of Behavioural Science and Health, University College London, WC1E 7HB London, UK
| | - Sabrina Kastaun
- Addiction Research and Clinical Epidemiology Unit, Centre for Health and Society (chs), Institute of General Practice (ifam), Medical Faculty of the Heinrich-Heine-University, 40225 Duesseldorf, Germany
- Patient-Physician Communication Research Unit, Centre for Health and Society (chs), Institute of General Practice (ifam), Medical Faculty of the Heinrich-Heine-University, 40225 Duesseldorf, Germany
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Weiger C, Cohen JE, David Kennedy R, Moran MB. Testing messaging strategies to correct beliefs about nicotine and relative harm perceptions of non-cigarette tobacco products compared to cigarettes: A 2 × 2 factorial experiment of factsheets. Addict Behav 2024; 150:107915. [PMID: 38042048 DOI: 10.1016/j.addbeh.2023.107915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/14/2023] [Accepted: 11/18/2023] [Indexed: 12/04/2023]
Abstract
INTRODUCTION The misperception that nicotine is a major cause of cancer is common and may relate to inaccurate relative harm perceptions about tobacco products. To assess if messaging can correct these misperceptions, we tested factsheets that manipulated presences vs absence of (1) a causal alternative (i.e., combustion, not nicotine, causes disease) and/or (2) a reason for the misinformation (i.e., nicotine is the focus of many health messages). METHODS We used an online 2 × 2 factorial experiment of n = 193 adults who smoke and believe nicotine causes cancer to assess the effect of different message strategies on perceptions of tobacco products and switch intention. Pre-post differences and between-condition differences were assessed. RESULTS Strength of agreement with the statement that nicotine is a major cause of cancer decreased and switch intentions increased after message exposure. The proportion of participants with low relative harm perceptions increased for e-cigarettes and smokeless tobacco (p <.0001) and decreased for very low nicotine cigarettes compared to cigarettes. The message with both strategies decreased agreement that nicotine causes cancer more than the message with only the causal alternative. There was no significant effect of condition on relative harm beliefs or switch intentions. CONCLUSIONS Messages with both corrective strategies can reduce the belief that nicotine causes cancer to a greater extent than messaging that only contains a causal alternative. Belief accuracy increased after any message exposure, but these findings should be interpreted cautiously given the study design. Combined strategies should be further investigated in larger samples.
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Affiliation(s)
- Caitlin Weiger
- Rutgers Center for Tobacco Studies Fifth Floor, 303 George St. New, Brunswick, NJ 08901, United States; Institute for Global Tobacco Control Johns Hopkins Bloomberg School of Public Health Department of Health, Behavior & Society, 2213 McElderry St. Fourth Floor, Baltimore, MD 21205, United States; Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior & Society, 624 N Broadway Seventh Floor, Baltimore, MD 21205, United States.
