Nicotine - Misperceptions, Misinformation, or Disinformation
For more information, please see this wiki page: Information manipulation
Multi-National
Consumers
- 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.
- Consistent with past studies,our findings confirm that harm perceptions influence nicotine product use, with accurate perceptions associated with greater likelihood of use as a smoking cessation aid, whereas inaccurate perceptions appear to deter their use for this purpose.
- Between 2017 and February–March 2020, youth exposure to negative news stories, and perceptions of vaping harms, increased, and increases were exacerbated during and immediately after ‘EVALI’. By August 2020, exposure to negative news stories returned to 2019 levels, while perceptions of harm were sustained.
- This is the first study to explore the effect of exposure to misinformation about e-cigarette harms on Twitter, showing that after brief exposure to tweets that e-cigarettes are as or more harmful than smoking, current smokers may be deterred from using e-cigarettes (measured with intention to purchase e-cigarettes) as a harm reduction strategy. They are also more likely to wrongly believe that e-cigarettes are more harmful than regular cigarettes.
- The increasing trends of misperceptions about the relative harms of e-cigarettes compared with regular cigarettes are important for public health because perceived harms of e-cigarettes are associated with smokers' willingness to use e-cigarettes6 as a harm reduction strategy.
- PDF of full report
- 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...
- A reason why users of tobacco and THR products around the world find it hard to distinguish between the health risks of smoking and nicotine use may be due to conflicting messages from the media that deviate from the most recent scientific evidence base, overemphasize certain opinions or omit findings that do not align with their readers’ beliefs.
- We observed that the majority of current and previous product users estimated the harmfulness of nicotine and cigarettes alike. This has led to the misled conclusion that nicotine is responsible for the detrimental effects related to combustible tobacco consumption, even though science has found only very limited and often inconclusive evidence to date that nicotine is any more harmful than other legally consumed stimulants.
- Contradictory statements by leading researchers supported by renowned funding agencies and misreporting by the media may further public confusion as people have stated they use the media as a source of health information.
- These products have been subjected to regulatory bans and heavy taxation and are rejected by smokers and society based on misperceptions about nicotine, sensational media headlines...
- The misperception of the risks of these products results in smokers rejecting them, misperceptions that arise from inaccurate information and sensational media headlines. Public health officials are misinformed by these sources as well...
- These barriers will need to be addressed if tobacco harm reduction is to make the maximum impact on the tobacco endemic.
- The review only identified studies exploring the attitudes of socioeconomically disadvantaged smokers towards NCNP (non-combustible nicotine products) for harm reduction or cessation purposes (i.e. we did not identify any relevant studies of more advantaged socioeconomic groups).
- Using a lines-of-argument meta-ethnographic approach, we identified a predominantly pessimistic attitude to NCNP for harm reduction or cessation of smoking due to:
- wider circumstances of socioeconomic disadvantage;
- lack of a perceived advantage of alternative products over smoking;
- and a perceived lack of information about relative harms of NCNP compared to smoking.
Health Care
- However, when asked to rank components of cigarettes based on their health risks, GPs ranked nicotine as the third riskiest (74 percent England, 87 percent Sweden), after tar and carbon monoxide, but before smoke or tobacco.
- Article: ‘GPs falsley believe nicotine most harmful cigarette ingredient’
- ...less than half believe that long-term nicotine replacement therapy (NRT) is preferable to smoking (31% UK, 48% Sweden).
- Many (44% UK, 56% Sweden) also wrongly believe that nicotine in tobacco products is associated with cancer, while 15% in the UK and 22% in Sweden believe the same for pharmaceutical nicotine.
Australia
Consumers
- 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.
- Consistent with past studies,our findings confirm that harm perceptions influence nicotine product use, with accurate perceptions associated with greater likelihood of use as a smoking cessation aid, whereas inaccurate perceptions appear to deter their use for this purpose.
- The incorrect reporting of Australia’s purported ‘youth vaping epidemic’ has been used to argue for even tougher restrictions on access to nicotine vaping products. We should be restricting access to the nicotine product that causes the greatest harm in Australia, tobacco cigarettes. Cigarettes are still used by 2.9 million Australians who easily access them at retail outlets, despite being the leading preventable cause of disease burden.
- There was widespread misperception about relative risk of nicotine-containing products, with 37% of respondents perceiving nicotine-containing NVPs to be as harmful as combustible cigarettes.
Healthcare
- 24% of respondents believe e-cigarettes are equally as harmful as conventional cigarettes.
Canada
Consumers
- 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.
- Consistent with past studies,our findings confirm that harm perceptions influence nicotine product use, with accurate perceptions associated with greater likelihood of use as a smoking cessation aid, whereas inaccurate perceptions appear to deter their use for this purpose.
- Between 2017 and February–March 2020, youth exposure to negative news stories, and perceptions of vaping harms, increased, and increases were exacerbated during and immediately after ‘EVALI’. By August 2020, exposure to negative news stories returned to 2019 levels, while perceptions of harm were sustained.
China
Healthcare
- Physicians Have Misperceptions About Nicotine
- Participants were asked: “To what extent do you agree that nicotine by itself directly causes each of the smoking-related conditions below. The results include responses from “moderately agree” to “completely agree.”
- 92% - Nicotine causes atherosclerosis
- 92% - Nicotine causes COPD
- 91% - Nicotine causes lung cancer
- 82% - Nicotine causes head/neck gastric cancers
- 80% - Nicotine causes birth defects
- 78% - Nicotine causes bladder cancer
France
Consumers
Germany
Health Care
- Physicians Have Misperceptions About Nicotine
- Participants were asked: “To what extent do you agree that nicotine by itself directly causes each of the smoking-related conditions below. The results include responses from “moderately agree” to “completely agree.”
- 83% - Nicotine causes atherosclerosis
- 80% - Nicotine causes birth defects
- 78% - Nicotine causes COPD
- 78% - Nicotine causes head/neck gastric cancers
- 77% - Nicotine causes lung cancer
- 74% - Nicotine causes bladder cancer
2009: Medical students lack basic knowledge about smoking: Findings from two European medical schools
- A substantial number of students falsely assumed that nicotine causes coronary artery disease.
Greece
Consumers
- PDF of full report
- 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...
- A reason why users of tobacco and THR products around the world find it hard to distinguish between the health risks of smoking and nicotine use may be due to conflicting messages from the media that deviate from the most recent scientific evidence base, overemphasize certain opinions or omit findings that do not align with their readers’ beliefs.
- We observed that the majority of current and previous product users estimated the harmfulness of nicotine and cigarettes alike. This has led to the misled conclusion that nicotine is responsible for the detrimental effects related to combustible tobacco consumption, even though science has found only very limited and often inconclusive evidence to date that nicotine is any more harmful than other legally consumed stimulants.
- Contradictory statements by leading researchers supported by renowned funding agencies and misreporting by the media may further public confusion as people have stated they use the media as a source of health information.
Healthcare
- Physicians Have Misperceptions About Nicotine
- Participants were asked: “To what extent do you agree that nicotine by itself directly causes each of the smoking-related conditions below. The results include responses from “moderately agree” to “completely agree.”
- 74% - Nicotine causes atherosclerosis
- 65% - Nicotine causes lung cancer
- 64% - Nicotine causes COPD
- 63% - Nicotine causes bladder cancer
- 61% - Nicotine causes head/neck gastric cancers
- 59% - Nicotine causes birth defects
India
Consumers
- PDF of full report
- 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...
