- 63 per cent of adults who use little cigars and cigarillos overestimate nicotine’s harm
- 65.7 per cent have incorrect perceptions about nicotine’s health risks
- No significant difference compared with people who smoke cigarettes or use both products
- Using additional tobacco products linked to more accurate nicotine perceptions
Most adults who use little cigars and cigarillos overestimate the dangers of nicotine – and they are just as likely to get it wrong as people who smoke cigarettes, according to a new U.S. study.
The analysis, published in the journal Tobacco Induced Diseases, examined data from more than 5,500 U.S. adults who currently used little cigars and cigarillos (LCCs), cigarettes, or both, drawn from Wave 7 (2022 to 2023) of the Population Assessment of Tobacco and Health (PATH) Study
Researchers reported that “approximately 63 per cent of respondents who use LCCs overestimated nicotine harms and 65.7 per cent reported nicotine misperceptions”
What the study looked at
The researchers noted that “Little is known about nicotine perceptions among people who use little cigars and cigarillos (LCCs)”
While previous research has shown that many people who smoke cigarettes misunderstand nicotine’s role in smoking-related disease, nationally representative data on LCC users have been lacking.
Using cross-sectional data from adults aged 18 and over, the team assessed responses to the question: “How harmful do you think nicotine is to health?”
Participants answered on a five-point scale ranging from “not at all” to “extremely” harmful.
The study defined two types of misperceptions: overestimating nicotine’s harm (rating it “very” or “extremely” harmful), and broader incorrect perceptions (rating it “not at all”, “very” or “extremely” harmful).
The sample included people who used cigarettes only, LCCs only, and those who used both. People who only used LCCs as blunts were excluded.
No difference between product types
One of the central findings was that nicotine misperceptions were widespread – and did not differ significantly by product type. The authors concluded: “People who use LCCs are equally likely to overestimate or be incorrect about nicotine harms as those who exclusively or dual use cigarettes”
Statistical analysis showed no significant differences in adjusted odds ratios between exclusive cigarette users (the reference group), dual users, and those who used LCCs without cigarettes
In other words, switching between or combining combustible products did not appear to change how harmful respondents believed nicotine to be.
Other tobacco use linked to more accurate views
However, the study did identify one notable difference. “People who used other tobacco products in addition to LCCs and/or cigarettes were significantly less likely.. to overestimate the harms of nicotine compared to those who did not use other tobacco products”
The same group was also less likely to hold incorrect perceptions more broadly.
The additional products captured in the analysis included electronic nicotine products (vapes), traditional cigars, pipe tobacco, hookah, snus and other smokeless tobacco.
The authors concluded: “using additional products is associated with correct responses about nicotine harms.”
Demographic differences
The study also found significant differences across demographic groups.
Adults aged 25 to 54 were more likely than those aged 18 to 24 to overestimate and misjudge nicotine’s harms. Males were less likely than females to hold misperceptions.
Non-Hispanic Black and Hispanic respondents were more likely than non-Hispanic White respondents to overestimate nicotine’s harms and to hold incorrect perceptions. Higher educational attainment was associated with lower odds of misperception.
Overall, the authors wrote: “..people who use LCCs and/or cigarettes are likely to overestimate the harm of nicotine (63.0 per cent; 95 per cent CI: 61.8-64.2) and have incorrect perceptions about the harm of nicotine (65.7 per cent; 95 per cent CI: 64.6-66.9)”.
Policy implications
The findings are particularly relevant in the context of U.S. regulatory authority over nicotine levels in tobacco products. As the paper notes, “The FDA has regulatory authority to set nicotine levels for tobacco products in the US”
The authors suggest that misperceptions may have real-world consequences. “Prior research indicates that individuals in population sub-groups that overestimate the harms of nicotine may not realize that nicotine replacement therapy is an FDA-approved, safe, and effective cessation tool”.
They add that “Ongoing monitoring of nicotine misperceptions in these specific groups of LCC users will help detect changes to the absolute prevalence of misperceptions following regulatory actions and estimate how these misperceptions impact the continued use of combustible tobacco products”
Strengths and limits
The study draws on what the authors describe as “the most recent nationally representative PATH Study data to provide an estimate of nicotine perceptions”.
However, they acknowledge limitations. The research “uses self-reported data susceptible to social desirability biases”, “is cross-sectional and thus does not allow for causal inference”, and “was conducted using only US data, which limits its generalizability for adult LCC users in other countries”.
Even so, the central message is that misunderstanding about nicotine’s harms remains common – not only among people who smoke cigarettes, but also among those who use little cigars and cigarillos.
