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Reynolds RM, Popova L, Ashley DL, Henderson KC, Ntansah CA, Yang B, Hackworth EE, Hardin J, Thrasher J. Messaging about very low nicotine cigarettes (VLNCs) to influence policy attitudes, harm perceptions and smoking motivations: a discrete choice experiment. Tob Control 2024; 33:325-332. [PMID: 36171147 PMCID: PMC10043050 DOI: 10.1136/tc-2022-057577] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/12/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND To reduce smoking and the harms it causes, countries, including the USA, are considering policies to reduce nicotine in combustible tobacco to minimally addictive levels. Effective messages about very low nicotine cigarettes (VLNCs) and this policy are crucial in combating misperceptions threatening the policy's effectiveness. DATA AND METHODS A discrete choice experiment assessed messages about VLNCs. Participants were 590 adults who smoked exclusively, 379 adults who both smoked and used e-cigarettes, 443 adults who formerly smoked and 351 young adults who never smoked (total n=1763). Seven message attributes were varied systematically (source, harm, chemicals, nicotine, satisfaction, addictiveness and quitting efficacy). Outcomes were selection of messages that generated the most positive attitude towards reduced nicotine policy, the greatest perceived harmfulness of VLNCs, and most strongly motivated quitting and initiating behaviour for VLNCs. RESULTS Information about specific harms and chemicals of VLNCs had the largest effects on selection of messages as eliciting more negative attitudes towards VLNCs policy, increasing perceived VLNC harmfulness, increasing motivation to quit VLNCs and decreasing motivation to try VLNCs. Messages with information about quitting efficacy were selected as more motivating to quit among those who smoke, but also more motivating to try VLNCs among those who do not smoke. CONCLUSION Harm and chemical information can be prioritised to ensure VLNCs are not misperceived as less harmful than regular cigarettes. Messages about increased quitting efficacy and reduced addictiveness associated with VLNCs may backfire if presented to those who do not smoke.
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Affiliation(s)
- Reed M Reynolds
- Communication Department, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - David L Ashley
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | | | - Charity A Ntansah
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Bo Yang
- Department of Communication, University of Arizona, Tucson, Arizona, USA
| | - Emily E Hackworth
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - James Hardin
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - James Thrasher
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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Kim SS, Prasad A, Nayak MM, Chen H, Srisoem C, DeMarco RF, Castaldi P, Cooley ME. Predictors of Nicotine Replacement Therapy Adherence: Mixed-Methods Research With a Convergent Parallel Design. Ann Behav Med 2024; 58:275-285. [PMID: 38401531 DOI: 10.1093/abm/kaae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Few studies have examined the effect of baseline attitudes toward nicotine replacement therapy (NRT) on its actual adherence in a smoking cessation intervention. PURPOSE This study (i) examined the predictability of baseline variables (quantitative data) on NRT adherence and (ii) explored the congruence of participants' statements about NRT products (qualitative data) during counseling sessions with their baseline attitudes. METHODS This is a mixed-methods research study using a convergent parallel design. Participants included 74 individuals in the treatment group who received behavioral counseling and combination NRT. A Poisson regression analysis was performed to identify baseline variables predicting NRT adherence. Thematic analysis was completed with a subset of participants (n = 38) who varied in NRT attitude scores and adherence. A joint display was created to integrate quantitative and qualitative data and discover convergence. RESULTS Approximately 59% of the participants (41/74) used NRT continuously for ≥5 weeks. Having negative attitudes toward NRT and depressive symptoms predicted NRT adherence even after controlling for education and anxiety symptoms. Thematic analysis revealed that NRT adherence is a learning process that consists of the following three distinctive but interrelated phases: (i) information needs, (ii) comprehensive readiness, and (iii) experiential learning. Of the 38 participants, 34 (89.5%) showed convergence between baseline attitude scores and statements about NRT made during counseling sessions. CONCLUSIONS Individuals who have negative attitudes toward NRT are less likely to use the products in a smoking cessation intervention. Counselors should assess attitudes toward NRT at baseline and address them proactively during counseling sessions.
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Affiliation(s)
- Sun S Kim
- Department of Nursing, Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Anyah Prasad
- Department of Gerontology, Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Manan M Nayak
- Department of Psychosocial Oncology and Palliative Care, The Phyllis F. Cantor Center Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Hua Chen
- Department of Nursing, Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Chaowalit Srisoem
- Department of Nursing, Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Rosanna F DeMarco
- Department of Nursing, Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Peter Castaldi
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mary E Cooley
- Phyllis F. Cantor Center, Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Johnson AC, Mercincavage M, Tan ASL, Villanti AC, Delnevo CD, Strasser AA. Effects of reduced nicotine content cigarette advertising with warning labels and social media features on product perceptions among young adults. J Behav Med 2023; 46:948-959. [PMID: 37605036 PMCID: PMC10591832 DOI: 10.1007/s10865-023-00441-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 07/24/2023] [Indexed: 08/23/2023]
Abstract
This study sought to understand reactions to very low nicotine (VLN) cigarette advertising compared with conventional cigarette advertising with consideration of warning labels and social media context. The online experimental study recruited young adult cigarette smokers and nonsmokers (N = 1,608). Participants completed a discrete choice task with a 2 × 2 × 3 mixed design: brand, (VLN, Marlboro), context (Ad only, Ad on social media), and warning (Text-only, Well-known risk pictorial, or Lesser-known risk pictorial). Participants made choices about attention, appeal, harm, buying, and quitting intentions. Social media context increased attention and appeal. A well-known risk pictorial warning outperformed a text-only warning. Smokers had increased odds of quit intentions for VLN ads, yet nonsmokers had increased intentions to buy cigarettes on social media with a text-only warning. Results indicate differences in how young adults react to cigarette ads on social media, especially with the warnings they portray.
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Affiliation(s)
- Andrea C Johnson
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104-3309, USA.