| | - Joanna E Cohen
- Rutgers Center for Tobacco Studies Fifth Floor, 303 George St. New, Brunswick, NJ 08901, United States; Institute for Global Tobacco Control Johns Hopkins Bloomberg School of Public Health Department of Health, Behavior & Society, 2213 McElderry St. Fourth Floor, Baltimore, MD 21205, United States; Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior & Society, 624 N Broadway Seventh Floor, Baltimore, MD 21205, United States
| | - Ryan David Kennedy
- Rutgers Center for Tobacco Studies Fifth Floor, 303 George St. New, Brunswick, NJ 08901, United States; Institute for Global Tobacco Control Johns Hopkins Bloomberg School of Public Health Department of Health, Behavior & Society, 2213 McElderry St. Fourth Floor, Baltimore, MD 21205, United States; Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior & Society, 624 N Broadway Seventh Floor, Baltimore, MD 21205, United States
| | - Meghan B Moran
- Rutgers Center for Tobacco Studies Fifth Floor, 303 George St. New, Brunswick, NJ 08901, United States; Institute for Global Tobacco Control Johns Hopkins Bloomberg School of Public Health Department of Health, Behavior & Society, 2213 McElderry St. Fourth Floor, Baltimore, MD 21205, United States; Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior & Society, 624 N Broadway Seventh Floor, Baltimore, MD 21205, United States
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Selya A, Shiffman S. Comparative risk perceptions of switching to JUUL vs. continued smoking and subsequent switching away from cigarettes: a longitudinal observational study. BMC Psychol 2023; 11:305. [PMID: 37798775 PMCID: PMC10552465 DOI: 10.1186/s40359-023-01351-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 09/26/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Evidence indicates that electronic nicotine delivery systems (ENDS) pose lower risk than cigarettes; however, many smokers harbor misperceptions that ENDS are equally or more harmful, possibly deterring them from switching. This study examines whether comparative risk perceptions of JUUL vs. smoking are associated with subsequent switching, among smokers who recently purchased JUUL. METHODS N = 16,996 current established smokers who recently purchased a JUUL Starter Kit were followed 6 times over 12 months. Comparative risk perceptions were assessed using both direct and indirect measures (i.e., contrasting JUUL and smoking directly in questions, and deriving from separate absolute scales). Repeated-measures logistic regression examined switching across follow-up (no smoking in past 30 days) as a function of baseline risk perceptions, adjusting for demographics and baseline smoking behavior. RESULTS Perceiving JUUL as less harmful than smoking was associated with higher switching rates, using both direct (e.g., adjusted odds ratio [AOR] = 1.48 for "JUUL much less" vs. "more/much more harmful") and indirect (AOR = 1.07, for each 10-unit increase in fraction; AOR = 1.51 for highest (6-100) vs. lowest (0 to < 1) fraction categories) comparative risk measures (all p < 0.0001). Among the subset smoking 10 + cigarettes per day, associations between risk perceptions and switching were more pronounced (AOR = 2.51 for "JUUL much less" vs. "more/much more harmful"; AOR = 1.81 for 6-100 vs. 0 to < 1 fraction, both p < 0.0001). CONCLUSIONS Smokers who perceive JUUL as less harmful than cigarettes have higher odds of switching. Future research should examine whether messaging which aligns comparative risk perceptions with current evidence can facilitate switching, especially among heavier smokers.
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Affiliation(s)
- Arielle Selya
- Pinney Associates, Inc, 201 N Craig St., Suite 320, Pittsburgh, PA, 15213, USA.
| | - Saul Shiffman
- Pinney Associates, Inc, 201 N Craig St., Suite 320, Pittsburgh, PA, 15213, USA
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4
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Brett EI, Lee Z, Leavens ELS, Fridberg DJ, King AC. Cue Reactivity Effects of Heated Tobacco Product Use in Current, Former, and Never Smokers in the United States. Nicotine Tob Res 2023; 25:1014-1021. [PMID: 36205373 PMCID: PMC10077945 DOI: 10.1093/ntr/ntac228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 09/16/2022] [Accepted: 10/06/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Heated tobacco products (HTPs) share similar characteristics as combustible cigarettes and electronic nicotine delivery systems (ENDS) and thus may serve as cues for smoking and vaping. While HTP familiarity is low in the United States, HTPs may be perceived as a less harmful alternative to cigarettes. AIMS AND METHODS The present study examined if visual exposure to HTP use influenced cigarette and e-cigarette craving in a large national sample of adults with varied smoking patterns. Current, former, and never cigarette smokers (N = 515; Mage = 40) were recruited from online crowd-sourcing panels throughout the United States from January to April 2020. Participants completed surveys before and after watching a video depicting the use of an HTP, cigarette, or bottled water. Main outcomes were changes in cigarette craving after exposure to the video cue. Secondary outcomes included changes in e-cigarette craving. RESULTS Relative to the water cue, the HTP and cigarette cues increased cigarette craving in current smokers. The HTP cue also increased e-cigarette craving (desire for a mod or vape pen and JUUL) across all subgroups. CONCLUSIONS Current smokers demonstrated cue reactivity to the use of an HTP as they reported increases in both cigarette and e-cigarette craving after exposure. All smoking groups reported e-cigarette reactivity to the HTP cue. As HTPs gain traction globally, it is crucial to consider how their use may influence active users and passive viewers to inform future health policies. IMPLICATIONS Noncombustible nicotine delivery systems are known cues for cigarette smoking and e-cigarette vaping, and this study examined whether relatively novel heated tobacco products (HTPs) may also act as a smoking or vaping cue in adults across varied smoking backgrounds. Results showed that passive exposure to HTP use increased desire for both a cigarette and an e-cigarette in current smokers and also increased desire for an e-cigarette in former and nonsmokers. Thus given its similarity to smoking and vaping, HTP use may affect passive observers and could play a role in perpetuating the dual use of cigarettes and vape products.