- A reason why users of tobacco and THR products around the world find it hard to distinguish between the health risks of smoking and nicotine use may be due to conflicting messages from the media that deviate from the most recent scientific evidence base, overemphasize certain opinions or omit findings that do not align with their readers’ beliefs.
- We observed that the majority of current and previous product users estimated the harmfulness of nicotine and cigarettes alike. This has led to the misled conclusion that nicotine is responsible for the detrimental effects related to combustible tobacco consumption, even though science has found only very limited and often inconclusive evidence to date that nicotine is any more harmful than other legally consumed stimulants.
- Contradictory statements by leading researchers supported by renowned funding agencies and misreporting by the media may further public confusion as people have stated they use the media as a source of health information.
Healthcare
- Physicians Have Misperceptions About Nicotine
- Participants were asked: “To what extent do you agree that nicotine by itself directly causes each of the smoking-related conditions below. The results include responses from “moderately agree” to “completely agree.”
- 88% - Nicotine causes lung cancer
- 87% - Nicotine causes atherosclerosis
- 86% - Nicotine causes COPD
- 78% - Nicotine causes head/neck gastric cancers
- 75% - Nicotine causes birth defects
- 71% - Nicotine causes bladder cancer
Indonesia
Healthcare
- Physicians Have Misperceptions About Nicotine
- Participants were asked: “To what extent do you agree that nicotine by itself directly causes each of the smoking-related conditions below. The results include responses from “moderately agree” to “completely agree.”
- 97% - Nicotine causes lung cancer
- 92% - Nicotine causes COPD
- 90% - Nicotine causes head/neck gastric cancers
- 89% - Nicotine causes atherosclerosis
- 89% - Nicotine causes birth defects
- 87% - Nicotine causes bladder cancer
Israel
Healthcare
- Physicians Have Misperceptions About Nicotine
- Participants were asked: “To what extent do you agree that nicotine by itself directly causes each of the smoking-related conditions below. The results include responses from “moderately agree” to “completely agree.”
- 71% - Nicotine causes atherosclerosis
- 69% - Nicotine causes bladder cancer
- 69% - Nicotine causes lung cancer
- 68% - Nicotine causes birth defects
- 66% - Nicotine causes COPD
- 65% - Nicotine causes head/neck gastric cancers
Italy
Healthcare
- Physicians Have Misperceptions About Nicotine
- Participants were asked: “To what extent do you agree that nicotine by itself directly causes each of the smoking-related conditions below. The results include responses from “moderately agree” to “completely agree.”
- 77% - Nicotine causes birth defects
- 76% - Nicotine causes atherosclerosis
- 69% - Nicotine causes COPD
- 69% - Nicotine causes bladder cancer
- 67% - Nicotine causes lung cancer
- 64% - Nicotine causes head/neck gastric cancers
Japan
Consumers
- PDF of full report
- 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...
- A reason why users of tobacco and THR products around the world find it hard to distinguish between the health risks of smoking and nicotine use may be due to conflicting messages from the media that deviate from the most recent scientific evidence base, overemphasize certain opinions or omit findings that do not align with their readers’ beliefs.
- We observed that the majority of current and previous product users estimated the harmfulness of nicotine and cigarettes alike. This has led to the misled conclusion that nicotine is responsible for the detrimental effects related to combustible tobacco consumption, even though science has found only very limited and often inconclusive evidence to date that nicotine is any more harmful than other legally consumed stimulants.
- Contradictory statements by leading researchers supported by renowned funding agencies and misreporting by the media may further public confusion as people have stated they use the media as a source of health information.
Korea
Health Care
- We undertook a nationwide survey of pulmonologists, thoracic surgeons, medical and radiological oncologists who are members of Korean Association for Lung Cancer. Survey items included beliefs and attitudes toward e-cigarettes, attitudes toward e-cigarette regulation and preparedness on discussing e-cigarettes with their patients.
- Most respondents believed that e-cigarettes are not safer than conventional tobacco cigarettes (75.7%) or smokeless tobacco (83.2%), and feared that discussing e-cigarettes with the patients would encourage use (65.4%). They did not consider it a smoking cessation treatment (78.3%), and thus would not recommend it to smokers who do not want to quit (82.2%) or who failed to quit with conventional smoking cessation treatment (74.1%).
- Most learned about e-cigarettes from media and advertisements, or conversation with patients rather than through professional scientific resources, and reported discomfort when discussing e-cigarette with patients.
Netherlands (Holland)
Consumers
- Adopts false and misleading claims about the risks of e-cigarettes.
- Draws on irrelevant information about an outbreak of lung injuries in North America.
- Misunderstands “dual-use”.
- Asserts a “gateway effect” but there is more likely to be a diversion away from smoking.
Norway
Consumers
- PDF of full report
- 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...
- A reason why users of tobacco and THR products around the world find it hard to distinguish between the health risks of smoking and nicotine use may be due to conflicting messages from the media that deviate from the most recent scientific evidence base, overemphasize certain opinions or omit findings that do not align with their readers’ beliefs.
- We observed that the majority of current and previous product users estimated the harmfulness of nicotine and cigarettes alike. This has led to the misled conclusion that nicotine is responsible for the detrimental effects related to combustible tobacco consumption, even though science has found only very limited and often inconclusive evidence to date that nicotine is any more harmful than other legally consumed stimulants.
- Contradictory statements by leading researchers supported by renowned funding agencies and misreporting by the media may further public confusion as people have stated they use the media as a source of health information.
Poland
Consumers
- Approximately half of the respondents believed they [HTPs] are safer than traditional cigarettes and almost 1/4 believed they are safer than e-cigarettes.
- Among the respondents, 57.9% declared, that e-cigarette use causes serious diseases, with significant differences between smokers and non-smokers (60.4% vs. 49.1%, p = 0.01). Over a quarter of respondents (27.9%) did not know whether e-cigarette use causes disease. Lung cancer was the most common (65.8%) health effect of e-cigarette use indicated by the respondents. More than half of respondents believed that e-cigarette use causes stroke (54.4%) or myocardial infarction (59.4%), wherein non-smokers compared to smokers (p < 0.001) more often declared that e-cigarette use causes cardiovascular diseases.
- Among the respondents, 70% declared that e-cigarettes are as harmful as traditional cigarettes, wherein smokers compared to non-smokers more often declared that e-cigarettes are less harmful than traditional cigarettes (28.6% vs. 19.5%; p = 0.01). There were no statistically significant differences (p > 0.05) between smokers and non-smokers in the perception of the harmfulness of heated tobacco products. One-fourth of the respondents declared that smokeless tobacco is less harmful than traditional cigarettes with significant differences between smokers (32.3%) and non-smokers (22.9%; p = 0.01).
- The linear regression analysis indicated that relative to women, men consider slim cigarettes, smokeless tobacco and e-cigarettes to be more harmful than traditional cigarettes (p < 0.05).
- The smokers of traditional cigarettes reported menthol cigarettes to be less harmful than traditional cigarettes, relative to the non-smokers (p = 0.05).
- The smokers of traditional cigarettes reported more harmfulness (compared to traditional cigarettes) in menthol, slim cigarettes, and e-cigarettes comparing to the non-smokers (p ≤ 0.03).
Health Care
- Among participants, 40.9% disagreed (“rather disagree” or “totally disagree”) that e-cigarettes are less harmful than conventional cigarettes.