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA.
| | - Melissa Mercincavage
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104-3309, USA
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Andy S L Tan
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104-3309, USA
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrea C Villanti
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ, USA
| | - Cristine D Delnevo
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ, USA
| | - Andrew A Strasser
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104-3309, USA
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
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Villanti AC, Peasley-Miklus C, Mercincavage M, Mays D, Donny EC, Cappella JN, Strasser AA. Effect of nicotine corrective messaging on nicotine-related beliefs in US adults: a randomised controlled trial. Tob Control 2023:tc-2023-058252. [PMID: 37989586 DOI: 10.1136/tc-2023-058252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 11/01/2023] [Indexed: 11/23/2023]
Abstract
INTRODUCTION Widespread misperceptions of the health risks of nicotine could undermine the public health benefits of the Food and Drug Administration's actions, including modified risk tobacco product authorisations and a reduced nicotine product standard for cigarettes. METHODS 794 US adults (aged 18+) in NORC's AmeriSpeak panel participated in a randomised controlled trial in Spring 2021 to test the effect of three exposures to eight nicotine corrective messages (NCM) on beliefs about nicotine, nicotine replacement therapy (NRT), e-cigarettes and reduced nicotine content (RNC) cigarettes at 3-month follow-up. Analyses conducted in 2022 examined the effect of study condition (NCM (n=393) vs no message control (n=401)) on nicotine beliefs, use intentions and use of nicotine and tobacco products. RESULTS Exposure to three NCM doses reduced nicotine (b=-0.33; 95% CI -0.60, -0.07), NRT (b=-0.49; 95% CI -0.85, -0.14), e-cigarette (b=-0.32; 95% CI -0.59, -0.05) and RNC cigarette false beliefs (b=-0.64; 95% CI -1.26, -0.02) compared with the control, controlling for baseline beliefs. Baseline tobacco use and concern about nicotine addiction attenuated intervention effects on false beliefs about RNC cigarettes. There were few intervention effects on intention or use of nicotine and tobacco products. CONCLUSIONS Repeated exposure to NCM was necessary to reduce false beliefs about nicotine and tobacco products. Future studies will improve understanding of the dose and duration of nicotine education needed to shift intentions and behaviour, as well as tailored content for tobacco product users to achieve similar reductions in false beliefs as non-users. TRIAL REGISTRATION NUMBER NCT04805515.
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Affiliation(s)
- Andrea C Villanti
- Rutgers Institute for Nicotine and Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Catherine Peasley-Miklus
- Vermont Center on Behavior and Health, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - Melissa Mercincavage
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Darren Mays
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Eric C Donny
- Baptist Comprehensive Cancer Center and Department of Physiology and Pharmacology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Joseph N Cappella
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew A Strasser
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Johnson AC, Mercincavage M, Souprountchouk V, Deatley T, Mays D, Strasser AA. Assessing Attention to Tobacco Warnings With a Heatmapping Task. Am J Prev Med 2023; 65:809-817. [PMID: 37257762 PMCID: PMC10592484 DOI: 10.1016/j.amepre.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/24/2023] [Accepted: 05/24/2023] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Attention is a critical outcome to understanding the impacts of tobacco warning labels and is commonly measured using eye tracking. Self-report, online methods may be efficient, scalable alternatives to capture attention. This study assesses warning label attention on cigarette marketing using a heatmapping task. METHODS Young adults (n=1,608) aged 18-30 years and registered on Mechanical Turk with a WorkerID verified in the U.S. were included. Data were collected in 2021-2022 and analyzed in 2022. Tobacco advertisement exposure included a 2 × 3 between-subjects factorial design for varying contexts and warnings. Attention was operationalized with self-reported frequency and timing of warning selection. Outcomes include credibility, willingness to use the advertised cigarettes, and intentions to use cigarettes and low-nicotine cigarettes. RESULTS Early and more frequent attention to the warning was associated with higher credibility (frequent: β=0.28, 95% CI=0.11, 0.44; early: β=0.14, 95% CI=0.02, 0.25), lower willingness to use the advertised cigarettes (frequent: β= -1.78, 95% CI= -2.24, -1.32; early: β= -1.16, 95% CI= -1.49, -0.84), lower cigarette use intentions in the next week (frequent: β= -0.44, 95% CI= -0.64, -0.25; early: β= -0.21, 95% CI= -0.35, -0.08), and lower low-nicotine cigarette use intentions in the next week (frequent: β= -0.47, 95% CI= -0.66, -0.28; early: β= -0.25, 95% CI= -0.38, -0.12) than no attention at all. CONCLUSIONS Greater attention as measured by a heatmapping task was observed for pictorial warnings and associated with lower intentions to use tobacco. Heatmapping selection patterns were a suitable proxy for attention in this online sample.
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Affiliation(s)
- Andrea C Johnson
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Tobacco Center of Regulatory Science (TCORS), Annenberg School of Communication, University of Pennsylvania-Rutgers University, Philadelphia, Pennsylvania.
