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Tobacco Merchants Association Annual Meeting 2023

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Population Health Impact Associated with Nicotine Perceptions

To kick off the 2023 Tobacco Merchants Association Annual (TMA) Meeting, Dr. Hannel joined a panel to discuss nicotine misperceptions and harm reduction. During the session, Dr. Hannel shared results of a model based on data from the Population Assessment of Tobacco and Health (PATH) Study, which shows correcting nicotine misperceptions among adults who smoke could prevent nearly 800,000 premature deaths over an 85-year period.

While not risk free, nicotine is not what causes the majority of harm caused by smoking cigarettes. As the Food and Drug Administration (FDA) says 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.”1 However, analysis of Wave 4 data from PATH, which is a collaboration by the National Institutes of Health (NIH) and FDA, shows that 63% of adults who smoke have an incorrect understanding of nicotine.

Powerpoint slide talking about Nicotine Misperceptions with a bar chart displaying percentage of people who believe nicotine causes cancer. 19% say definitely yes, 44% probably yes, 30% probably not, and 7% definitely not.

And when looking at the transition probability to smoke-free products, Thad observed adults who smoke with an incorrect understanding of the risks of nicotine are associated with lower rates of switching compared to those with a correct understanding. 

Powerpoint slide talking about Nicotine Misperceptions associated with lower switch rates with a bar chart displaying the transition probability to smoke free products. The groups that believe nicotine does not cause cancer are more likely to switch.
Dr. Hannel developed a Base Case model – representing the world as it is today – using estimates of cigarette smoking initiation, cessation, and switching to exclusive smoke-free product use (i.e., use of e-cigarettes, smokeless tobacco and/or snus). He then developed Modified Case scenarios based on switching rates associated with each of four nicotine perception response groups. Based on the modified case scenarios, Thad then estimated the public health impact of nicotine misperceptions as the difference in all-cause mortality between the Base Case and Modified Case scenarios.
Powerpoint slide discussing population impact difference in tobacco use prevalence and all-cause mortality between base and modified case.
If adults who smoke had truthful and accurate information on nicotine, the model predicts a net population health benefit of nearly 800,000 premature deaths prevented over an 85-year period. 
Powerpoint slide discussing the population health impact of nicotine misperceptions among those who identify definitely yes, probably yes, probably not, and definitely not causes cancer. Correcting smokers’ misperceptions of nicotine can result in a public health benefit. Failing to do so can cause harm.
Dr. Hannel’s analysis shows that correcting deeply entrenched misperceptions regarding the health risks of nicotine can have a positive impact on public health. It’s imperative that adults who smoke have access to truthful and accurate information to make informed decisions. Unfortunately, misperceptions about nicotine remain high and pose a major barrier to adults who smoke switching to authorized reduced-harm products. 

We continue to advocate for FDA 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 combustible and smoke-free products.2 By helping to correct nicotine misperceptions, FDA can help eliminate a clear barrier to tobacco harm reduction for adults who smoke while minimizing reach to unintended audiences, including youth.

You can view Dr. Hannel’s presentation, “Population Health Impact Associated with Nicotine Perceptions” here.

 

1https://www.fda.gov/tobacco-products/health-effects-tobacco-use/nicotine-why-tobacco-products-are-addictive
2https://www.altria.com/-/media/Project/Altria/Altria/about-altria/federal-regulation-of-tobacco/regulatory-filings/documents/ALCS-Letter-to-FDA-081822.pdf