Nicotine - Misperceptions, Misinformation, or Disinformation

Multi-National

Consumers

2022: Do smokers' perceptions of the harmfulness of nicotine replacement therapy and nicotine vaping products as compared to cigarettes influence their use as an aid for smoking cessation? Findings from the ITC Four Country Smoking and Vaping Surveys

• 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: Exposure to Negative News Stories About Vaping, and Harm Perceptions of Vaping, Among Youth in England, Canada, and the United States Before and After the Outbreak of E-cigarette or Vaping-Associated Lung Injury (‘EVALI’)

• 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.

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: Effects of brief exposure to misinformation about e-cigarette harms on twitter: a randomised controlled experiment

• 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.

2020: Perceptions of nicotine in current and former users of tobacco and tobacco harm reduction products from seven countries

• 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.

2020: Tobacco harm reduction in the 21st century

• 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.

2020: Inequalities, harm reduction and non-combustible nicotine products: a meta-ethnography of qualitative evidence

• 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

2013: Survey of GPs' understanding of tobacco and nicotine products

• 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

2022: Do smokers' perceptions of the harmfulness of nicotine replacement therapy and nicotine vaping products as compared to cigarettes influence their use as an aid for smoking cessation? Findings from the ITC Four Country Smoking and Vaping Surveys

• 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.

Canada

Consumers

2022: Do smokers' perceptions of the harmfulness of nicotine replacement therapy and nicotine vaping products as compared to cigarettes influence their use as an aid for smoking cessation? Findings from the ITC Four Country Smoking and Vaping Surveys

• 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: Exposure to Negative News Stories About Vaping, and Harm Perceptions of Vaping, Among Youth in England, Canada, and the United States Before and After the Outbreak of E-cigarette or Vaping-Associated Lung Injury (‘EVALI’)

• 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.

Greece

Consumers

2020: Perceptions of nicotine in current and former users of tobacco and tobacco harm reduction products from seven countries

• 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.

India

Consumers

2020: Perceptions of nicotine in current and former users of tobacco and tobacco harm reduction products from seven countries

• 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.

Japan

Consumers

2020: Perceptions of nicotine in current and former users of tobacco and tobacco harm reduction products from seven countries

• 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.

Netherlands (Holland)

Consumers

2021: Regulation of e-cigarette flavours – a response

• 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

2020: Perceptions of nicotine in current and former users of tobacco and tobacco harm reduction products from seven countries

• 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

2021: The Frequency of Use and Harm Perception of Heated Tobacco Products (HTPs): The 2019 Cross-Sectional Survey among Medical Students from Poland

• Approximately half of the respondents believed they [HTPs] are safer than traditional cigarettes and almost 1/4 believed they are safer than e-cigarettes.

2021: Perception of Harmfulness of Various Tobacco Products and E-Cigarettes in Poland: A Nationwide Cross-Sectional Survey

• 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).

2017: How Social Care Beneficiaries in Poland Rate Relative Harmfulness of Various Tobacco and Nicotine-Containing Products

• 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).

2016: Perceived Relative Harm of Selected Cigarettes and Non-Cigarette Tobacco Products—A Study of Young People from a Socio-Economically Disadvantaged Rural Area in Poland

• 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).

South Africa

Consumers

2020: Perceptions of nicotine in current and former users of tobacco and tobacco harm reduction products from seven countries

• 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

2010: Harm perception among Swedish daily smokers regarding nicotine, NRT-products and Swedish Snus

• 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

2013: Survey of GPs' understanding of tobacco and nicotine products

• 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

2022: Do smokers' perceptions of the harmfulness of nicotine replacement therapy and nicotine vaping products as compared to cigarettes influence their use as an aid for smoking cessation? Findings from the ITC Four Country Smoking and Vaping Surveys

• 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

2022: Myths and Misinformation: Mapping the barriers to smoking cessation and the uptake of nicotine alternatives

• ...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.

2022: Exposure to Negative News Stories About Vaping, and Harm Perceptions of Vaping, Among Youth in England, Canada, and the United States Before and After the Outbreak of E-cigarette or Vaping-Associated Lung Injury (‘EVALI’)

• 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.

2022: The Khan review Making smoking obsolete

• 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.

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: Effects of brief exposure to misinformation about e-cigarette harms on twitter: a randomised controlled experiment

• 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.

2020: Association between changes in harm perceptions and e-cigarette use among current tobacco smokers in England: a time series analysis

• 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%

2020: Perceptions of nicotine in current and former users of tobacco and tobacco harm reduction products from seven countries

• 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: Harm perceptions of e-cigarettes and other nicotine products in a UK sample

• 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."

2015: Nicotine “no more harmful to health than caffeine”

• 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.

Health Care

2018: E-cigarettes as a Smoking Cessation aid in Cancer Patients: Health Professionals knowledge, attitude and current practice

• 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.

