Deficiencies in public understanding about tobacco harm reduction: results from a United States national survey

Harm Reduction Journal

Lynn T. Kozlowski¹  Marc T. Kiviniemi¹ 

[1] Department of Community Health and Health Behavior, University at Buffalo, State University of New York, School of Public Health and Health Professions, 3425 Main Street, Buffalo 14214, NY, USA

关键词: Health communication;    Risk perception;    Public health education;    Electronic cigarettes;    Smokeless tobacco;    Cigarettes;    Tobacco harm reduction;   

Others  :  1221141
DOI  :  10.1186/s12954-015-0055-0

 received in 2015-03-13, accepted in 2015-06-25,  发布年份 2015

【 摘 要 】

Background

Tobacco products differ in their relative health harms. The need for educating consumers about such harms is growing as different tobacco products enter the marketplace and as the FDA moves to regulate and educate the public about different products. However, little is known about the patterns of the public’s knowledge of relative harms.

Methods

Data were analyzed from the Health Information National Trends Survey (HINTS) 4 Cycle 2, a population-representative survey of US adults conducted between October 2012 and January 2013 (N = 3630). Participants reported their perceptions of the relative risks of e-cigarettes, smokeless tobacco, and different types of cigarettes compared to “traditional” cigarettes. Relative risk perceptions for each product type, as well as the consistency and accuracy of harm reduction beliefs, were analyzed.

Results

About 65 % of the respondents accurately reported that no cigarettes were less harmful than any others. Slightly more than half of US adults perceived e-cigarettes to be safer than regular cigarettes, a belief in line with current scientific evidence. By contrast, only 9 % of respondents perceived some smokeless tobacco products to be safer, a belief strongly supported by the evidence. Only 3.5 % of respondents had patterns of relative risk perceptions in line with current scientific evidence for all three modalities.

Conclusions

The discrepancy between current evidence and public perceptions of relative risk of various tobacco/nicotine products was marked; for most tobacco types, a large proportion of the population held inaccurate harm reduction beliefs. Although there was substantial awareness that no cigarettes were safer than any other cigarettes, there could be benefits from increasing the percentage of the public that appreciates this fact, especially among current smokers. Given the potential benefits of tobacco risk reduction strategies, public health education efforts to increase understanding of basic harm reduction principles are needed to address these misperceptions.

