Misperceiving Nicotine Health Risks

My research group published survey data in 2010 documenting that a highly educated population (faculty at the University of Louisville) misperceived the health risks of smokeless tobacco use compared with smoking (discussed here).  Half of survey participants incorrectly believed that smokeless tobacco use confers general health risks that are equal to or greater than smoking; the misperception rate for oral cancer risk was 86%.

In a new study, we measure misperceptions of nicotine.  My co-authors are Dimple Patel and Nicholas Peiper, graduate students in public health at the University of Louisville; the article appears in Addiction Research and Theory (abstract here).  

Our study quantifies risk perceptions of cigarette smoking and nicotine use with respect to general health, heart attack/stroke, all cancer and oral cancer among full-time faculty. We compare the results from faculty on the health science campus with those in schools not related to health.  

We find that “the majority [of faculty] incorrectly categorized nicotine as moderate or high risk for all health domains, which is contrary to expert assessments.”

Our findings confirm that misperception of nicotine is widespread.  As we note, “Several surveys previously documented smokers’ misperceptions of nicotine’s risks. In 2001, a nationally representative survey of American smokers revealed that two thirds incorrectly believed that nicotine causes cancer, and 65% believed that nicotine patches confer the same or higher risk for heart attack as cigarettes (here). A majority of smokers also believe that reducing nicotine in cigarettes reduces harm (here). A 2009 survey involving smokers in Norway and Sweden reported exaggerated perceptions of harm from nicotine and NRT products (here). It found that 55% of smokers incorrectly regarded nicotine as being a relatively large to very large part of cigarette harm, and 59% wrongly believed that long-term use of nicotine from patches or gum is almost as harmful as smoking. Smokers in Minnesota had strong misperceptions that nicotine was the cause of heart attack, stroke, lung cancer, and oral cancer.”(here)

We write that “The FDA, which since 2009 has had regulatory authority over both tobacco and pharmaceutical nicotine, could serve as an educational resource for correcting misperceptions about the health effects of nicotine.  In fact, there is evidence that the agency is looking at its options. In October 2010, the FDA Center for Drug Evaluation and Research conducted a workshop on the risks and benefits associated with long-term use of pharmaceutical nicotine products (information here). It is clear from the presentations that almost all participants believe that the health risks from long-term nicotine use are minimal to negligible. In addition, a presentation by Dr. Dorothy Hatsukami from the University of Minnesota addressed the importance of educating the public to correct misperceptions about pharmaceutical nicotine use.”

That workshop was held two years ago, but the agency has been slow to take the simplest steps concerning nicotine.  As I wrote three years ago (here), the FDA never responded to New York State Health Commissioner Richard Daines’s 2008 petition requesting minor revisions in package labeling and sale of nicotine that would greatly expand consumer awareness and availability.  But the FDA has allowed Niconovum, a pharmaceutical nicotine company affiliated with Reynolds American, to sell 10-packs of its Zonnic nicotine gum to compete directly with cigarettes (website here).

On April 1 the FDA removed the 12-week limit on pharmaceutical nicotine products (here).  This is a message to smokers that nicotine is not the problem, and it may also signal the agency’s recognition that a small percentage of former smokers use nicotine for months, even years, after quitting.    

We conclude: “Nicotine is not the cause of any of the diseases associated with smoking.  There is an immense disconnect between the scientific and medical facts about nicotine and the perception of highly educated people, including health professionals… Our study documents that health education initiatives are still needed to minimize and/or eliminate these misperceptions and to inform smokers about noncombustible nicotine products that are vastly less hazardous than smoking.”