International research published in Drugs and Alcohol Today found that the public struggles to distinguish between the health impacts of nicotine and those of tobacco, complicating efforts to help smokers switch to science-based smoking cessation and harm reduction strategies, according to the Foundation for a Smoke-Free World.
Perceptions of Nicotine in Current and Former Users of Tobacco and Tobacco Harm Reduction Products from Seven Countries analyses the perceptions of more than 55,000 nicotine consumers across seven geographically dispersed countries against media coverage of nicotine research and products.
The Perceptions of Nicotine publication concludes that significant public awareness gaps exist between science and public perception concerning the role that nicotine can play in affecting users' behaviour and health as a core component of harm reduction products (patches, gums, e-cigarettes etc).
This is despite the agreement among most medical researchers that nicotine is not a carcinogen, and that the harm from cigarettes comes predominantly from other ingredients found in tobacco, including tar, writes the Foundation in a press statement.
"The fact that the majority of smokers don't know the difference between nicotine and cigarettes is troubling for anyone committed to ending the tobacco epidemic," said Dr Sarah Rajkumar, director of Epidemiology for Health, Science, and Technology at the Foundation for a Smoke-Free World, an author of the report.
"We would like to work with the media and communications experts to help them provide clearer communications about the current state of knowledge surrounding the health impacts of nicotine versus tobacco. The goal is to educate policy-makers on the importance of addressing harm reduction products differently than combustible tobacco."
Confusion over health risks
A 2017 survey found that in many countries a vast majority of smokers use the terms "nicotine" and "cigarettes" interchangeably, suggesting a lack of awareness that nicotine consumption via tobacco harm reduction (THR) products does not carry the same health risks as cigarettes.
The study also examines the Global State of Smoking Poll 2019, which surveyed more than 50,000 current and former tobacco users in the United States, United Kingdom, India, Greece, Norway, Japan and South Africa.
The survey revealed that 65.7% of adult participants believe nicotine causes cancer. This misperception persists even among people who had successfully quit smoking. A majority of quitters in all countries thought nicotine was harmful, while the proportion of quitters who believed nicotine is the primary cause of cancer was slightly higher than among current users.
Media seen as contributing to misperception
To better understand the source of the misperception, the "Perceptions of Nicotine" report also examined media dialogue and public reporting on nicotine in top-tier, English language outlets across the US, UK, India and South Africa between January 2019 and March 2020.
The results, the Foundation reports in the statement, indicated a consistent pattern of negative media coverage mentioning nicotine, with nearly one third of stories referencing nicotine's addictive nature and the dangers of dependency.
While much of the commentary included limited discussion about the efficacy of e-cigarettes as a smoking cessation tool, there was no media coverage on the potential therapeutic uses of nicotine. Commentary failed to mention, for example, use of nicotine for possible protection against Parkinson's or Alzheimer's disease – applications that are being actively explored.
Call for accuracy and transparency in public dialogue
Rajkumar's article concludes with a call-to-action to enhance accurate characterisations of the science behind nicotine research and tobacco harm reduction products to ensure the global smoker population has access to the resources they need to quit.
"The data is clear that public perceptions of nicotine often conflict with available scientific evidence," said Dr. Derek Yach, president of the Foundation for a Smoke-Free World.
"High levels of confusion – driven by deliberate mischaracterisations of nicotine – hamper the adoption of science-based cessation and harm reduction strategies to reduce death and disease from smoking."
The "Perceptions of Nicotine" article was published as part of a broader special edition of Drugs and Alcohol Today, featuring forthcoming research developed by Foundation staff and global health experts. The additional articles cover an array of issues related to tobacco control, science-based cessation, and harm reduction strategies.
The Foundation for a Smoke-Free World is an independent, US non-profit 501(c)(3) organisation with the purpose of improving global health by ending smoking in this generation. See: www.smokefreeworld.org.
Perceptions of nicotine in current and former users of tobacco and tobacco harm reduction products from seven countries
Drugs and Alcohol Today. Published 10 July 2020
Authors
Sarah Rajkumar, Nada Adibah, Michael Jonathan Paskow and Brian Eric Erkkila.
Abstract
Nicotine is widely known as a tobacco constituent and for its use as a tobacco cessation aid. The development of new devices for nicotine delivery in recent years has led to uncertainty among consumers regarding the health risks of nicotine relative to tobacco.
The purpose of this study was to discover if current and former consumers of tobacco and tobacco harm reduction (THR) products could distinguish between “nicotine” and “cigarettes” and examined the preceding media dialogue to determine if conflicting messages by the media influence public perceptions.
Design/methodology/approach
A quantitative survey was administered online in Norway (NO), Japan (JP), the United Kingdom (UK) and the United States (US), while face-to-face computer-aided interviews were conducted with randomly selected samples in India (IN), Greece (GR) and South Africa (SA). Participants were between 18 and 69 years of age and either current users of tobacco and THR products or previous users who quit within the past five years.
Questions assessed beliefs about harmfulness of nicotine. Nicotine and other products and substances were also independently rated for harmfulness on a scale of 1–10 and subsequently compared. In addition, the authors examined the media dialogue of top media outlets in four countries to assess the potential influence on people’s beliefs.
Findings
A total of 54,267 participants (NO: 1,700, JP: 2,227, UK: 2,250, USA: 2,309, IN: 41,633, GR: 1,801, SA: 2,359) were sampled with the percentage of women participants ranging from 14.8% (IN) to 53.8% (UK). Between 68.3% (men, IN) and 88.7% (men, USA) of current consumers believed nicotine is harmful.
Current consumers who agreed with the statement that nicotine is the primary cause of tobacco-related cancer ranged from 43.7% (men, UK) to 78.0% (men, SA). In six countries nicotine was rated nearly as harmful as cigarettes and alcohol, while other substances such as sugar, salt or caffeine, were usually rated as less harmful.
Research limitations/implications
A large proportion of consumers across all surveyed countries view nicotine and cigarettes similarly. Clearer communication on the harmful properties of both by the media is needed to help consumers make informed decisions about products across the continuum of risk.
Messaging to consumers, especially via the media, propagates misinformation about the relative harms of tobacco and nicotine through reporting that is often incomplete and biased toward more negative aspects.
Originality/value
This study specifically assessed public perceptions of nicotine as opposed to products containing nicotine, which is the focus of previous studies. Apart from showing that consumers often incorrectly perceive nicotine and cigarettes as similar in terms of harmfulness, the authors highlight the need for more accurate and complete reporting by the media to clarify widespread misunderstandings and mitigate public uncertainty.
[link url="https://www.prnewswire.com/news-releases/global-confusion-about-health-impacts-of-nicotine-hampers-efforts-to-stop-smoking-and-save-lives-301095879.html"]Global Confusion About Health Impacts of Nicotine Hampers Efforts to Stop Smoking and Save Lives[/link]
[link url="https://www.emerald.com/insight/content/doi/10.1108/DAT-04-2020-0022/full/html"]Perceptions of nicotine in current and former users of tobacco and tobacco harm reduction products from seven countries[/link]