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Affiliation(s)
- Emma I Brett
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Zoe Lee
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Eleanor L S Leavens
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Daniel J Fridberg
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Andrea C King
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
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5
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Effects of Heat-Not-Burn Cigarette Smoking on the Secretion of Saliva and Its Innate Immune System Components. Healthcare (Basel) 2022; 11:healthcare11010132. [PMID: 36611591 PMCID: PMC9819160 DOI: 10.3390/healthcare11010132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
Saliva and salivary antimicrobial proteins play important roles in the innate immunity, which prevents infections of orally invading bacteria and viruses. In this study, we compared the secretion rates of salivary lactoferrin (Lac) and lysozyme (Lys) in heat-not-burn (HNB) cigarette smokers and non-smokers. The analysis population for this study included 212 members of the fire department, including 32 HNB cigarette smokers, 17 paper cigarette smokers, 14 combined HNB and paper cigarette smokers, and 149 non-smokers. Salivary Lac and Lys concentrations were assessed using enzyme immunoassay. Saliva secretion was significantly lower among HNB cigarette smokers (p < 0.01) than among non-smokers. Accompanying this result, salivary Lac and Lys secretion rates were significantly lower among smokers, particularly HNB cigarette smokers, than among non-smokers (all p < 0.01). Our findings suggest a possible adverse effect of HNB cigarette on the amount of Lac and Lys released into the oral cavity.
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Rose JE, Behm FM, Botts TL, Botts DR, Willette PN, Vocci F, McCarty J. Novel rapid-acting sublingual nicotine tablet as a cigarette substitution strategy. Psychopharmacology (Berl) 2022; 239:2853-2862. [PMID: 35768615 DOI: 10.1007/s00213-022-06171-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/26/2022] [Indexed: 10/17/2022]
Abstract
RATIONALE Current nicotine replacement products provide a much slower onset of nicotine delivery than cigarettes, and hence are only marginally effective at supplanting cigarette smoking. Therefore, more effective forms of nicotine replacement are needed. OBJECTIVES This initial investigation characterized the pharmacokinetic (PK) and subjective effects of a novel sublingual (SL) nicotine tablet designed to deliver nicotine more rapidly to the bloodstream of smokers. METHODS Study 1 (N = 6) characterized the pharmacokinetics of a 2 mg nicotine SL tablet in comparison to an FDA-approved, marketed 2 mg nicotine lozenge. Study 2 (N = 24) assessed subjective responses of smokers to a single use of a 1 mg and 2 mg SL tablet. RESULTS Study 1 found that the time to maximum blood nicotine concentrations was significantly shorter for the SL tablet (14 min) than for the lozenge (82 min), and the initial rate of nicotine absorption was higher (0.4 ng/mL*min vs. 0.0 ng/mL*min), supporting the hypothesis that the SL tablet delivered nicotine more rapidly. Study 2 found that participants reported immediate relief of nicotine withdrawal symptoms after tablet administration, and craving reduction after the 2 mg tablet approached the degree reported for their usual brands of cigarettes (4.2 vs. 4.6 on a 7-point scale). Other subjective responses showed the tablet to be an appealing alternative to smoking. CONCLUSIONS The novel SL tablet studied shows promise as a nicotine substitution strategy for tobacco harm reduction and smoking cessation treatment. Additional studies are warranted to further investigate the potential of this new approach.