| | - Melissa Mercincavage
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Tobacco Center of Regulatory Science (TCORS), Annenberg School of Communication, University of Pennsylvania-Rutgers University, Philadelphia, Pennsylvania; Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Valentina Souprountchouk
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Tobacco Center of Regulatory Science (TCORS), Annenberg School of Communication, University of Pennsylvania-Rutgers University, Philadelphia, Pennsylvania
| | - Teresa Deatley
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Tobacco Center of Regulatory Science (TCORS), Annenberg School of Communication, University of Pennsylvania-Rutgers University, Philadelphia, Pennsylvania
| | - Darren Mays
- Center for Tobacco Research, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio; Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Andrew A Strasser
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Tobacco Center of Regulatory Science (TCORS), Annenberg School of Communication, University of Pennsylvania-Rutgers University, Philadelphia, Pennsylvania; Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania; Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania
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Yong HH, Karmakar C, Motin MA, Borland R, Cummings KM, Gravely S, Fong GT. Individual and Conjoint Factors Associated With Beliefs About the Harmfulness of Nicotine Replacement Therapies Relative to Combustible Cigarettes Among People Who Smoke: Findings From the 2020 ITC Four Country Smoking and Vaping Survey. Nicotine Tob Res 2023; 25:1594-1602. [PMID: 37195899 PMCID: PMC10439491 DOI: 10.1093/ntr/ntad075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 04/20/2023] [Accepted: 05/15/2023] [Indexed: 05/19/2023]
Abstract
INTRODUCTION This study examined individual and conjoint factors associated with beliefs about the harmfulness of nicotine replacement therapies (NRTs) relative to combustible cigarettes (CCs). AIMS AND METHODS Data analyzed came from 8642 adults (≥18 years) who smoked daily/weekly and participated in the 2020 ITC Four Country Smoking and Vaping Survey in Australia (n = 1213), Canada (n = 2633), England (n = 3057), and United States (n = 1739). Respondents were asked: "Compared to smoking cigarettes, how harmful do you think nicotine replacement products are?" Responses were dichotomized into "much less" versus otherwise for analysis using multivariable logistic regression models, complemented by decision-tree analysis to identify conjoint factors. RESULTS Percentages believing that NRTs are much less harmful than CCs were 29.7% (95% CI = 26.2% to 33.5%) in Australia, 27.4% (95% CI = 25.1% to 29.8%) in England, 26.4% (95% CI = 24.4% to 28.4%) in Canada, and 21.7% (95% CI = 19.2% to 24.3%) in the United States. Across all countries, believing nicotine is not at all/slightly harmful to health (aOR = 1.53-2.27), endorsing nicotine vaping products (NVPs) as less harmful than CCs (much less harmful: aOR = 7.24-14.27; somewhat less harmful: aOR = 1.97-3.23), and possessing higher knowledge of smoking harms (aOR = 1.23-1.88) were individual factors associated with increased odds of believing NRTs are much less harmful than CCs. With some country variations, these nicotine-related measures also interacted with each other and sociodemographic variables to serve as conjoint factors associated with the likelihood of accurate NRT relative harm belief. CONCLUSIONS Many people who regularly smoke cigarettes are unaware that NRTs are much less harmful than cigarettes. Additionally, beliefs about NRTs relative harmfulness appear to be influenced by both individual and conjoint factors. IMPLICATIONS This study demonstrates that despite past efforts to educate people who smoke about the harms of NRTs relative to CCs, misperceptions around the relative harmfulness of NRTs remain substantial. In all four studied countries, subgroups of people who smoke regularly who are misinformed about the relative harmfulness of NRTs, and who may be reluctant to use NRTs for smoking cessation can be reliably identified for corrective interventions based on their understanding of the harms related to nicotine, NVPs and smoking along with sociodemographic markers. The identified subgroup information can be used to prioritize and inform the development of effective interventions to specifically address the gaps in knowledge and understanding of the various subgroups identified. Our results suggest these may need to be tailored for each country.
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Affiliation(s)
| | | | | | | | | | | | - Geoffrey T Fong
- University of Waterloo, Waterloo, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
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Keller-Hamilton B, Stevens EM, Villanti AC, Leshner G, Wagener TL, Mays D. Messaging to prevent and reduce young adults' waterpipe tobacco smoking: A randomized trial. Addict Behav 2023; 138:107546. [PMID: 36455379 PMCID: PMC9780172 DOI: 10.1016/j.addbeh.2022.107546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 11/14/2022]
Abstract
INTRODUCTION More than 10% of U.S. young adults have smoked waterpipe tobacco in the past month and >25% of those who have never smoked are susceptible. We tested messages designed to prevent and reduce waterpipe tobacco smoking (WTS). METHODS In 2020, we recruited 830 U.S. young adults (18-30 years) who had never smoked waterpipe tobacco and were susceptible or currently smoked waterpipe tobacco for an online study. We randomized participants to intervention messages about the risks of WTS or control messages unrelated to tobacco. Participants had up to four message exposures over 12 weeks and completed two-, four-, and six-month follow-ups. Outcomes were WTS initiation and curiosity (susceptible never smokers), WTS frequency, cessation, motivation to quit (those who currently smoked), and WTS risk perceptions. RESULTS Intervention messages increased perceived addictiveness of WTS at two months (β = 0.27; 95% CI: 0.11, 0.43) in susceptible never smokers. There were no significant intervention effects in those who currently smoked. Exploratory analyses among intervention participants showed that higher dose of message exposure decreased WTS initiation at six months in susceptible never smokers (RR = 0.68; 95% CI: 0.48, 0.96) and decreased WTS frequency (IRR = 0.84; 95% CI: 0.73, 0.97) and increased cessation (RR = 1.31; 95% CI: 1.07, 1.59) at six months in those who smoked. CONCLUSIONS Although the WTS intervention messages had few significant effects on outcomes overall, a higher dose of message exposure affected behavioral outcomes in the intervention arm. Findings highlight the need to identify effective message content and optimal message dose, especially for digital media campaigns.
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Affiliation(s)
- Brittney Keller-Hamilton
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Elise M Stevens
- Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Andrea C Villanti
- Rutgers Center for Tobacco Studies, Department of Health, Behavior, Society, & Policy, Rutgers School of Public Health, New Brunswick, NJ, United States
| | - Glenn Leshner
- Gaylord College of Journalism and Mass Communication, University of Oklahoma, Norman, OK, United States
| | - Theodore L Wagener
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Darren Mays
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States.
