Consumers need – and are entitled to – truthful and accurate information to make informed decisions. We believe this should include the millions of adults who smoke in the U.S., many of whom are seeking reduced-risk alternatives to combustible cigarettes.1
 
Unfortunately, misperceptions about nicotine and the relative risks of tobacco products are a major obstacle to harm reduction and transitioning adults who smoke to smoke-free products. We believe the Center for Tobacco Products (CTP) has an opportunity to develop and deliver targeted communications – aimed at adults who smoke and the health care providers they look to for advice — about the role of nicotine and the relative risks of tobacco products.

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Watch our scientists share about how misperceptions are hindering the shift to smoke-free products and how correcting them could help reduce harm from tobacco products.

While nicotine is not risk-free and is highly addictive, nicotine is not a carcinogen and is not what makes smoking cigarettes harmful. Instead, it’s the exposure to smoke that causes most tobacco-related disease. As the Food and Drug Administration (FDA) states on its website: "Nicotine is what keeps people using tobacco products. However, it’s the thousands of chemicals contained in tobacco and tobacco smoke that make tobacco use so deadly.”2
 
And while tobacco science generates robust debate, various data sources highlight the existence of misperceptions about nicotine as well as the relative risks of tobacco products. For example:

 

  • Recent studies co-led by Cristine Delnevo, the Director of the Center for Tobacco Studies at Rutgers University and the Chair of TPSAC, found that over 80% of physicians incorrectly believed that nicotine directly contributes to the development of cancer and more than 60% believe all tobacco products to be equally harmful.3,4
  • A recent study by Rutgers University found that 88% of adults who smoke believe e-cigarettes are as or more harmful than smoking cigarettes or are unsure about the relative risk.5
  • A 2016 study by CTP scientists analyzing data from the Health Information National Trends Survey found that around “three quarters of people either were unsure of the relationship between nicotine and cancer or incorrectly believe that nicotine causes cancer.”6
  • Data from Wave 4 of the Population Assessment of Tobacco and Health (PATH) Study found that a majority of adults who smoke believe smoke-free products – e-vapor, smokeless and snus – are about the same or more harmful than smoking cigarettes.7

 

As a result of these misperceptions, adults who smoke and their health care providers are misinformed about the harm reduction potential of smoke-free products. In fact, the FDA has argued that misinformation causes consumers to make decisions that are bad for them and declared that “one of the most basic responsibilities of the FDA is to disseminate facts about science and medicine to the public in order to help Americans make informed choices about their health.”8-11

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By providing truthful and accurate information on the role of nicotine and the relative risks of tobacco products, CTP can help adults who smoke make informed decisions and realize the positive health impact that could result if these misperceptions are corrected. To attempt to quantify the public health impact, we used an Agent-based Model to demonstrate how many premature deaths could be prevented among those with correct and incorrect perceptions of the role of nicotine in tobacco products. Based on our analysis from Wave 4 of the PATH Study, correcting smokers’ misperceptions of nicotine can result in a significant public health benefit, preventing nearly 800,000 premature deaths over the next ~80 years. Our analysis also found that failing to correct these misperceptions will create more harm to public health. View the modeling analysis.
Correcting misperceptions about nicotine and the relative risks of tobacco products should be a top priority for CTP, which has the resources, expertise, and the statutory authority to correct these misperceptions and help millions of adults who smoke make decisions based on truthful and accurate information. We urge CTP to develop and deliver targeted communications – aimed at smokers and the health care providers they look to for advice – about the role of nicotine and the relative risks of combustible and smoke-free products.

1 Based on ALCS analysis of PATH Wave 1 data (Sept. 12, 2013 - Dec. 14, 2014), approximately 23 million adult smokers (18+) are interested in and likely to use tobacco products that may reduce their health risks. 

2 FDA. Nicotine Is Why Tobacco Products Are Addictive. 29 June 2022.
https://www.fda.gov/tobacco-products/health-effects-tobacco-use/nicotine-why-tobacco-products-are-addictive
 
3 Delnevo, Cristine, et al. Nicotine Risk Misperception Among US Physicians. Journal of Internal Medicine, Volume 36. 1 September 2020.
https://link.springer.com/article/10.1007/s11606-020-06172-8
 
4 Delnevo, Cristine, et al. Communication Between US Physicians and Patients Regarding Electronic Cigarette Use. JAMA. 15 April 2022. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2791164
 
5 Wackowski, Olivia, et al. Perceptions about levels of harmful chemicals in e-cigarettes relative to cigarettes, and associations with relative e-cigarette harm perceptions, e-cigarette use and interest. Addiction. 23 May 2023. https://onlinelibrary.wiley.com/doi/10.1111/add.16258
 
6 O'Brien, E. K., Nguyen, A. B., Persoskie, A., & Hoffman, A. C. (2017). U.S. adults' addiction and harm beliefs about nicotine and low nicotine cigarettes. Preventive Medicine. 27 December 2016. https://pubmed.ncbi.nlm.nih.gov/28034733/
 
7 Altria Client Services LLC analysis of PATH Wave 4 (2018-2019) Data on Adults Who Smoke Cigarettes.
 
8 Califf, Robert, Commissioner of Food and Drug Administration. Remarks by Commissioner Robert Califf to the 2023 Food and Drug Law Institute (FDLI) Annual Conference. 17 May 2023. https://www.fda.gov/news-events/speeches-fda-officials/remarks-commissioner-robert-califf-2023-food-and-drug-law-institute-fdli-annual-conference-05172023
 
9 Califf, Robert, Commissioner of Food and Drug Administration. Speech by Commissioner Robert M. Califf to the House of Medicine. 30 June 2023.
https://www.fda.gov/news-events/speeches-fda-officials/speech-commissioner-robert-m-califf-house-medicine-06162023
 
10 Abdoulenein, Ahmed. New U.S. FDA chief says he will prioritize fighting misinformation. Reuters. 17 February 2022.
https://www.reuters.com/world/us/new-us-fda-chief-says-he-will-prioritize-fighting-misinformation-2022-02-17/.
 
11 Tirrell, Meg. Health misinformation is lowering U.S. life expectancy, FDA Commissioner Robert Califf says. CNBC. 11 April 2023.
https://www.cnbc.com/2023/04/11/us-life-expectancy-hurt-by-misinformation-fda-commissioner-robert-califf.html