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Affiliation(s)
- Jed E Rose
- Rose Research Center, 7240 ACC Blvd., Raleigh, NC, 27617, USA.
| | | | - Tanaia L Botts
- Rose Research Center, 7240 ACC Blvd., Raleigh, NC, 27617, USA
| | - David R Botts
- Rose Research Center, 7240 ACC Blvd., Raleigh, NC, 27617, USA
| | | | - Frank Vocci
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, 21201, USA
| | - John McCarty
- Nicotine BRST LLC, 8250 SW 27th Avenue, Ocala, FL, 34476, USA
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Aoike M, Mori Y, Hotta K, Shigeno Y, Aoyama Y, Tanaka M, Kouzai H, Kawamura H, Tsurudome M, Ito M. Evaluation of Japanese university students' perception of smoking, interest in quitting, and smoking behavior: An examination and public health challenges during the COVID-19 pandemic. Drug Discov Ther 2022; 16:118-123. [PMID: 35753801 DOI: 10.5582/ddt.2022.01041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study examined college students' perceptions of the association between smoking and novel coronavirus disease 2019 (COVID-19), changes in smoking behavior, and interest in quitting categorized by smoking device, to identify public health challenges. A questionnaire survey was conducted among 8,547 students in a Japanese university in March and April 2021. In response to "Awareness of the increased risk of COVID-19 infection due to smoking and the tendency to develop severe disease", current smokers (70.2%) were more aware of the risk than non-smokers (49.8%) (p < 0.001), with no significant difference according to smoking device (p = 0.213). "Interest in quitting smoking" (p = 0.323), and "Changes in smoking behavior during the COVID-19 pandemic" (p = 0.146) did not differ by smoking device. However, approximately 50% of the respondents answered that they were not interested in quitting smoking, while two-thirds reported that the number of cigarettes they smoked did not change during the pandemic. During the COVID-19 pandemic, college students were found to be less interested in quitting and not likely to change their smoking behavior, despite the knowledge of the increased risk of COVID-19 transmission and severity of disease from smoking, regardless of smoking device.
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Affiliation(s)
- Makoto Aoike
- Graduate School of Life and Health Sciences, Chubu University, Aichi, Japan
| | - Yukihiro Mori
- Graduate School of Life and Health Sciences, Chubu University, Aichi, Japan.,Center for Nursing Practicum Support, Chubu University, Aichi, Japan
| | - Kiyoshi Hotta
- Center for Nursing Practicum Support, Chubu University, Aichi, Japan
| | - Yukihiro Shigeno
- Center for Emergency Medical Technician Practicum Support, Chubu University, Aichi, Japan
| | - Yuka Aoyama
- Department of Clinical Engineering, College of Life and Health Sciences, Chubu University, Aichi, Japan
| | - Mamoru Tanaka
- Department of Food and Nutritional Sciences, College of Bioscience and Biotechnology, Chubu University, Aichi, Japan
| | - Hana Kouzai
- Department of Food and Nutritional Sciences, College of Bioscience and Biotechnology, Chubu University, Aichi, Japan
| | - Hatsumi Kawamura
- Graduate School of Life and Health Sciences, Chubu University, Aichi, Japan
| | - Masato Tsurudome
- Graduate School of Life and Health Sciences, Chubu University, Aichi, Japan.,Department of Biomedical Sciences, College of Life and Health Science, Chubu University, Aichi, Japan
| | - Morihiro Ito
- Graduate School of Life and Health Sciences, Chubu University, Aichi, Japan.,Department of Biomedical Sciences, College of Life and Health Science, Chubu University, Aichi, Japan
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8