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Parker MA, Byers JE, Villanti AC. Effect of brief nicotine corrective messaging on nicotine beliefs in persons who use opioids. Exp Clin Psychopharmacol 2022; 30:1008-1015. [PMID: 34291993 PMCID: PMC8782917 DOI: 10.1037/pha0000497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This pilot study tested the effect of a brief nicotine education messaging exposure on beliefs about nicotine, nicotine-replacement therapy (NRT), and e-cigarettes. Participants ages 18 and older were recruited via Amazon Mechanical Turk to complete a 20-min online survey in April/May 2020 to assess relationships between opioid use, smoking, and other behaviors. Participants with past-month extra-medical opioid use completed questions on background characteristics and literacy and then were randomized in a 2:1 ratio of two conditions: nicotine education (n = 362) or no message control (n = 181). Beliefs about nicotine, NRT, and e-cigarettes were asked of all participants; this occurred after message exposure for the nicotine education condition. Bivariate and multivariable analyses examined differences in beliefs by study condition. Brief nicotine messaging increased the probability of a correct response to "Nicotine is a cause of cancer" (false, 63% vs. 36%) and reduced the probability of a don't know response (9% vs. 17%) compared to the no message control condition. Nicotine education also reduced false beliefs about harms of long-term NRT use compared to cigarettes (p < .05). In adjusted models, participants in the nicotine education group had lower mean false beliefs about nicotine (p < .001) and to a lesser extent NRT (p = .053) compared with the control group; there was no difference in mean false beliefs about e-cigarettes (p = .547) between groups. A brief education intervention produced similar changes in nicotine beliefs in adults with past-month extra-medical opioid use as in a general adult sample. Findings support the potential for impact of nicotine public education messaging in vulnerable populations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Maria A. Parker
- Indiana University School of Public Health, Department of Epidemiology & Biostatistics, Bloomington, IN, United States
| | - Jodi E. Byers
- Indiana University School of Public Health, Department of Applied Health Science, Bloomington, IN, United States
| | - Andrea C. Villanti
- Vermont Center on Behavior & Health, University of Vermont, Burlington, VT, United States
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Tidey JW, Snell LM, Colby SM, Cassidy RN, Denlinger-Apte RL. Effects of very low nicotine content cigarettes on smoking across vulnerable populations. Prev Med 2022; 165:107099. [PMID: 35642796 PMCID: PMC9699899 DOI: 10.1016/j.ypmed.2022.107099] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/19/2022] [Accepted: 05/22/2022] [Indexed: 10/18/2022]
Abstract
There has been long-standing interest in a reduced-nicotine product standard for combusted tobacco, which is within the regulatory purview of the Food and Drug Administration (FDA). In weighing whether to establish this standard, it is important to consider potential responses among people who are at elevated risk for tobacco-related health harms. In this narrative review, we summarize studies of very low nicotine content (VLNC) cigarettes conducted between 2010 and 2021 in groups that the FDA has identified as vulnerable populations. Studies conducted to date in adults with mental health conditions, adults with opioid use disorder, socioeconomically-disadvantaged adults, and youth or young adults indicate that immediate switching to VLNC cigarettes decreases smoking, with minimal or no unintended negative consequences. Few studies have investigated the effects of VLNC cigarettes in racial or ethnic minorities, people who smoke menthol cigarettes, and pregnant women, but initial findings suggest that responses of these individuals are similar to responses observed in other vulnerable populations. We are not aware of studies that have investigated VLNC cigarettes in military/veteran populations, sexual or gender minority individuals, or people living in underserved rural environments. Future research directions include understanding how to promote cessation in the context of a reduced-nicotine standard, and how to correct VLNC misperceptions in vulnerable populations. Nevertheless, the evidence to date indicates that a reduced-nicotine standard is likely to have the same beneficial effects on smoking reductions as it does in less vulnerable populations, which should provide some confidence in pursuing this regulatory approach.
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Affiliation(s)
- Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, USA.
| | - L Morgan Snell
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, USA
| | - Suzanne M Colby
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, USA
| | - Rachel N Cassidy
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, USA
| | - Rachel L Denlinger-Apte
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, USA
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11
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Villanti AC, Wackowski OA, LePine SE, West JC, Stevens EM, Unger JB, Mays D. Effects of Vaping Prevention Messages on Electronic Vapor Product Beliefs, Perceived Harms, and Behavioral Intentions among Young Adults: A Randomized Controlled Trial. Int J Environ Res Public Health 2022; 19:14182. [PMID: 36361061 PMCID: PMC9655851 DOI: 10.3390/ijerph192114182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
Youth have been the focus of electronic vapor product (EVP) prevention efforts though young adults had similar increases in current EVP use from 2015-2019. This study tested messages to reduce EVP use in young adults. Eight messages on vaping related harms and addictiveness combined with themes on social use and flavors were selected for inclusion in an online randomized controlled trial. Vermont young adults aged 18-24 (n = 569) were randomized to view the eight vaping prevention messages (n = 295) or eight messages on sun safety (n = 274). After completing baseline measures, participants viewed study messages and completed measures on message perceptions and perceived message effectiveness (PME), EVP-related beliefs, and EVP-related harm perceptions. Participants completed EVP-related beliefs and harm perception measures again at 1-month follow-up, as well as measures on tobacco and EVP-related behavioral intentions and behavior (ever and past 30-day use). Intervention participants reported positive impacts on vaping-related message responses. However, findings suggested no effect of vaping prevention messages on EVP-related beliefs, harm perceptions, or behaviors in the full sample. Exploratory analyses in the intervention condition showed that greater PME was associated with lower odds to intent to try cigarettes in the next year at follow-up.
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Affiliation(s)
- Andrea C. Villanti
- Rutgers Center for Tobacco Studies, New Brunswick, NJ 08901, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ 08854, USA
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT 05401, USA
| | - Olivia A. Wackowski
- Rutgers Center for Tobacco Studies, New Brunswick, NJ 08901, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ 08854, USA
| | - S. Elisha LePine
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT 05401, USA
- Department of Psychology, University of Florida, Gainesville, FL 32611, USA
| | - Julia C. West
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT 05401, USA
- Department of Psychological Science, University of Vermont, Burlington, VT 05401, USA
| | - Elise M. Stevens
- Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
| | - Jennifer B. Unger
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA
| | - Darren Mays
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43214, USA
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Hameed A, Malik D, El-demerdash FM. Public Health Practitioners’ Knowledge towards Nicotine and Other Cigarette Components on Various Human Diseases in Pakistan: A Contribution to Smoking Cessation Policies. BioMed Research International 2022; 2022:1-13. [PMID: 36225984 PMCID: PMC9550448 DOI: 10.1155/2022/7909212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022]
Abstract
Smoking cessation seems to be a weak link in the struggle against tobacco epidemic in Pakistan. Awareness regarding nicotine is lacking not only in the general population but also among public health practitioners. This lack of knowledge is one of the key barriers to bringing down the prevalence of smoking. Using primary survey data and nonparametric econometric techniques, this study assesses the knowledge of nicotine and harm reduction among public health practitioners in Pakistan. Results indicate physicians have misconceptions about nicotine. The majority of the medical professionals associate nicotine use with birth defects, cancer, cardiovascular illness, and chronic obstructive pulmonary disease (COPD). More than two-thirds of doctors (70%) strongly agreed and 17.9% somewhat agreed with the statement that nicotine causes cancer. This study suggests physicians need to be better informed about the fact that nicotine in tobacco products is addictive while chemicals, particularly those causing combustion, are the primary risk sources for tobacco-related illnesses. Misconceptions regarding nicotine can be quickly remedied with communication interventions. This study also suggests that alternative nicotine delivery systems can help smoking cessation and reduce the consumption of combustible tobacco in Pakistan.