- We have observed that only 21% of physicians get information about e-cigarettes from scientific articles. Most participants learned about e-cigarettes from non-scientific sources such as news stories or storefronts. Information obtained from such sources are not scientifically verified and might be biased. This poses a threat that education and guidance about e-cigarettes delivered by physicians is not based on evidence. Similar results were observed among healthcare providers’ in the US where the most frequently reported source of knowledge about e-cigarettes were patients (62%) or news stories (39%).
South Africa
Consumers
- PDF of full report
- 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...
- A reason why users of tobacco and THR products around the world find it hard to distinguish between the health risks of smoking and nicotine use may be due to conflicting messages from the media that deviate from the most recent scientific evidence base, overemphasize certain opinions or omit findings that do not align with their readers’ beliefs.
- We observed that the majority of current and previous product users estimated the harmfulness of nicotine and cigarettes alike. This has led to the misled conclusion that nicotine is responsible for the detrimental effects related to combustible tobacco consumption, even though science has found only very limited and often inconclusive evidence to date that nicotine is any more harmful than other legally consumed stimulants.
- Contradictory statements by leading researchers supported by renowned funding agencies and misreporting by the media may further public confusion as people have stated they use the media as a source of health information.
Sweden
Consumers
- A majority, 59% of the answers to the question about harmfulness of NRT-products, and 75% of the answers about harmfulness of Snus, were inconsistent with the scientific evidence by demonstrating exaggerated perceptions of harmfulness. The strongest predictor of consistent answers was the perception of the harmfulness of nicotine.
Health Care
- However, when asked to rank components of cigarettes based on their health risks, GPs ranked nicotine as the third riskiest (74 percent England, 87 percent Sweden), after tar and carbon monoxide, but before smoke or tobacco.
- Article: ‘GPs falsley believe nicotine most harmful cigarette ingredient’
- ...less than half believe that long-term nicotine replacement therapy (NRT) is preferable to smoking (31% UK, 48% Sweden).
- Many (44% UK, 56% Sweden) also wrongly believe that nicotine in tobacco products is associated with cancer, while 15% in the UK and 22% in Sweden believe the same for pharmaceutical nicotine.
United Kingdom or countries in the UK
Consumers
- 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.
- Consistent with past studies,our findings confirm that harm perceptions influence nicotine product use, with accurate perceptions associated with greater likelihood of use as a smoking cessation aid, whereas inaccurate perceptions appear to deter their use for this purpose.
2022: What are people’s views about the risks of vaping? Findings from conversations with the public.
- The graph (see website) shows that since 2013 there has been an increase in people inaccurately thinking that vaping is equally or more harmful than smoking among adults in Great Britain.
- People were asked what they thought was causing this increase in inaccurate beliefs:
- ‘Youth vaping epidemic’ (the increase in youth vaping, particularly seen in the US) and increasing perceptions that vaping is for younger people
- Misinformation about vaping (for example, that it can cause popcorn lung)
- Negative news stories about vaping
- Increasing disapproval of vaping
- Vaping becoming the ‘new smoking’ (smoking becoming less prevalent while vaping becomes more prevalent, so there’s less to compare vaping to / less of a ‘negative comparison’)
- Increasing discussions and education in school about ‘negative consequences of vaping’
- Desensitisation to public health messaging about the reduced harm of vaping relative to smoking
- ...with 93% of Brits overestimating the health risk of nicotine,...The over 60s and those from the lowest socio economic groups (C2DE) are the most likely to be misinformed...
- Our research has also revealed the scale of misunderstanding around vaping, with 90% of Brits’ responses ‘broadly incorrect’ about its harm compared to tobacco cigarettes; this despite public health evidence asserting that vaping is unlikely to exceed 5% of the harm that comes from smoking cigarettes.
- Between 2017 and February–March 2020, youth exposure to negative news stories, and perceptions of vaping harms, increased, and increases were exacerbated during and immediately after ‘EVALI’. By August 2020, exposure to negative news stories returned to 2019 levels, while perceptions of harm were sustained.
- However, there is lots of confusion, even misinformation, about vaping. The most common relates to its harm. I have spoken to the very best academics and scientists across the country and internationally. They all told me that vaping is far less harmful than smoking.
- In cigarettes, we know that it is not the nicotine that kills you but the other thousands of toxic chemicals such as tar and carbon monoxide. Vapes give smokers the nicotine they crave but protect them from the toxins they would inhale from a cigarette.
- Nearly two thirds of current vapers are ex-smokers (64.6%), and the proportion continues to grow, while the proportion who also smoke (known as dual users) has fallen to 30.5% in 2021.
- Fewer than 1% of never smokers are current vapers (amounting to 4.9% of vapers).
- As in previous years the main reason given by ex-smokers for vaping is to help them quit (36%) then to prevent relapse (20%).
- The main reason given by current smokers for vaping is to cut down (26%) then to help them quit (17%) and to prevent relapse (14%).
- Nearly a third of smokers incorrectly believe vaping is more or equally as harmful as smoking (32% compared to 34% in 2020).
- Citation: Action on Smoking and Health (ASH). Use of e-cigarettes (vapes) among adults in Great Britain. 2021
2021: Video: Depression causes vaping!
- In this talk Professor Notley will discuss the latest evidence exploring associations between nicotine use and common mental health conditions, including depression.
- Interpretive assumptions will be drawn out, including inappropriate claims of causal relationships between vaping and depression.
- This is the first study to explore the effect of exposure to misinformation about e-cigarette harms on Twitter, showing that after brief exposure to tweets that e-cigarettes are as or more harmful than smoking, current smokers may be deterred from using e-cigarettes (measured with intention to purchase e-cigarettes) as a harm reduction strategy. They are also more likely to wrongly believe that e-cigarettes are more harmful than regular cigarettes.
- The increasing trends of misperceptions about the relative harms of e-cigarettes compared with regular cigarettes are important for public health because perceived harms of e-cigarettes are associated with smokers' willingness to use e-cigarettes6 as a harm reduction strategy.
- Between 2014 and 2019 in England, at the population level, monthly changes in the prevalence of accurate harm perceptions among current tobacco smokers were strongly associated with changes in e-cigarette use.
- For every 1% decrease in the mean prevalence of current tobacco smokers who endorsed the belief that e-cigarettes are less harmful than combustible cigarettes, the mean prevalence of e-cigarette use decreased by 0.48%
- PDF of full report
- 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...
- A reason why users of tobacco and THR products around the world find it hard to distinguish between the health risks of smoking and nicotine use may be due to conflicting messages from the media that deviate from the most recent scientific evidence base, overemphasize certain opinions or omit findings that do not align with their readers’ beliefs.
- We observed that the majority of current and previous product users estimated the harmfulness of nicotine and cigarettes alike. This has led to the misled conclusion that nicotine is responsible for the detrimental effects related to combustible tobacco consumption, even though science has found only very limited and often inconclusive evidence to date that nicotine is any more harmful than other legally consumed stimulants.
- Contradictory statements by leading researchers supported by renowned funding agencies and misreporting by the media may further public confusion as people have stated they use the media as a source of health information.
2019: Video: John Britton takes anti-vaping media to task
- E-cigarette Summit 2019
- John Britton, respiratory physician and Director of the UK Centre for Tobacco and Alcohol Studies at the University of Nottingham tells media and medical journals that when they publish hyperbolic stories about the harms of vaping they are sending people back to smoking and early death. Full video of Britton's E-cigarette Summit presentation available at vimeo.com/373905893
- Large proportions of UK smokers and ex-smokers overestimate the relative harmfulness of e-cigarettes and nicotine replacement therapy compared with smoking; misattributing smoking harms to nicotine is associated with increased misperceptions.