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AlMoosawi S, Bajec M, Mainy N, Kallischnigg G, Zwisele B, Fischer K, Magnani P, Roulet S. Risk perception of IQOS™ and cigarettes: Temporal and cross-country comparisons. SSM Popul Health 2022; 18:101123. [PMID: 35669892 PMCID: PMC9162949 DOI: 10.1016/j.ssmph.2022.101123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/28/2022] [Accepted: 05/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Risk perception (RP) is central to smokers’ decision to switch to smoke-free tobacco and nicotine products (TNP). This study assessed temporal trends in the health RP of a novel heated tobacco product, IQOSTM, relative to cigarettes, among current IQOSTM users. Methods The analyses included repeated cross-sectional data from online surveys in Germany (2018–19), Italy (2018–19), and Japan (2016–17, 2017–18, and 2018–19) among a random sample of current adult IQOSTM users from local registers of IQOSTM users. The health RPs of cigarettes and IQOSTM were assessed using the ABOUT™–Perceived Risk instrument, and their difference was described as the relative RP of IQOSTM to cigarettes (RPCig:IQOSTM). Results After adjustment for covariates, the relative RPCig:IQOSTM was higher in 2018 than in 2019 (0.93; standard error, 0.33; P = 0.005). This was driven by an increase in the RP of IQOSTM over time in Italy (2018: 42.6 [95% CI, 41.6–43.5]; 2019: 44.4 [43.4–45.4]) and Japan (2017: 44.0 [43.1–44.9); 2018: 45.9 [45.2–46.7]; 2019: 48.6 [47.9–49.4]), while the RP of cigarettes remained stable. Conclusions The relative RP of IQOSTM decreased over time, driven by an increase in the RP of IQOSTM, in agreement with epidemiological studies indicating a temporal reduction in the relative RP of smoke-free TNPs. Continued surveillance of the RP of novel TNPs is warranted to inform effective TNP risk communication and ensure that adults smokers who would otherwise continue to smoke understand the relative risks of novel TNPs. Risk perception is central to smokers' decision to switch from cigarettes. Little is known of temporal changes in risk perception of novel tobacco products. Risk perception of heated tobacco increased in Italy and Japan. Difference in risk perception of heated tobacco relative to cigarettes declined.
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Affiliation(s)
- Suzana AlMoosawi
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
- Corresponding author.
| | - Martha Bajec
- Bajec Senseworks consulting, Hamilton, L9A 1L5, Ontario, Canada
| | - Nelly Mainy
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
| | - Gerd Kallischnigg
- ARGUS – Statistics and Information Systems in Environment and Public Health GmbH, Karl-Heinrich-Ulrichs-Straße 20a, DE-10785, Berlin, Germany
| | - Bertram Zwisele
- ARGUS – Statistics and Information Systems in Environment and Public Health GmbH, Karl-Heinrich-Ulrichs-Straße 20a, DE-10785, Berlin, Germany
| | - Karina Fischer
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
| | - Pierpaolo Magnani
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
| | - Steve Roulet
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
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Yong HH, Gravely S, Borland R, Gartner C, Cummings KM, East K, Tagliaferri S, Elton-Marshall T, Hyland A, Bansal-Travers M, Fong GT. Do smokers' perceptions of the harmfulness of nicotine replacement therapy and nicotine vaping products as compared to cigarettes influence their use as an aid for smoking cessation? Findings from the ITC Four Country Smoking and Vaping Surveys. Nicotine Tob Res 2022; 24:1413-1421. [PMID: 35368082 PMCID: PMC9356684 DOI: 10.1093/ntr/ntac087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 03/25/2022] [Accepted: 03/31/2022] [Indexed: 12/02/2022]
Abstract
Introduction This study examined whether smokers’ harm perceptions of nicotine replacement therapy (NRT) and nicotine vaping products (NVPs) relative to cigarettes predicted their subsequent use as smoking cessation aids during their last quit attempt (LQA). Aims and Methods We analyzed data from 1,315 current daily smokers (10+ cigarettes per day) who were recruited at Wave 1 (2016), and who reported making a quit attempt by Wave 2 (2018) of the International Tobacco Control Four Country Smoking and Vaping Surveys in Australia, Canada, England, and the United States. We used multinomial logistic regression models to examine prospective associations between harm perceptions of (a) NRT and (b) NVPs and their use at LQA, controlling for socio-demographic and other potential confounders. Results Smokers who perceive that (a) NRT and (b) NVPs are much less harmful than cigarettes were more likely to subsequently use the respective product as an aid than using no aid or other aids during LQA (adjusted relative risk ratio [aRRR] = 3.79, 95%CI = 2.16–6.66; and aRRR = 2.11, 95%CI = 1.29–3.45, respectively) compared to smokers