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Jackson I, Etuk A, Jackson N, Osaghae I. Effect of nicotine, low nicotine, and e-cigarette beliefs on cigarette and e-cigarette use in the US population and cancer survivors. J Public Health (Oxf) 2022; 30:861-869. [DOI: 10.1007/s10389-020-01361-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Janmohamed K, Walter N, Sangngam N, Hampsher S, Nyhan K, De Choudhury M, Kumar N. Interventions to Mitigate Vaping Misinformation: A Meta-Analysis. J Health Commun 2022; 27:84-92. [PMID: 35220901 DOI: 10.1080/10810730.2022.2044941] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The impact of misinformation about vapes' relative harms compared with smoking may lead to increased tobacco-related burden of disease and youth vaping. Unfortunately, vaping misinformation has proliferated. Despite growing attempts to mitigate vaping misinformation, there is still considerable ambiguity regarding the ability to effectively curb the negative impact of misinformation. To address this gap, we use a meta-analysis to evaluate the relative impact of interventions designed to mitigate vaping-related misinformation. We searched (from January 2020 till August 2021) various databases and gray literature. Only English language, original studies that employed experimental designs where participants were randomly assigned either to receive mitigating information or to a no-mitigation condition (either misinformation-only or neutral control) were included. Meta-analysis was conducted for the four eligible studies. The mean effect size of attempts to mitigate vaping misinformation was positive but not statistically significant (d = 0.383, 95% CI [-0.029, 0.796], p = .061, k = 5) with lack of evidence for publication bias. Given limited studies included, we were unable to determine factors affecting the efficacy of interventions. The limited focus on non-US studies and youth populations is concerning given the popularity of vaping in low- to middle-income countries (LMICs) and among youth. The findings of this meta-analysis describe the current state of the literature and prescribe specific recommendations to better address the proliferation of vaping misinformation, providing insights helpful in limiting the tobacco mortality burden and curtailing youth vaping.
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Affiliation(s)
| | - Nathan Walter
- Department of Communication Studies, Northwestern University, Evanston, Illinois, USA
| | | | - Sam Hampsher
- BOTEC Analysis, LLC, Woodland Hills, California, USA
| | - Kate Nyhan
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, Connecticut, USA
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | | | - Navin Kumar
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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Differding M, Katz SJ, Strayer LG, White C, Strasser AA, Donny EC, Hatsukami DK, Carroll DM. Educating the Public on the Health Risks of Very Low Nicotine Content Cigarettes: Results From a US-Based Convenience Sample. Nicotine Tob Res 2022; 24:871-880. [PMID: 35023564 PMCID: PMC9048884 DOI: 10.1093/ntr/ntac010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/23/2021] [Accepted: 01/10/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION US FDA issued an advance notice of proposed rulemaking to reduce nicotine in cigarettes. To maximize the benefits of this potential standard, very low nicotine content (VLNC) cigarettes must be communicated in a way that does not result in misperceptions. AIMS AND METHODS Adults (n = 567 who smoke; n = 610 non-smokers) from an online platform were randomized to a control message previously associated with accurate addictiveness perceptions of VLNC cigarettes but health misperceptions or to one of five messages that also included messaging on nicotine morbidity effects or VLNC cigarettes morbidity or mortality effects. p value <.01 was significant. RESULTS In participants who smoke, perceived lung cancer risk (responses: 1, very little risk to 10, very high risk) if smoked VLNC cigarettes regularly was higher in conditions that communicated mortality effects of VLNC cigarettes compared to the control (7.12-7.18 vs. 5.97, p values < .01). In non-smokers, perceived lung cancer risk was higher in all five message conditions when compared with the control (7.58-8.22 vs. 6.35, p values < .01). Proportion who responded accurately (ie, False) to the statement Cigarettes with 95% less nicotine are safer than cigarettes with normal nicotine levels was higher in conditions describing VLNC morbidity or mortality effects when compared with the control in both participants who smoke (52.04-67.37% vs. 30.85%, p values < .01) and do not smoke (62.50-72.38% vs. 32.00%, p values < .01). CONCLUSIONS Messaging on mortality effects of VLNC cigarettes (ie, cigarettes with 95% less nicotine are as deadly as current cigarettes) was associated with more accurate perceptions of the health risks of VLNC cigarettes than the control; however, misperceptions remained in one-third of participants. IMPLICATIONS One approach to communicating a VLNC cigarette standard to the public is to include messaging on the mortality effects of VLNC cigarettes. However, further study and possible refinement of this message condition are recommended since approximately one-third of participants exposed to this message still perceived VLNC cigarettes to be safer than normal nicotine content cigarettes.
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Affiliation(s)
| | - Sherri Jean Katz
- Hubbard School of Journalism and Mass Communication, University of Minnesota, Minneapolis, MN, USA
| | - Lori G Strayer
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Cassidy White
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Andrew A Strasser
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Eric C Donny
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Dorothy K Hatsukami
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
- Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Dana Mowls Carroll
- Corresponding Author: Dana Mowls Carroll, MPH, PhD, Division of Environmental Health Sciences, School of Public Health, Masonic Cancer Center, University of Minnesota, 717 Delaware St SE, Room 254, Minneapolis, MN 55414, USA. Telephone: 612-624-0132; E-mail:
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Steinberg MB, Bover Manderski MT, Wackowski OA, Singh B, Strasser AA, Delnevo CD. Nicotine Risk Misperception Among US Physicians. J Gen Intern Med 2021; 36:3888-3890. [PMID: 32875504 PMCID: PMC8642586 DOI: 10.1007/s11606-020-06172-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/17/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Michael B Steinberg
- Department of Medicine, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA.