- eCancer Article: Misperceptions about vaping common among UK smokers
- "Lead researcher Dr Leonie Brose, from the Institute of Psychiatry, Psychology & Neuroscience, said 'Tobacco cigarettes kill over half of those who smoke long-term, yet very few people know that nicotine is not the direct cause of smoking-related death and disease. We found those people who think nicotine is to blame for harms from smoking are more likely to think e-cigarettes and NRT are just as bad as smoking.'"
- "Knowledge about nicotine was particularly poor, with nearly nine out of ten misattributing a greater portion of the risk in smoking to nicotine, and nearly four out of ten wrongly believing nicotine is what causes cancer from smoking."
- Alarmingly RSPH research reveals that 90% of the public still regard nicotine itself as harmful and the organisation is now calling for measures to promote safer forms of nicotine products to smokers and make it harder to use tobacco.
Healthcare
- Clinicians had sought information about e-cigarettes from...news/media/advertising (24%)...and charities (18%). Nineteen per cent of clinicians had never sought information about e-cigarettes.
- One-quarter of respondents (25%, n=124) were uncertain whether e-cigarettes were less harmful than smoking tobacco, while 10% (n=52) thought e-cigarettes were equally harmful or more harmful than smoking tobacco. Eighteen per cent (n=93) considered using e-cigarettes to be more harmful than regular nicotine replacement therapies (eg, gum, nasal spray, patches) and 54% (n=273) were uncertain.
- Over half of HPs believed their knowledge was not sufficient to recommend e-cigarettes to cancer patients, and 25% did not know whether e-cigarettes were less harmful than smoking tobacco cigarettes.
- However, when asked to rank components of cigarettes based on their health risks, GPs ranked nicotine as the third riskiest (74 percent England, 87 percent Sweden), after tar and carbon monoxide, but before smoke or tobacco.
- Article: ‘GPs falsley believe nicotine most harmful cigarette ingredient’
- ...less than half believe that long-term nicotine replacement therapy (NRT) is preferable to smoking (31% UK, 48% Sweden).
- Many (44% UK, 56% Sweden) also wrongly believe that nicotine in tobacco products is associated with cancer, while 15% in the UK and 22% in Sweden believe the same for pharmaceutical nicotine.
2009: Medical students lack basic knowledge about smoking: Findings from two European medical schools
- A substantial number of students falsely assumed that nicotine causes coronary artery disease.
United States
Consumers
- This is a secondary data analysis of Dr. Ahluwalia’s important work testing e-cigarettes for smoking cessation among Black and Latinx adults, examining the association between risk perceptions of e-cigarettes and cigarettes smoked per week (CPW):
- Results: The mean CPW decreased from 82.8 (SD=49.8) at baseline to 15.8 (SD=29.8) at week 6. A one-level increase in EC risk perception (i.e., EC perceived as riskier than CC from baseline to week 6) was associated with an increase in CPW (IRR: 1.83, 95% CI: 1.03; 3.24). Latinx participants were more likely to have higher CPW as EC risk perception increased compared to Black participants (IRR=1.89, 95% CI: 1.09; 3.26).
- This is a dramatic short-term decrease in cigarettes per week, of over 80%; such reductions have been associated with improvements in health. However, this study shows that risk perceptions might inhibit some of this progress, even among those who are already using e-cigarettes in a cessation trial. In other words, even after getting over the potential hurdle of starting e-cigarette use (which itself can be impacted by risk perceptions), risk perceptions also play a role “downstream” in later stages of the possible switching process.
- Lee SC, Maglalang DD, Avila JC, Leavens ELS, Nollen NL, Pulvers K, Ahluwalia JS. Drug Alcohol Depend. 2023 Feb 26;245:109824. doi: 10.1016/j.drugalcdep.2023.109824. Online ahead of print. PMID: 36857841
- Sensationalized youth-oriented anti-vaping messages may have unintended public health consequences upon adult audiences.
- Exposure to the PSA resulted in overall more negative expectancies about e-cigarettes, as well as increased perceived harmfulness and reduced effectiveness of e-cigarettes for smoking cessation. Findings showed that these PSAs could deter adult smokers from utilization of e-cigarettes as a smoking cessation or harm reduction strategy.
- Perceptions of E-cigarettes as more harmful than cigarettes doubled year on year, increasing most between 2019 and 2020...
- Exclusive cigarette smoking increased between 2019 and 2020 among those who perceived E-cigarettes as relatively more harmful...
- ...dual use increased linearly in those who perceived them relatively as harmful...
- Article: Vaping Safety Views Shifted Following Lung Injury Reports
- The main finding that people started smoking cigarettes when they thought e-cigarettes were more harmful should be a wake-up to public health officials and doctors...
- The new study showed a sharp change in public perception of e-cigarettes following media coverage of cases of users who presented to emergency rooms with mysterious lung symptoms (EVALI) in 2019.
- 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.
- Consistent with past studies,our findings confirm that harm perceptions influence nicotine product use, with accurate perceptions associated with greater likelihood of use as a smoking cessation aid, whereas inaccurate perceptions appear to deter their use for this purpose.
- Between 2017 and February–March 2020, youth exposure to negative news stories, and perceptions of vaping harms, increased, and increases were exacerbated during and immediately after ‘EVALI’. By August 2020, exposure to negative news stories returned to 2019 levels, while perceptions of harm were sustained.
- About 61.2% of smokers believe nicotine causes cancer or don't know.
- High perceived threat of tobacco may be overgeneralized to nicotine. High prevalence of the misperception among Non-Hispanic Black and low-income smokers is concerning, considering existing health disparities. Messaging should attempt to correct the misperception that nicotine causes cancer.
2022: Audio: Cliff Douglas on WOSU
- Misinformation, continuum of risk, etc.
- Public mistrust about ECs is exacerbated by the spread of misinformation and distortion of scientific truth.
- Although EC use by young non-smokers is a legitimate concern, known risks from vaping are often greatly exaggerated; common misconceptions about EC use and the evidence to refute these misconceptions have been summarized in Table 2
2022: Opinion: A Bold U.K. Plan to End the Smoking Epidemic
- Youth vaping is no longer an "epidemic." But these efforts, which too often inaccurately portray the risks of e-cigarettes, have led to significant public misunderstanding regarding the substantially lower health risks of e-cigarettes compared to combustible tobacco products. This, in turn, has impeded the promotion of tobacco harm reduction to the more than 30 million adults who still smoke.
- Nicotine causes dependency but does not itself cause the many diseases resulting from the inhalation of burned tobacco, a fact misunderstood by the majority of physicians...
- Nicotine replacement therapy (NRT) is a relatively effective and accessible smoking cessation aid; however, individuals frequently stop use of NRT early due to side effects and misperceptions about the products.
- The in vivo group uses NRT in session and discusses perceptions and experiences of using NRT in real time...
- Objectives: To assess whether the late 2019 US outbreak of pulmonary disease linked to vaping ('E-cigarette, or Vaping, product use Associated Lung Injury' (EVALI)) impacted online shopping queries for vaping products and the Philip Morris 'IQO' brand of heated tobacco.