【 授权许可】

   
2015 Kiviniemi and Kozlowski.

【 参考文献 】

• [1]National Center for Chronic Disease Prevention and Health Promotion. Reports of the Surgeon General. The Health Consequences of Smoking-50 Years of Progress: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2014.
• [2]Harm reduction in nicotine addiction: helping people who can’t quit. Royal College of Physicians, London; 2007.
• [3]U.S. Food and Drug Administration. Deeming Tobacco Products To Be Subject to the Federal Food, Drug, and Cosmetic Act, as Amended by the Family Smoking Prevention and Tobacco Control Act; Regulations on the Sale and Distribution of Tobacco Products and Required Warning Statements for Tobacco Products; 2014. https://federalregister.gov/a/2014-09491. Accessed February 10, 2014 2015.
• [4]Sweanor D, Alcabes P, Drucker E. Tobacco harm reduction: how rational public policy could transform a pandemic. Int J Drug Policy. 2007; 18(2):70-74.
• [5]Zeller M. Reflections on the ‘endgame’ for tobacco control. Tob Control. 2013; 22(suppl 1):i40-i41.
• [6]Nutt DJ, Phillips LD, Balfour D, Curran HV, Dockrell M, Foulds J et al.. Estimating the harms of nicotine-containing products using the MCDA approach. Eur Addict Res. 2014; 20(5):218-225.
• [7]Twombly R. Snus use in the U.S.: reducing harm or creating it? J Natl Cancer I. 2010; 102(19):1454-1456.
• [8]Clearing the smoke: assessing the science base for tobacco harm reduction. National Academy Press, Washington; 2001.
• [9]National Institute for Health and Care Excellence. Tobacco: harm-reduction approaches to smoking; 2013. https://www.nice.org.uk/guidance/ph45. Accessed May 24, 2015.
• [10]Kozlowski LT. Prospects for a nicotine-reduction strategy in the cigarette endgame: alternative tobacco harm reduction scenarios. Int J Drug Policy. http://dx. doi.org/10.1016/j.drugpo.2015.02.001 webcite
• [11]U.S. Food and Drug Administration. Public Education Campaigns; 2015. http://www.fda.gov/TobaccoProducts/PublicHealthEducation/PublicEducationCampaigns/default.htm. Accessed June 29, 2015.
• [12]O’Connor RJ, McNeill A, Borland R, Hammond D, King B, Boudreau C et al.. Smokers’ beliefs about the relative safety of other tobacco products: findings from the ITC collaboration. Nicotine Tob Res. 2007; 9(10):1033-1042.
• [13]Biener L, Nyman AL, Stepanov I, Hatsukami D. Public education about the relative harm of tobacco products: an intervention for tobacco control professionals. Tob Control. 2014; 23(5):385-388.
• [14]Kozlowski LT, O’Connor RJ. Apply federal research rules on deception to misleading health information: an example on smokeless tobacco and cigarettes. Public Health Rep. 2003; 118(3):187.
• [15]Kozlowski LT, Edwards BQ. “Not safe” is not enough: smokers have a right to know more than there is no safe tobacco product. Tob Control. 2005; 14 Suppl 2:ii3-ii7.
• [16]Kozlowski LT. Harm reduction, public health, and human rights: smokers have a right to be informed of significant harm reduction options. Nicotine Tob Res. 2002; 4 Suppl 2:S55-S60.
• [17]Health Information an d National Trends Survey 4 (HINTS 4): cycle 2. Westat, Rockville; 2013.
• [18]Tan AS, Bigman CA. E-cigarette awareness and perceived harmfulness: prevalence and associations with smoking-cessation outcomes. Am J Prev Med. 2014; 47(2):141-149.
• [19]Risks associated with smoking cigarettes with low machine-measured yields of tar and nicotine. Smoking and tobacco control monograph 13. Department of Health and Human Services NIoH, National Cancer Institute, U.S.; 2001.
• [20]Kozlowski LT, Pillitteri JL. Compensation for nicotine by smokers of lower yield cigarettes. The FTC cigarette test method for determining tar, nicotine, and carbon monoxide yields of US cigarettes. In: Report of the NCI Expert Committee on Smoking and Tobacco Control. National Cancer Institute, National Institutes of Health, Bethesda; 1996: p.161-172.
• [21]Kozlowski LT. Effect of smokeless tobacco product marketing and use on population harm from tobacco use: Policy perspective for tobacco-risk reduction. Am J Prev Med. 2007; 33(6):S379-S386.
• [22]Scientific Committee on Emerging and Newly Identified Health Risks. Scientific opinion on the health effects of smokeless tobacco products; 2008. http://ec.europa.eu/health/ph_risk/committees/04_scenihr/docs/scenihr_o_013.pdf. Accessed December 9, 2014.
• [23]Hajek P, Etter JF, Benowitz N, Eissenberg T, McRobbie H. Electronic cigarettes: review of use, content, safety, effects on smokers and potential for harm and benefit. Addiction. 2014.
• [24]Royal College of Physicians. RCP Statement on e-cigarettes; 2014. www.rcplondon.ac.uk/press-releases/rcp-statement-e-cigarettes. Accessed December 4, 2014.
• [25]Rao JNK, Scott AJ. The analysis of categorical-data from complex sample-surveys - chi-squared tests for goodness of fit and independence in 2-way tables. J Am Stat Assoc. 1981; 76(374):221-230.
• [26]Rao JNK, Scott AJ. On chi-squared tests for multiway contingency-tables with cell proportions estimated from survey data. Ann Stat. 1984; 12(1):46-60.
• [27]O’Connor RJ, Hyland A, Giovino GA, Fong GT, Cummings KM. Smoker awareness of and beliefs about supposedly less-harmful tobacco products. Am J Prev Med. 2005; 29(2):85-90.
• [28]Kozlowski LT, O’Connor RJ. Cigarette filter ventilation is a defective design because of misleading taste, bigger puffs, and blocked vents. Tob Control. 2002; 11(suppl 1):i40-i50.
• [29]Kozlowski LT, Sweeney CT, Palmer RF, Pillitteri JL, White EL, Stine MM et al.. Smoker reactions to a “radio message” that light cigarettes are as dangerous as regular cigarettes. Nicotine Tob Res. 1999; 1(1):67-76.
• [30]Kozlowski LT, Yost B, Stine MM, Celebucki C. Massachusetts’ advertising against light cigarettes appears to change beliefs and behavior. Am J Prev Med. 2000; 18(4):339-342.
• [31]Lund I, Scheffels J. Perceptions of the relative harmfulness of snus among Norwegian general practitioners and their effect on the tendency to recommend snus in smoking cessation. Nicotine Tob Res. 2012; 14(2):169-175.
• [32]Kaufman AR, Mays D, Koblitz AR, Portnoy DB. Judgments, awareness, and the use of snus among adults in the United States. Nicotine Tob Res. 2014; 16(10):1404-1408.
• [33]Strasser AA, Orom H, Tang KZ, Dumont RL, Cappella JN, Kozlowski LT. Graphic-enhanced information improves perceived risks of cigar smoking. Addict Behav. 2011; 36(8):865-869.
• [34]Erickson PG. Introduction: the three phases of harm reduction. An examination of emerging concepts, methodologies, and critiques. Subst Use Misuse. 1999; 34(1):1-7.
• [35]Berridge V. Histories of harm reduction: illicit drugs, tobacco, and nicotine. Subst Use Misuse. 1999; 34(1):35-47.
• [36]Wackowski OA, Lewis MJ, Delnevo CD, Ling PM. Smokeless tobacco risk comparison and other debate messages in the news. Health Behav Policy Rev. 2014; 1(3):183-190.
• [37]Pearson JL, Richardson A, Niaura RS, Vallone DM, Abrams DB. e-Cigarette awareness, use, and harm perceptions in US adults. Am J Public Health. 2012; 102(9):1758-1766.
• [38]Popova L, Ling PM. Perceptions of relative risk of snus and cigarettes among US smokers. Am J Public Health. 2013; 103(11):e21-e23.
• [39]Kozlowski LT, Goldberg ME, Yost BA. Measuring smokers’ perceptions of the health risks from smoking light cigarettes. Am J Public Health. 2000; 90(8):1318.
• [40]U.S. Food and Drug and Administration. Tobacco Control Act. http://www.fda.gov/TobaccoProducts/GuidanceComplianceRegulatoryInformation/ucm298595.htm. Accessed September 10, 2014.
• [41]Kozlowski L, Strasser A, Giovino G, Erickson P, Terza J. Applying the risk/use equilibrium: use medicinal nicotine now for harm reduction. Tob Control. 2001; 10(3):201.
• [42]Rethinking drinking: alcohol and your health. National Institute of Alcohol Abuse and Alcoholism, Washington; 2010.