| | | | - Olivia A Wackowski
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ, USA
| | - Binu Singh
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ, USA
| | - Andrew A Strasser
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Cristine D Delnevo
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ, USA
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Erku DA, Bauld L, Dawkins L, Gartner CE, Steadman KJ, Noar SM, Shrestha S, Morphett K. Does the content and source credibility of health and risk messages related to nicotine vaping products have an impact on harm perception and behavioural intentions? A systematic review. Addiction 2021; 116:3290-3303. [PMID: 33751707 DOI: 10.1111/add.15473] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 11/02/2020] [Accepted: 02/24/2021] [Indexed: 01/10/2023]
Abstract
AIMS To systematically review the literature on (i) whether and how various risk messages about nicotine vaping products (NVPs) alter harm perception and behavioural intentions of smokers and non-smokers and (ii) how trust in sources of NVP risk communication affects message reception and behavioural intentions. METHODS Seven electronic databases and reference lists of relevant articles were searched for articles published up to April 2020. Experimental and quasi-experimental studies on message effects and cross-sectional studies on source credibility were included. The Newcastle-Ottawa Scale and the Evidence Project Risk of Bias Tool were used to assess the quality of observational and intervention studies, respectively. For each outcome variable, we indicated whether there was an effect (as a 'yes' or 'no') and used effect direction plots to display information on the direction of effects. RESULTS Nicotine addiction messages resulted in greater health and addiction risk perceptions, relative risk messages comparing the health risks of NVPs to cigarette smoking increased the perception that NVPs are less harmful than combustible cigarettes, and a nicotine fact sheet corrected misperceptions of nicotine and NVPs. Smokers' intention to purchase, try or switch to NVPs was higher when exposed to a relative risk message and lower when exposed to nicotine addiction warnings. Trust in NVP risk information from public health agencies was associated with lower odds of; (i) NVP use and (ii) perceiving NVPs as less harmful, whereas those who trusted information from NVP companies were more likely to perceive NVPs as less harmful than combustible cigarettes. CONCLUSIONS Relative risk messages may help improve the accuracy of harm perceptions of nicotine vaping products and increase smokers' intentions to quit smoking and/or to switch to vaping, although the literature is nascent.
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Affiliation(s)
- Daniel A Erku
- Centre for Applied Health Economics, Griffith University, Nathan, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.,School of Pharmacy, The University of Queensland, 20 Cornwall Street, Woolloongabba, QLD, 4102, Australia
| | - Linda Bauld
- Usher Institute and SPECTRUM Consortium, College of Medicine and Veterinary Medicine, University of Edinburgh, Teviot Place, Edinburgh, Edinburgh, Scotland, EH8 9AG, UK
| | - Lynne Dawkins
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, 103 Borough Road, London, UK
| | - Coral E Gartner
- School of Public Health, The University of Queensland, Herston Road, Herston, QLD, 4006, Australia.,Queensland Alliance for Environmental Health Sciences, The University of Queensland, 20 Cornwall Street, Woolloongabba, QLD, 4102, Australia
| | - Kathryn J Steadman
- School of Pharmacy, The University of Queensland, 20 Cornwall Street, Woolloongabba, QLD, 4102, Australia
| | - Seth M Noar
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-3365, USA
| | - Shakti Shrestha
- School of Pharmacy, The University of Queensland, 20 Cornwall Street, Woolloongabba, QLD, 4102, Australia
| | - Kylie Morphett
- School of Public Health, The University of Queensland, Herston Road, Herston, QLD, 4006, Australia
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Snell LM, Colby SM, DeAtley T, Cassidy R, Tidey JW. Associations Between Nicotine Knowledge and Smoking Cessation Behaviors among U.S. Adults Who Smoke. Nicotine Tob Res 2021; 24:855-863. [PMID: 34850185 PMCID: PMC9048939 DOI: 10.1093/ntr/ntab246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/17/2021] [Accepted: 11/23/2021] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Misperceptions about nicotine's contribution to smoking-related health harms could complicate efforts to reduce the public health burden of smoking. Study goals were to describe nicotine knowledge among adults who smoke and investigate whether misperceiving nicotine as a source of health harm was associated with beneficial health behaviors, or lower uptake of using less harmful sources of nicotine to support smoking cessation attempts. METHOD This study used longitudinal data from 9,140 adults who participated in four waves of the Population Assessment of Tobacco and Health Study and were current smokers during the first wave. Logistic regressions estimated odds ratios for correct responses across six aspects of nicotine knowledge assessed in Wave 4. Longitudinal models estimated associations between misperceptions and cigarette consumption, and odds of making a quit attempt; self-reported cessation; e-cigarette use; and use of NRT or e-cigarettes to support quit attempts. RESULTS Participants who were non-White, older, and had lower educational attainment or income tended to be least knowledgeable about nicotine. Misperceiving nicotine as harmful to health was associated with increased odds of quit attempts (AOR: 1.12, 95% CI: 1.03, 1.23), lower odds of cessation success (AOR: 0.84, 95% CI: 0.73, 0.98) and e-cigarette use (AOR: 0.79, 95% CI: 0.72, 0.86), and lower odds of using NRT (AOR: 0.84, 95% CI: 0.71, 0.99) or e-cigarettes to support quit attempts (AOR: 0.59, 95% CI: 0.49, 0.71). CONCLUSION Harm reduction efforts may be impeded by misperceptions about nicotine. Further work should evaluate the effects of correcting such misperceptions through public education. IMPLICATIONS This study provides longitudinal evidence that among adult smokers, misperceiving nicotine as a primary cause of smoking-related diseases may be associated with reduced cessation success and lower likelihood of using less harmful nicotine products. These misperceptions may therefore impede efforts to encourage smokers ready to quit to use evidence-based cessation support such as nicotine replacement during quit attempts and limit the success of policies designed to shift smokers to less harmful sources of nicotine. Further work should evaluate the longitudinal effects of correcting nicotine misperceptions through public education targeted toward adults who smoke.