- Results: During the outbreak, vape shopping queries were 34% (95% CI 30% to 38%) lower than expected and JUUL shopping queries were 39% (95% CI 34% to 45%) lower than expected, translating into about 7.2 and 1.0 million fewer searches. IQOS shopping queries were 58% (95% prediction interval (PI): 34-87) higher than expected, translating into 35 000 more searches. Moreover, IQOS shopping queries reached a historic high the week they were discussed as a potentially safe alternative to vaping (the week of 29 September 2019), when they were 382% (95% PI: 219-881) above expected rates for the week.
- Note from the Safer Nicotine Wiki team: EVALI during the time of this study was being incorrectly blamed on nicotine vapor products. IQOS is a heated tobacco product, not a traditional vapor product.
- Nonetheless, a sizable proportion of participants in our sample rated e-cigarettes as harmful and rated e-cigarettes as more or equivalently harmful as cigarettes. Our findings align with recent work in the general population demonstrating increases in perceived harm of e-cigarettes following EVALI
2021: Associations Between Nicotine Knowledge and Smoking Cessation Behaviors Among US Adults Who Smoke
- 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.
- Many US governmental health agencies and nongovernmental medical and health organizations focus primarily on vaping’s risks for young people. These organizations’ pronouncements and their influence on policymakers and the media have had a profound impact on the public’s understanding of vaping.
- A study of US news articles on e-cigarettes found that, from 2015 to 2018, 70% of articles mentioned vaping’s risks for youths, while only 37.3% noted potential benefits for adult smokers.
- Unfortunately, the public has a distorted view of the dangers associated with nicotine per see. Of respondents to a 2019 national survey, nearly half considered vaping nicotine just as harmful as or more harmful than cigarette smoking. Only 1 in 8 considered vaping less harmful.
- The public’s inaccurate perception worsened following a 2019 vaping-associated acute pulmonary disease outbreak [EVALI]...research attributed the illness to vitamin E acetate, an adulterant in illicit tetrahydrocannabinol (THC) vaping devices...Yet, after the outbreak, two thirds of respondents to a poll related the lung disease deaths to use of “e-cigarettes such as JUUL.” Only 28% related the deaths to use of “marijuana or THC e-cigarettes.”
- In a recent survey of physicians, 80% strongly, but incorrectly, agreed that nicotine causes cancer, cardiovascular disease, and chronic obstructive pulmonary disease.
2021: Video: Depression causes vaping!
- In this talk Professor Notley will discuss the latest evidence exploring associations between nicotine use and common mental health conditions, including depression.
- Interpretive assumptions will be drawn out, including inappropriate claims of causal relationships between vaping and depression.
- This is the first study to explore the effect of exposure to misinformation about e-cigarette harms on Twitter, showing that after brief exposure to tweets that e-cigarettes are as or more harmful than smoking, current smokers may be deterred from using e-cigarettes (measured with intention to purchase e-cigarettes) as a harm reduction strategy. They are also more likely to wrongly believe that e-cigarettes are more harmful than regular cigarettes.
- The increasing trends of misperceptions about the relative harms of e-cigarettes compared with regular cigarettes are important for public health because perceived harms of e-cigarettes are associated with smokers' willingness to use e-cigarettes6 as a harm reduction strategy.
- 36% of study participants falsely believed vaping was as harmful as smoking.
2021: Opinion Michael Madden, MD: Misinformation Threatens Efforts to Reduce Tobacco Harm
- Their well-intentioned but misguided and unscientific beliefs, however, may actually reap a consequence they certainly do not intend: increased youth cigarette smoking.
- Yet many government regulators and elected officials have allowed misinformed and misguided activists who refuse to discuss the science behind tobacco harm reduction to take the reins on this vital public health issue, while in other countries (Great Britain and New Zealand, for example), governments leverage tobacco harm reduction strategies to save lives.
- In this study, the proportion of US adults who incorrectly perceived e-cigarettes as equal to, or more, harmful than cigarettes increased steadily regardless of smoking or vaping status.
- Current adult smokers appear to be poorly informed about the relative risks of e-cigarettes yet have potentially the most to gain from transitioning to these products.
- The findings of this study emphasise the urgent need to accurately communicate the reduced relative risk of e-cigarettes compared to continued cigarette smoking and clearly differentiate absolute and relative harms.
- PDF of full report
- 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...
- A reason why users of tobacco and THR products around the world find it hard to distinguish between the health risks of smoking and nicotine use may be due to conflicting messages from the media that deviate from the most recent scientific evidence base, overemphasize certain opinions or omit findings that do not align with their readers’ beliefs.
- We observed that the majority of current and previous product users estimated the harmfulness of nicotine and cigarettes alike. This has led to the misled conclusion that nicotine is responsible for the detrimental effects related to combustible tobacco consumption, even though science has found only very limited and often inconclusive evidence to date that nicotine is any more harmful than other legally consumed stimulants.
- Contradictory statements by leading researchers supported by renowned funding agencies and misreporting by the media may further public confusion as people have stated they use the media as a source of health information.
- In 2 nationally representative multiyear cross-sectional surveys of US adults, the proportion who perceived e-cigarettes to be as harmful as or more harmful than cigarettes increased substantially from 2012 to 2017.
- Given the demonstration by previous studies that perception of risk plays a critical role in decisions to use tobacco, our results imply that at least some smokers may have been deterred from using or switching to e-cigarettes due to the growing perception that e-cigarettes are equally harmful or more harmful than cigarettes.
- Between 2017 and 2018, the percentage of US adults who perceived ENDS to be less harmful than cigarettes decreased, while there was an increase in the proportion of US adults who perceived ENDS to be more harmful or much more harmful.
- Recent population-level data highlight that 49%–80% of US adults incorrectly believe that nicotine is responsible for most of the cancer caused by smoking.
- Additionally, between 23% and 43% of young adults responded “don’t know” to items on nicotine perceptions and more than 50% of respondents, including past 30-day tobacco users, perceived nicotine gum and patch to be as harmful or more harmful than cigarettes to overall health and specifically, to causing cancer or heart attack.
- Public education is an essential complement to the Food and Drug Administration’s efforts to move smokers away from combusted tobacco products and prevent non-users from trying nicotine and tobacco products.
- Following exposure, nicotine education participants reported fewer false beliefs about nicotine, nicotine replacement therapies, e-cigarettes, and reduced nicotine cigarettes compared with the control conditions.
- Nicotine messaging doubled the probability of a correct response (false, 78.3% vs 36.8%) to nicotine is a cause of cancer and dramatically reduced the probability of responding don’t know to this item (5.3% vs 26.0%).
- Given these common misperceptions about nicotine, a low nicotine product standard has potential to further confuse consumers about tobacco product risks in the absence of public education efforts.
- Stating that 95% of nicotine would be removed more accurately conveyed the nicotine content and addictiveness of VLNC cigarettes. However, descriptions that better conveyed nicotine content and addictiveness misled people about cancer risk.
- The findings of the current study indicate that, over time, U.S. adults, irrespective of smoking history, increasingly believe that e-cigarettes could be as harmful as combustible cigarettes
- Higher risk perceptions of e-cigarettes could deter current smokers from using e-cigarettes as a cessation aid of smoking combustible cigarettes and preventing a potential public health benefit.
- The finding that the higher percentages of adults, including current smokers, misperceived e-cigarettes to be equally or more harmful than cigarettes between 2012 and 2015 may be stemming from misinformed media stories
- Whereas perception of harm associated with e-cigarettes was significantly lower for smokers than for nonsmokers, most respondents (80%), regardless of current smoking status, believed that nicotine is the primary disease-causing agent in tobacco products (nicotine harm perception).
