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Public misperception that very low nicotine cigarettes are less carcinogenic
  1. M Justin Byron1,2,
  2. Michelle Jeong2,3,
  3. David B Abrams4,
  4. Noel T Brewer2,3
  1. 1 Department of Family Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
  2. 2 Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
  3. 3 Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
  4. 4 Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York City, New York, USA
  1. Correspondence to Dr M Justin Byron, Department of Family Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina 27599, USA ; jbyron{at}


Objective The USA is considering a very low nicotine content (VLNC) cigarette standard. We sought to characterise the prevalence and correlates of the incorrect belief that VLNC cigarettes are less carcinogenic than current cigarettes, as this could reduce motivation to quit.

Methods Participants were a nationally representative sample of 650 adult smokers in the USA. In 2015–2016, before the VLNC proposal became public, these smokers took part in an online survey. We used multivariate weighted analyses to calculate ORs and percentages and a χ2 test to examine the association between variables.

Results Overall, 47.1% of smokers believed that smoking VLNC cigarettes for 30 years would be less likely to cause cancer than smoking current cigarettes. This misperception was more common among smokers who were aged above 55 (56.6%) and black (57.4%). Additionally, 23.9% of smokers reported they would be less likely to quit if the USA adopted a VLNC standard. Thinking that VLNC cigarettes would be less carcinogenic was associated with smokers reporting they would be less likely to quit (P<0.01).

Conclusions Many smokers had the misperception that smoking VLNC cigarettes is less likely to cause cancer, and some stated that they would be less likely to quit. A VLNC standard may be more effective if accompanied by a communication campaign that emphasises the continued dangers of smoking VLNC cigarettes due to the many toxic chemicals in smoke.

  • nicotine
  • harm reduction
  • cessation
  • public opinion
  • public policy

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  • Contributors MJB and NTB led instrument development, data collection and data analysis. MJB wrote the manuscript. All authors contributed substantively to conceptualising, writing, revising and final review of this manuscript.

  • Funding Research reported in this publication was supported by grant number P50CA180907 from the National Cancer Institute and the FDA Center for Tobacco Products (CTP). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the Food and Drug Administration.

  • Competing interests NTB has served as a paid expert consultant in litigation against tobacco companies.

  • Ethics approval University of North Carolina Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Due to our university’s requirements on grant-funded research, we can share the study data with a signed data use agreement. Investigators wishing to access the data may contact the first or last author of the paper.