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Johnson AC, Mercincavage M, Souprountchouk V, Rogelberg S, Sidhu AK, Delnevo CD, Strasser AA. Responses to reduced nicotine cigarette marketing features: a systematic review. Tob Control 2021; 32:tobaccocontrol-2021-056826. [PMID: 34620718 PMCID: PMC8986886 DOI: 10.1136/tobaccocontrol-2021-056826] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/20/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To systematically review the literature regarding responses to commercial and public health marketing features for reduced nicotine cigarettes (RNCs) to anticipate potential industry and regulatory actions should an RNC product standard be issued. DATA SOURCES We searched PubMed for English-language articles using several keywords for reduced nicotine products, cigarettes and marketing features published through 2020. STUDY SELECTION Of 4092 records, 26 studies were retained for review that met criteria focusing on responses to RNC marketing features. DATA EXTRACTION Search terms created by the research team were used for review and included independent extraction and coding by two reviewers. Coding was categorised using study design terminology, commercial and public health features in tobacco regulatory science, and their association with individual responses outlined by several message processing outcomes. DATA SYNTHESIS Most studies focused on current cigarette smokers and were cross-sectional. Reactions to RNCs and attitudes and beliefs were the most common outcomes measured. For commercial features, articles generally studied RNC advertisements, products and/or descriptors. For public health features, articles studied counter-messaging (eg, warning labels) or general descriptors about nicotine or a reduced nicotine product standard. Commercial features were generally associated with favourable responses. Public health features offset favourable responses across most outcomes, though their efficacy was mixed. Contrasts in results by smoking status are discussed. CONCLUSIONS Commercial marketing of RNCs is appealing and may need stronger regulations or communication campaigns to accurately convey risks. Opportunities exist for future research within tobacco regulatory science.
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Affiliation(s)
- Andrea C Johnson
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, Pennsylvania, USA
| | - Melissa Mercincavage
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, Pennsylvania, USA
| | - Valentina Souprountchouk
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, Pennsylvania, USA
| | - Sasha Rogelberg
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anupreet K Sidhu
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, Pennsylvania, USA
| | - Cristine D Delnevo
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, Pennsylvania, USA
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
| | - Andrew A Strasser
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, Pennsylvania, USA
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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20
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Donny EC, White CM. A review of the evidence on cigarettes with reduced addictiveness potential. Int J Drug Policy 2021; 99:103436. [PMID: 34535366 PMCID: PMC8785120 DOI: 10.1016/j.drugpo.2021.103436] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 12/17/2022]
Abstract
Background In May 2018, the Secretariat for the World Health Organization Framework Convention on Tobacco Control convened a meeting to discuss the potential for reducing the addictiveness of tobacco products. A central focus was to review research findings on the behavioral effects of reducing the addictiveness of cigarettes. Methods This manuscript reports the results of a review of the behavioral science literature, updated through April 2021, with special attention to both the potential benefits and unintended consequences of reducing nicotine in cigarettes. Results Available evidence suggests that reducing nicotine content in cigarettes to very low levels could benefit public health in three primary ways, by 1) decreasing uptake of regular smoking, 2) decreasing the amount people smoke, and 3) increasing the likelihood of smoking cessation. Current evidence also suggests that reducing nicotine in cigarettes may produce similar benefits across many important subpopulations of people who smoke, including those with psychiatric comorbidities, those who use other substances, those with low socioeconomic status, young people, people who smoke infrequently and people who prefer menthol cigarettes. Cigarette nicotine reduction could also lead to some undesirable outcomes, such as experiencing withdrawal, product manipulation, an illicit market, and harm misperceptions; strategies that may mitigate each are discussed. Conclusion Overall, behavioral research suggests product standards that limit the nicotine content of combusted tobacco products could render cigarettes and similar products less addictive. The availability of legal, non-combusted products that effectively substitute for cigarettes and the dissemination of public health campaigns that clarify misperceptions about the relationship between nicotine, tobacco and disease may facilitate the extent to which a nicotine reduction policy reduces smoking.
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Affiliation(s)
- Eric C Donny
- Wake Forest University School of Medicine, Department of Physiology and Pharmacology, Winston-Salem, NC, USA.
| | - Cassidy M White
- Wake Forest University School of Medicine, Department of Physiology and Pharmacology, Winston-Salem, NC, USA
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21
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Hatsukami DK, Xu D, Ferris Wayne G. Regulatory approaches and implementation of minimally addictive combusted products. Nicotine Tob Res 2021; 24:453-462. [PMID: 34192324 DOI: 10.1093/ntr/ntab138] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 06/29/2021] [Indexed: 01/10/2023]
Abstract
INTRODUCTION A joint meeting was held by the World Health Organization (WHO) and the Convention Secretariat of the WHO Framework Convention on Tobacco Control to examine the potential effects of a regulatory policy to reduce nicotine in cigarettes to minimally addictive levels. This paper reviews the feasibility of and approaches to implementing a nicotine product standard. METHODS Prior WHO reports on this topic were consulted and a systematic review of the scientific literature was conducted. The paper was reviewed by the participants at the aforementioned meeting and their feedback was incorporated. RESULTS The nicotine dose most likely to consistently reduce smoking behavior and dependence is < 0.4 mg nicotine/g tobacco. An immediate rather than a gradual nicotine reduction approach appears to be more beneficial. Smokers are likely to seek nicotine from alternate sources (e.g., nicotine replacement therapies, e-cigarettes) or potentially, the illegal market. As such, the availability of alternative products, as well as strong policies against illegal markets, can potentially mitigate unintended consequences. An effective reduced nicotine regulation must be imbedded in a comprehensive and strong tobacco control program that includes public education and surveillance. Barriers and challenges to implementing a nicotine product standard exist, particularly in low-capacity countries. CONCLUSION Not all countries will have the capacity to implement a regulation to reduce nicotine in cigarettes (and preferably other combusted tobacco products) to minimally addictive levels. However, for the countries that choose to implement it, such a policy could potentially dramatically reduce the burden of tobacco use.