- In multivariable analyses, believing that e-cigarettes were more harmful was associated with greater support for bans on indoor e-cigarette use, use in cars with children present, and a ban on e-cigarette sales to minors. As beliefs about e-cigarette harm increased, there was less support for a differentiated tax structure for e-cigarettes relative to combustible cigarettes.
2017: Opinion: America needs a candid smoking control champion
- Unfortunately, misinformation about nicotine abounds. The majority of Americans wrongly believe that e-cigarettes are at least as harmful as cigarettes.
- But current and future smokers, who are the ones in immediate peril, must also be able to make decisions based on truthful information about how new smokeless products differ in their relative harms from smoked tobacco.
- A purist stance misleads the public into thinking that all tobacco products are equally harmful.
2017: Article: Guest Post: Where Is FDA Going with Nicotine and Tobacco?
- The FDA faces many challenges to realize this future. But perhaps the greatest obstacle, based on FDA’s own data, is that upwards of 80% of smokers believe that nicotine itself is the primary ingredient that causes cancer. We hope that FDA uses its bully pulpit and other communication channels to correct the record; its bold plan will be even harder to execute if they do not.
- Overall, we found that many people, particularly the demographic subgroups identified here, held incorrect beliefs about nicotine and potentially inaccurate beliefs about LNCs.
- Incorrectly believing that nicotine causes cancer could discourage smokers from switching to safer nicotine-containing alternatives, and could lead nonsmokers to experiment with low nicotine tobacco products, believing that cancer risk would be reduced.
- 93% of smokers did not know that smoking while wearing the nicotine patch does not cause heart attacks; 76% that nicotine gum/lozenge are not as addictive as cigarettes; and 69% that NRT products are not as dangerous as cigarettes. Over half of the smokers with misperceptions reported that they would be more likely to use NRT (nicotine replacement therapy) to help them quit smoking if they were exposed to information correcting their concerns
- Two-thirds (66%) of respondents either agreed that 'Stop-smoking products with nicotine are just as harmful as cigarettes' or were unsure whether the statement was true.
Health Care
- 60% of physician respondents incorrectly believe all tobacco products were equally harmful
- It is critical to address physician nicotine misperceptions and to correct misperceptions regarding the relative harm of various tobacco products as more modified-risk tobacco products may be introduced through an FDA authorization process.
- Twitter thread by Cristine D. Delnevo, PhD, MPH about the study
- Question wording is important when measuring physicians’ beliefs about nicotine; however, even after accounting for question version, misperceptions about the direct health effects of nicotine were common and varied by sex and specialty.
- The response rate for faculty was 55.1% and that for students was 37.5%. The majority of faculty and students “agreed” or “strongly agreed” that nicotine causes cancer, birth defects, cardiovascular disease, oral inflammation, and Chronic Obstructive Pulmonary Disease.
- Dental school faculty and students linked the risks of smoking tobacco to nicotine. Based on the results of this study, we feel our institution's curriculum should consider including information specific to nicotine in addition to tobacco in general.
- Overall, the majority of physicians “strongly agreed” that nicotine directly contributes to the development of cardiovascular disease (83.2%), COPD (80.9%), and cancer (80.5%). Comparatively fewer “strongly agreed” that nicotine directly contributes to the development of birth defects (32.9%) and 30.2% did not answer this question—a potential indicator of “do not know.”
- While it is possible that some physicians may have misunderstood the question (e.g., considered harm caused by tobacco, rather than nicotine), results are consistent with other studies finding notable nicotine misperceptions.
- PDF Version
- Rutgers Article: Rutgers-Led National Survey Uncovers Doctors' Misconceptions About Nicotine Risks
- Rutgers Article: Researchers say physicians need to understand accurate nicotine risks better to assist patients addicted to the most harmful tobacco products
- Filter Article: Majority of Surveyed Doctors Misattribute Tobacco Harms to Nicotine
- The most frequently cited sources of information about e-cigarettes were patients, news stories, and advertisements, rather than professional sources.
2007: Nurses' knowledge about the risk of light cigarettes and other tobacco "harm reduction" strategies
- Nurses had misperceptions about nicotine replacement: 60% believed that nicotine causes cancer, 72% believed that nicotine patches could cause heart attacks, and 40% and 15% believed that a prescription is needed for the nicotine patch or gum, respectively.
- Nurse misinformation could lead to inaccurate recommendations and failure to capitalize on the teachable moment provided by the medical encounter.
Unknown Nation(s)
Consumer
- Misinformation and conspiracy theories were present throughout all coding categories.
- 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 Misperceptions and VLNC (Very Low Nicotine Cigarettes)
Consumer
- The public incorrectly believes very low nicotine content (VLNC) cigarettes are less carcinogenic than current cigarettes, a belief associated with lower motivation to quit under a VLNC standard.
- Many smokers had the misperception that smoking VLNC cigarettes is less likely to cause cancer, and some stated that they would be less likely to quit. A VLNC standard may be more effective if accompanied by a communication campaign that emphasizes the continued dangers of smoking VLNC cigarettes due to the many toxic chemicals in smoke.
- About three quarters of people either were unsure of the relationship between nicotine and cancer or incorrectly believed that nicotine causes cancer. Incorrectly believing that nicotine causes cancer could discourage smokers from switching to safer nicotine-containing alternatives, and could lead nonsmokers to experiment with low nicotine tobacco products, believing that cancer risk would be reduced. Findings underscore the need to educate the public on the health effects of nicotine and LNCs...
- Subjects rated the "very low" nicotine cigarette as less harmful to their health overall compared to the "average" nicotine cigarette; this effect held true for specific smoking-related diseases.
Science Hygiene - The Call To Correct Misinformation About Nicotine
- This section will focus on attempts to correct misinformation about nicotine
Academic Community
2022: Referring to: The Association Between E-Cigarette Use and Prediabetes: Results From the Behavioral Risk Factor Surveillance System, 2016–2018
- 2022: Ignore The Headlines: There's No Science Linking Vaping To Prediabetes
- Limitations of this study include self-report of tobacco use and lack of medical confirmation of prediabetes and other diet information
- BRFSS is a cross-sectional survey, so a causal relationship between E-cigarette use and prediabetes cannot be inferred.
2022: Referring to: Electronic cigarettes and health outcomes: systematic review of global evidence
- 2022: A critical analysis of ‘Electronic cigarettes and health outcomes: Systematic review of global evidence’
- Contrary to the conclusions of the Banks review, the evidence suggests that vaping nicotine is an effective smoking cessation aid; that vaping is substantially less harmful than smoking tobacco; that vaping is diverting young people away from smoking; and that vaping by smokers is likely to have a major net public health benefit if widely available to adult Australian smokers.
2021: Referring to: Erosive potential of commonly available vapes: a cause for concern?
- 2022: Vaping misrepresentations
- We were disappointed to see several basic errors and misrepresentations.
- E-cigarettes do not contain tobacco and should not be categorised as such
- The authors incorrectly claim that nicotine causes a 'high risk of oral and whole-body health complications'.
- The authors claim that e-cigarettes are associated with cancer. The supporting reference does not make this claim...
- The authors state that 'diacetyl is found in most flavoured vapes'. Again, the supporting reference is inappropriate...
- The authors grossly misrepresent the public health guidance on e-cigarette use as a smoking cessation device.
