Modeling the population health impact of nicotine misperceptions

Abstract

Abstract Background: Scientific evidence clearly demonstrates that inhaling the smoke from the combustion of cigarettes is responsible for most of the harm caused by smoking, and not the nicotine. However, a majority of U.S. adults who smoke (AS) inaccurately believe that nicotine causes cancer which may be a significant barrier, preventing AS from switching to potentially reduced-harm, smoke-free products (SFP) like electronic nicotine delivery systems (ENDS), smokeless tobacco, and snus. We quantify the population health impact associated with nicotine misperceptions. Methods: Using a previously validated agent-based model to the U.S. population, we analyzed nationally representative data from the Population Assessment of Tobacco and Health (PATH) study to estimate base case rates of sustained (maintained over four waves) cessation and switching to SFP use, by sex. Nicotine perception scenarios used data from Wave 4 of PATH as the baseline wave to analyze levels of nicotine misperceptions. The overall switch rate from smoking in Wave 4 to SFP use in Wave 5 (3.94%) was stratified based on responses to the nicotine perception question “Do you believe nicotine is the chemical that causes most of the cancer caused by smoking cigarettes?”, (Four-item scale from “Definitely not” to “Definitely yes”). The relative percent change between the overall and stratified rates, corresponding to each item, was used to adjust the base case rates of switching to reflect the impact if all AS exhibited switching behaviors based on responses to the nicotine perceptions question. The public health impact of nicotine perceptions was estimated as the difference in all-cause mortality between the base case and the four nicotine perception scenarios. Results: Switch rates associated with those who responded, “Definitely not” (8.39%) resulted in a net benefit of preventing nearly 800,000 premature deaths over an 85-year period. Conversely switch rates reflective of those who responded, “Definitely yes” (2.59%) resulted in a net harm of nearly 300,000 additional premature deaths over the same period. Conclusions: Accurate knowledge regarding the role of nicotine is associated with higher switch rates and prevention of premature deaths. Our findings suggest that promoting public education to correct nicotine misperceptions has potential to benefit public health.