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Affiliation(s)
- Dorothy K Hatsukami
- Masonic Cancer Center and Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
| | - Dongqun Xu
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
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Villanti AC, Byron MJ, Mercincavage M, Pacek LR. Misperceptions of Nicotine and Nicotine Reduction: The Importance of Public Education to Maximize the Benefits of a Nicotine Reduction Standard. Nicotine Tob Res 2019; 21:S88-S90. [PMID: 31867645 PMCID: PMC6939783 DOI: 10.1093/ntr/ntz103] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 06/20/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Andrea C Villanti
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington, VT
| | - M Justin Byron
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Melissa Mercincavage
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Lauren R Pacek
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC
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Villanti AC, Naud S, West JC, Pearson JL, Wackowski OA, Hair E, Rath JM, Niaura RS. Latent Classes of Nicotine Beliefs Correlate with Perceived Susceptibility and Severity of Nicotine and Tobacco Products in US young adults. Nicotine Tob Res 2019; 21:S91-S100. [PMID: 31867640 PMCID: PMC6939776 DOI: 10.1093/ntr/ntz156] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 08/21/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pervasive misperceptions about nicotine may influence uptake of quit smoking aids and the impact of policies addressing nicotine as a tobacco product constituent. METHODS Latent class analyses were conducted using four items on nicotine beliefs asked of 4037 adults aged 18-40 in wave 9 (February-March 2016) of the Truth Initiative Young Adult Cohort Study. Confirmatory factor analyses identified three factors from 12 items: nicotine susceptibility (NSUS), nicotine severity (NSEV), and tobacco severity (TSEV). Analyses assessed correlations between latent classes, sociodemographics, and nicotine/tobacco factor scores. RESULTS A four-class model of nicotine beliefs was the best fit, with the largest class believing that nicotine plays a major part in smoking risks (class 1, n = 2070; 52%). Class 2 shared that belief but also responded "Don't know" to addiction questions (class 2, n = 382; 11%). Fewer belonged in class 3, who reported that nicotine plays a small part in health risks (n = 1277; 30%), and class 4, who perceived nicotine as not cancer causing (n = 308; 7%). Latent class membership was correlated with sociodemographics, peer smoking, and past 30-day tobacco use. Classes 1 and 2 had similar NSUS scores and classes 3 and 4 had similar NSEV and TSEV scores. DISCUSSION Differences in the perceptions of nicotine and tobacco-related harms can be partially explained by clustering of underlying nicotine beliefs. These classes of beliefs are correlated with sociodemographic predictors of smoking. These findings may help to identify specific beliefs or groups to be targeted by public education efforts on nicotine. IMPLICATIONS The current study supports that underlying nicotine beliefs are associated with perceived harms of specific nicotine and tobacco products (relative to cigarettes), with greater false beliefs about nicotine correlated with greater perceived susceptibility to nicotine addiction. Two important inferences emerge from this study: first, that education to address nicotine beliefs may also reframe perceptions of the harms of nicotine and tobacco products; and second, that this type of education may differentially impact perceptions of the harms of nicotine products (e.g., nicotine replacement therapy and e-cigarettes) and tobacco products (e.g., cigars, smokeless, and hookah).
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Affiliation(s)
- Andrea C Villanti
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT
| | - Shelly Naud
- Department of Medical Biostatistics, University of Vermont, Burlington, VT
| | - Julia C West
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT
| | - Jennifer L Pearson
- Division of Social and Behavioral Sciences/Health Administration and Policy, School of Community Health Sciences, University of Nevada, Reno, Reno, NV
| | - Olivia A Wackowski
- Center for Tobacco Studies, Rutgers School of Public Health, State University of New Jersey, New Brunswick, NJ
| | | | | | - Raymond S Niaura
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York, NY
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Villanti AC, Naud S, West JC, Pearson JL, Wackowski OA, Niaura RS, Hair E, Rath JM. Prevalence and correlates of nicotine and nicotine product perceptions in U.S. young adults, 2016. Addict Behav 2019; 98:106020. [PMID: 31238235 PMCID: PMC6947657 DOI: 10.1016/j.addbeh.2019.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 06/05/2019] [Accepted: 06/07/2019] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Nicotine is not a human carcinogen and combustion compounds in tobacco smoke, rather than nicotine, cause tobacco-related cardiovascular disease. Few recent studies examine the public's beliefs about nicotine in relation to smoking. METHODS Participants aged 18-40 (n = 4,091) in Wave 10 (Fall 2016) of the Truth Initiative Young Adult Cohort Study responded to nineteen items on nicotine and nicotine product perceptions, including addictiveness and health harms of nicotine patch/gum and e-cigarettes compared to cigarettes. Analyses conducted in 2018 examined prevalence of perceptions and sociodemographic and tobacco use correlates of selected perceptions. RESULTS The majority of young adults reported that nicotine was responsible for a "relatively" or "very large" part of the health risks (66%) and cancer (60%) caused by smoking. More than half of young adults (55%) believed that nicotine is a cause of cancer. Between 23% and 43% of young adults responded "don't know" to items on nicotine. Females, blacks, Hispanics, and those with less than some college education were more likely to report true or "don't know" vs. false to "nicotine is a cause of cancer" and had higher odds of believing that nicotine was responsible for a "relatively" or "very large" part of the health risks of smoking and cancer caused by smoking. Past 30-day tobacco users had lower odds of reporting these beliefs. CONCLUSIONS Misperceptions of nicotine are widespread in young adults. Public education is needed to maximize the public health impact of FDA's required nicotine warning label and proposed nicotine reduction policies.
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Affiliation(s)
- Andrea C Villanti
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Shelly Naud
- Department of Medical Biostatistics, University of Vermont, Burlington, VT, USA
| | - Julia C West
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Jennifer L Pearson
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Division of Social and Behavioral Sciences/Health Administration and Policy, School of Community Health Sciences, University of Nevada, Reno, Reno, NV, USA
| | - Olivia A Wackowski
- Center for Tobacco Studies, School of Public Health, Rutgers, the State University, Piscataway, NJ, USA
| | - Raymond S Niaura
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York, NY, USA
| | - Elizabeth Hair
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Schroeder Institute at Truth Initiative, Washington, DC, USA
| | - Jessica M Rath
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Schroeder Institute at Truth Initiative, Washington, DC, USA
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