- Prof Mike Cummings presenting at E-Cigarette Summit 2021
- Successful public health campaigns rely on establishing and maintaining the public’s trust in the recommendations that are given. This presentation highlights concerns that I have about the erosion of trust in tobacco control that appears to be happening because previously trusted public health officials are staking out policy positions that distort the truth about lower risk alternative nicotine products.
2019: Referring to: 2019: Prevalence of vaping and smoking among adolescents in Canada, England, and the United States: repeat national cross sectional surveys
- 2020: Also referring to: Update 2020
- 2020: Canada takes a wrong turn after a flawed paper induces moral panic about youth vaping and smoking
- 2019 and 2020: PubPeer Comments
- >>>NOTE TO SKIP<<< Continue here
- In this brief peer review, we argue that the data reported by Gaiha et al (doi:10.1016/j.jadohealth.2020.07.002) regarding associations between vaping and COVID-19 testing are so suspect that any conclusions drawn from it cannot be relied upon. We discuss six main areas of concern and conclude that the paper should be retracted.
- More comments addressing concerns on PubPeer
- 7 comments at the time of this Wiki entry
- Letter to the journal editor: E-Cigarette Use and COVID-19: Questioning Data Reliability
- It is not biologically plausible that e-cigarette trial or experimentation would cause effects that result in stronger predisposition to COVID-19 than current/regular use. Therefore, no causal link between e-cigarette use and COVID-19 can be implied.
- Letter to the journal editor: Gaiha et al. Disregarded Conventional Publishing Standards
- The article deviated from standard reporting practices in several ways.
- We asked the authors to provide actual numbers. They declined.
- The authors’ claims have already prompted national policy recommendations by members of Congress.
- Letter to the journal editor: Gaiha et al. Response
- However, the association reported by Gaiha et al. is not necessarily indicative of a causal relationship between e-cigarette use and contracting COVID-19.
- Letter to the journal editor: In Response to “Association Between Youth Smoking, Electronic Cigarette Use, and COVID-19”
- We believe that this article has multiple scientific shortcomings leading to flawed data analysis that render the results unreliable. Of particular concern is the fact that this flawed study is being used as ‘evidence’ by Congressman Krishnamoorthi to campaign for a ban on the use of all e-cigarettes in the U.S.
- The Authors Respond
- We are in complete agreement with others' assertions that our study does not imply causality.
- Article: Experts Question Study Claiming E-Cigarettes Are a COVID-19 Risk Factor
- A number of experts responded swiftly to the study's abnormal findings that lacked a credible causal theory.
- Comments referring to: "The evolving landscape of e-cigarettes: a systematic review of recent evidence".
- In a previous issue of CHEST (May 2020), Bozier et al1 reviewed the recent research on the potential health effects of e-cigarettes. We would like to comment on several of the claims made in the article.
- Comments referring to: "The Evidence of Electronic Cigarette Risks Is Catching Up With Public Perception"
- The overall claim made by Professor Glantz is that the public is right to regard vaping as equivalent in risk to smoking, and science is catching up. This is an unambiguously false and dangerous claim with material risks for health: it may encourage vapers to revert to smoking or smokers not to switch, and policymakers to adopts unduly restrictive measures on e-cigarettes that amount to regulatory protection for the cigarette trade.
- A more in-depth commentary: Vaping risk compared to smoking: challenging a false and dangerous claim by Professor Stanton Glantz
2020: PubPeer Comments RE: Myocardial Infarction
- Comments referring to: Electronic Cigarette Use and Myocardial Infarction Among Adults in the US Population Assessment of Tobacco and Health.
- NOTE: This paper has been RETRACTED by the journal
- Dr. Brad Rodu: "The main findings from this study are false and invalid. Their analysis was an indefensible breach of any reasonable standard for research on association or causation."
- Additional comments follow Dr. Rodu's and document the difficulties encountered by Public Health experts to get the above-mentioned misleading study retracted.
- Retraction Notice: Retraction to: Electronic Cigarette Use and Myocardial Infarction Among Adults in the US Population Assessment of Tobacco and Health
- Given these issues, the editors are concerned that the study conclusion is unreliable. The editors hereby retract the article from publication in Journal of the American Heart Association.
- From Retraction Watch: Journal retracts hotly contested paper on vaping and heart attacks
- Article: Here Comes Trouble: An Anti-Tobacco Hero’s Complicated Legacy
Media
Regulators, Government Agencies, and Policy Makers
- Lawmakers who continue to flout misleading statements...
Multiple years - Ongoing even after being debunked: Popcorn Lung
- For more information on Popcorn Lung see: Science Hygiene - The Call To Correct Misinformation About Nicotine>> Non-profits or Their Funders
- 2020: Nora Volkow, MN (NIDA, NIH) - Collision of the COVID-19 and Addiction Epidemics
- The highly publicized lung illnesses from vaping, including “popcorn lung” and e-cigarette or vaping product use–associated lung injury, alert us to the potential for lung injury from vaping, which is on the rise especially in young persons.
- Article: Filter - Anti-Vaping Zealots Find Opportunity in the Pandemic
- 2015: New Study Finds that Average Diacetyl Exposure from Vaping is 750 Times Lower than from Smoking
- 2015: Medical journal MISPRESENTS a case of hypersensitivity pneumonitis as popcorn lung disease caused by e-cigarette
- Cancer Research UK: Does vaping cause popcorn lung?
- E-cigarettes don’t cause the lung condition known as popcorn lung
- There have been no confirmed cases of popcorn lung reported in people who use e-cigarettes
- E-cigarettes are one of the tools that can help people who smoke to stop
- 2022: What are people’s views about the risks of vaping? Findings from conversations with the public.
- What might be causing an increase in inaccurate views of the harms of vaping compared to smoking?
- Misinformation about vaping (for example, that it can cause popcorn lung)
- 'But when you're dealing with propaganda, it's best not to get too lost in the weeds... When targets of such communications realize they're being lied to, they tend to tune out all the information from official sources because they know it's not really unbiased, scientific, or seeking the truth."
2019 and Beyond: The CDC, the FDA, and others: EVALI
- Article: The CDC’s EVALI screwup
- Making a mistake is one thing. Failing to correct it is worse.
- But there is no evidence–none at all— that anyone got sick with EVALI from using e-cigarettes.
- Twitter thread by Mike Pesko about the letter to the CDC requesting them to change the name of EVALI, and the CDC's refusal to do so. This letter was signed by 75 international tobacco control / public health experts.
- Paper: Vitamin E Acetate is not Soluble in Nicotine E-liquids
- Vitamin E acetate is not soluble in formulations of nicotine e-liquids and if mixed into a nicotine e-liquid will form a visibly distinct layer. Therefore, it is unlikely that nicotine-only e-cig users will be exposed to vitamin E acetate.
- Paper: The outbreak of lung injuries often known as "EVALI" was nothing to do with nicotine vaping
- An examination of the evidence shows that EVALI cannot have been caused by nicotine vaping. The characteristics of the lung injury outbreak are consistent with localised supply chain contamination. The contaminant has been identified and is known to be Vitamin E Acetate. This had been used as a thickener or cutting agent in illicit Tetrahydrocannabinol (THC) cannabis vape pens. This agent cannot be mixed with nicotine vaping liquids and would serve no useful purpose if it could be.