2013: Survey of GPs' understanding of tobacco and nicotine products

• 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 States

Consumers

2022: Relative Harm Perceptions of E-Cigarettes Versus Cigarettes, U.S. Adults, 2018–2020

• 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.

2022: 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.

2022: Do smokers' perceptions of the harmfulness of nicotine replacement therapy and nicotine vaping products as compared to cigarettes influence their use as an aid for smoking cessation? Findings from the ITC Four Country Smoking and Vaping Surveys

• 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: Exposure to Negative News Stories About Vaping, and Harm Perceptions of Vaping, Among Youth in England, Canada, and the United States Before and After the Outbreak of E-cigarette or Vaping-Associated Lung Injury (‘EVALI’)

• 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.

2022: Beliefs and Characteristics Associated With Believing Nicotine Causes Cancer: A Descriptive Analysis to Inform Corrective Message Content and Priority Audiences

• 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.

2022: A Close Look at Vaping in Adolescents and Young Adults in the USA

• 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.

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: Effects of brief exposure to misinformation about e-cigarette harms on twitter: a randomised controlled experiment

• 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.

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.

2020: Perception of the relative harm of electronic cigarettes compared to cigarettes amongst US adults from 2013 to 2016: analysis of the Population Assessment of Tobacco and Health (PATH) study data

• 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.

2020: Perceptions of nicotine in current and former users of tobacco and tobacco harm reduction products from seven countries

• 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: Perceived Comparative Harm of Cigarettes and Electronic Nicotine Delivery Systems

• 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.

2019: Misperceptions of Nicotine and Nicotine Reduction: The Importance of Public Education to Maximize the Benefits of a Nicotine Reduction Standard

• 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.

2019: Impact of Brief Nicotine Messaging on Nicotine-Related Beliefs in a U.S. Sample

• 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%).

2019: Misperceptions of Nicotine and Nicotine Reduction: The Importance of Public Education to Maximize the Benefits of a Nicotine Reduction Standard

• 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.

2019: Reducing Nicotine Without Misleading the Public: Descriptions of Cigarette Nicotine Level and Accuracy of Perceptions About Nicotine Content, Addictiveness, and Risk

• 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.

2017: Changing Perceptions of Harm of E-Cigarettes Among U.S. Adults, 2012-2015

• 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

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.

2016: U.S. adults' addiction and harm beliefs about nicotine and low nicotine cigarettes

• 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.

2011: Providing accurate safety information may increase a smoker's willingness to use nicotine replacement therapy as part of a quit attempt

• 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

Health Care

2022: Communication Between US Physicians and Patients Regarding Electronic Cigarette Use

• 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

2021: Persistent Misperceptions about Nicotine among US Physicians: Results from a Randomized Survey Experiment

• 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.

2020: Nicotine Risk Misperception Among US Physicians

• 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

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

2022: Discussions and Misinformation About Electronic Nicotine Delivery Systems and COVID-19: Qualitative Analysis of Twitter Content

• Misinformation and conspiracy theories were present throughout all coding categories.

2021: Effect of brief nicotine corrective messaging on nicotine beliefs in persons who use opioids

• 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.

Science Hygiene - The Call To Correct Misinformation About Nicotine

Academic Community

2022: Vaping misrepresentations

• Comments referring to: "Erosive potential of commonly available vapes: a cause for concern?"
• We were disappointed to see several basic errors and misrepresentations. We would like to correct the five most major errors

2020: Bad Data and Bad Conclusions Will Lead to Bad Policy – Implausible Claims that Vaping Increases COVID-19 Risk for Youth and Young Adults

• 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

2020: Vaping Nicotine Is Far Less Harmful Than Smoking Tobacco

• 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.

2020: Vaping risk compared to smoking: challenging a false and dangerous claim

• Comments referring to: "The Evidence of Electronic Cigarette Risks Is Catching Up With Public Perception"
• Professor Glantz's commentary provides a useful basis for a review of many of the most false and misleading claims made about e-cigarette use compared to smoking.
• A more in-depth commentary: Vaping risk compared to smoking: challenging a false and dangerous claim by Professor Stanton Glantz

2020: PubPeer Comments

• 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

Regulators, Government Agencies, and Policy Makers

2019 and Beyond: The CDC and 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 MN
  • 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.

Non-profits or Their Funders

2022: AVM: What Anti-Vaping Activists Get Wrong In Their FDA Letter

To-Do: Popcorn Lung

Suggestions to add to this page

2017: RSPH - Targeting the supply and sale of e-cigarettes to smokers

• Among smokers who have never vaped, only 1 in 8 (12%) correctly believe e-cigarettes are a lot less harmful than cigarettes.

2017: Use of e-cigarettes among adults in Great Britain 2017

• 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.

2004: Stop-smoking medications: who uses them, who misuses them, and who is misinformed about them?