Misperceptions of Nicotine and Nicotine Reduction: The Importance of Public Education to Maximize the Benefits of a Nicotine Reduction Standard

Abstract

The public health impact of FDA's recently proposed nicotine reduction standard may be impacted by the extent to which tobacco users and non-users understand the harms of nicotine in relation to specific products (eg, e-cigarettes, nicotine replacement therapy [NRT], reduced nicotine content cigarettes), and how this influences decisions made by users regarding cessation, product switching, or continued use. FDA's 2018 Advance Notice of Proposed Rulemaking (ANPRM) addresses these questions related to perceptions of very low nicotine content (VLNC) cigarettes directly in asking: "IV.B.4. If FDA were to finalize a nicotine tobacco product standard, what is the potential that adults and adolescents would perceive these VLNC cigarettes as 'safe'-and how could youth and adult risk perceptions of these cigarettes impact initiation, use, and cessation habits of combusted tobacco products?" Below, we review current evidence as it pertains to this question and we recommend key elements of public education efforts to correct misperceptions of nicotine in order to maximize the potential benefits of a nicotine reduction standard.