- Article: E-Cigarettes Increasingly Blamed for Lung Illnesses, as Evidence Points Elsewhere
- CDC identified THC vapes with vitamin E acetate as culprit, but 66% of adults blame e-cigarettes for vaping deaths
- Tweets by Scott Gottlieb, MD
- An e-cigarette is an FDA regulated electronic nicotine delivery system (ENDS). It delivers nicotine. What CDC seems to be trying to refer to here are illegal vapes or “dabs” that contain THC. We develop precise regulatory nomenclature for a reason. It helps differentiate products
- CDC should reconsider the name it ascribed to these illnesses (EVALI) now that it seems to be definitively linked to THC vapes and dabs. By not speaking with precision it could leave a false impression as to the clear causal relationship between the tragic illnesses and THC vapes
- The public health risk is that kids using these illegal and dangerous THC products may not know that the CDC warnings relate to the THC products they’re using; since the CDC is not using a precise nomenclature to more clearly describe the THC vapes and dabs
- Tweet by Scott Gottlieb MD
- My point is simply if you know a THC product hurt someone, don’t call it an e-cigarette, call it a THC vape or THC vaping product. Nomenclature matters in helping consumers properly identify which products are causing which kinds of risks. That’s why we develop naming systems.
2018 and Beyond: Youth Vaping Epidemic: US Surgeon General, FDA, CDC, etc.
- Slide 22/83 - FDA research findings on using the word "epidemic" - shows they were aware of the unintended consequence of deterring adults from using e-cigs to quit smoking. They went ahead with the campaign.
- US Surgeon General issues advisory on youth vaping epidemic.
- Dec 2018: NPR story about SG advisory and the CDC issues information about the SG advisory.
- Dec 2019: FDA’s So-Called Laser Targeted Advertising is Hypocritical, and Deadly.
- The FDA found that its campaign would convince adult smokers that e-cigarettes were equally or more harmful than cigarettes and suppress quitting, and still the agency proceeded with its dangerous misinformation program.
- How did the FDA campaign, which has been supported by other government and medical organizations, work out? As the chart shows, pre-campaign, nearly 40% of Americans believed that e-cigarettes were safer than cigarettes in 2012. By 2018, that number had cratered to a mere 17%.
- A more careful read, however, reveals important areas where the report falls short.
- One of the more surprising shortcomings of the 2016 SGR is located early in the document when the reader is informed that recent studies were included if they conformed to conclusions that had already been reached...the selection of evidence to align with preset conclusions represents a type of bias known as “confirmation bias.”
- Other concerns not completely covered or covered in a biased way: age of purchase laws, studies on cognition, prenatal exposure...
- Incomplete or biased messaging on the effects of these and other nicotine products must be avoided at all costs in order to support the public in making personal choices that are informed by the best available evidence.
Non-profits or Their Funders
- “We’re not talking misinformation. We’re talking disinformation. This is willful misrepresentation of facts. It’s mind-blowing.”
- Prof Mike Cummings presenting at E-Cigarette Summit 2021
- Successful public health campaigns rely on establishing and maintaining the public’s trust in the recommendations that are given. This presentation highlights concerns that I have about the erosion of trust in tobacco control that appears to be happening because previously trusted public health officials are staking out policy positions that distort the truth about lower risk alternative nicotine products.
2021: Truth Initiative's Depression Sticks Campaign
- 2021: Video: Depression causes vaping!
- In this talk Professor Notley will discuss the latest evidence exploring associations between nicotine use and common mental health conditions, including depression.
- Interpretive assumptions will be drawn out, including inappropriate claims of causal relationships between vaping and depression.
- 2021: Video (Consumer) The Truth about #DepressionSticks
- Depression is nothing to laugh about or stigmatize. @TruthInitiative has created a multi-million dollar ad campaign that does both. @imaracingmom opens up about her struggle with depression and her pain magnified by the #DepressionStick misinformation campaign. They make light of youth depression and shame people for trying to minimize their suffering by any means necessary. It's time we told them you will not shame me. You will not reduce my suffering to a hashtag and you will not lie to me any more.
Multiple years - Ongoing even after being debunked: Popcorn Lung
- See also: Science Hygiene - The Call To Correct Misinformation About Nicotine >>> Regulators, Government Agencies, and Policy Makers
- Scaremongering shared by many health organizations. A few Examples:
- American Lung Association, Tobacco Free Colorado, Say San Diego
- Several NGOs sued the FDA in 2018 - they used misleading information on Popcorn lung as part of their evidence (#45 page 21/70) as to why they felt the submission date for Pre-Market Tobacco Applications (PMTA) needed to be changed.
- 2015: New Study Finds that Average Diacetyl Exposure from Vaping is 750 Times Lower than from Smoking
- 2015: Medical journal MISPRESENTS a case of hypersensitivity pneumonitis as popcorn lung disease caused by e-cigarette
- Cancer Research UK: Does vaping cause popcorn lung?
- E-cigarettes don’t cause the lung condition known as popcorn lung
- There have been no confirmed cases of popcorn lung reported in people who use e-cigarettes
- E-cigarettes are one of the tools that can help people who smoke to stop
- 2022: What are people’s views about the risks of vaping? Findings from conversations with the public.
- What might be causing an increase in inaccurate views of the harms of vaping compared to smoking?
- Misinformation about vaping (for example, that it can cause popcorn lung)
Learn more about misinformation - not nicotine related
Changing Minds & Bias - Why is it so hard to correct misinformation with facts?
2022: Podcast: You Are Not So Smart: The Truth Wins - Tom Stafford
2021: Podcast: How Do We Fix It? Amanda Ripley - High Conflict
2020: On Critics and Bullies
2018: Video: When was the last time you really changed your mind?
- 2022: A thought-provoking MUST READ follow up to this story: Fake News about our Fake News Study Spread Faster than its Truth… Just as We Predicted.
2014: Podcast: You Are Not So Smart: Belief
Reasons For Hiding The Truth
Suggestions to add to this page
2022: Critical Review of the Recent Literature on Organic Byproducts in E-Cigarette Aerosol Emissions
- "The Nicotine Vaping in England report suggests that health risks of vaping are often overstated, resulting in inaccurate risk perceptions that could deter people who use the most harmful product (cigarettes) from switching to less harmful product (e-cigarettes). According to representative surveys of young people (11–18 years) and adults (≥18 years) in England in 2021, 55°3% of young people and 65·9% of adult smokers and vapers in England mistakenly think that vaping is as harmful or more harmful than smoking.2 Such inaccurate perceptions have probably been fuelled by misrepresentative news coverage of e-cigarette harms, such as that of the US outbreak of vaping-associated lung injury in 2019, which was caused by inhaling vitamin E acetate, an additive in cannabis vaping devices, rather than standard nicotine e-cigarettes.4 In an effort to uphold the precautionary principle, the health community may have inadvertently aided the promotion of misinformation.5"
2022: France and Germany TOBACCO HARM REDUCTION AND NICOTINE PERCEPTIONS
2022: Analysis of state portrayals of the risks of e-cigarette use and the cause of the EVALI outbreak
- See: EVALI (and maybe other things)
- For Non-Subscribers to the Boston Globe, this is viewable "incognito"
- Singapore
2022: Analysis of common methodological flaws in the highest cited e‑cigarette epidemiology research
- Drug Science UK
- Among smokers who have never vaped, only 1 in 8 (12%) correctly believe e-cigarettes are a lot less harmful than cigarettes.
- In 2017 under a third of smokers understood that NRT was much less harmful than smoking. Among smokers, perceptions are also getting worse with only 20% accurately believing in 2017 that e-cigs are less harmful than smoking compared with 31% in 2015.