who perceive these products as equally or more harmful. Additionally, those who perceive NVPs as much less harmful than cigarettes were less likely to use NRT as a quit aid (aRRR = 0.34, 95%CI = 0.20–0.60). No country variations for these associations were found. Conclusions This study found that smokers’ perceptions of the harmfulness of (a) NRT and (b) NVPs relative to cigarettes predicted the respective product use when trying to quit smoking. Corrective education targeting misperceptions of nicotine products’ relative harmfulness may facilitate their use for smoking cessation. Implications Nicotine replacement therapy and nicotine vaping products are two commonly used smoking cessation aids. This study demonstrates that misperceptions of the harms of nicotine products relative to cigarettes influence their use for smoking cessation. Believing that nicotine vaping products are much less harmful than cigarette smoking may lead some smokers to prefer these products over nicotine replacement therapy to aid smoking cessation. Education targeting misperceptions of nicotine products’ harmfulness relative to cigarettes may enable smokers to make informed choices about which are appropriate to aid smoking cessation.
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Affiliation(s)
| | | | - Ron Borland
- The University of Melbourne, Melbourne, Victoria, Australia
| | - Coral Gartner
- The University of Queensland, Brisbane, Queensland, Australia
| | | | - Katherine East
- University of Waterloo, Waterloo, Ontario, Canada.,King's College London, London, UK
| | | | | | - Andrew Hyland
- Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | | | - Geoffrey T Fong
- University of Waterloo, Waterloo, Ontario, Canada.,Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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10
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Morgan JC, Silver N, Cappella JN. How did beliefs and perceptions about e-cigarettes change after national news coverage of the EVALI outbreak? PLoS One 2021; 16:e0250908. [PMID: 33930093 PMCID: PMC8087005 DOI: 10.1371/journal.pone.0250908] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 04/07/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Exposure to media content can shape public opinions about tobacco. In early September 2019, the outbreak of e-cigarette, or vaping, product use–associated lung injury (EVALI) became headline news in the United States. Methods In August and September 2019, we conducted two cross-sectional online surveys with current and former smokers assessing attitudes and beliefs about e-cigarettes. Study one (n = 865) was collected before the EVALI outbreak was widely covered and study two (n = 344) was collected after the outbreak had become nation-wide news. We examined differences in perceptions and beliefs between time points. Results E-cigarette harm perceptions increased between study one (mean = 2.67) and study two (mean = 2.90, p < .05). Ever-users of e-cigarettes largely account for this change. Endorsement of the belief that e-cigarettes were risky and more likely to cause lung damage compared to cigarettes increased between studies (p < .05). Seventy eight percent of participants at study two were aware of the vaping illness story. Being aware of the story was associated with more endorsement of the belief that e-cigarettes were risky to use, but not that using e-cigarettes would make the participant more likely to get damaged lungs. Discussion When the stories about the health and safety of tobacco products dominate the public information environment, it presents an opportunity to change beliefs that are frequently targeted by paid health campaigns. Changes in participant’s perceptions of e-cigarettes were associated with coverage of this large news story, underscoring the importance of working to ensure that coverage is a scientifically accurate as possible.
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Affiliation(s)
- Jennifer C. Morgan
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, United States of America
- * E-mail:
| | - Nathan Silver
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Joseph N. Cappella
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, United States of America
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