Article Text

Download PDFPDF
‘It brings light to what you really put into your body’: a focus group study of reactions to messages about nicotine reduction in cigarettes
  1. Hue Trong Duong1,
  2. Emily E Loud2,
  3. James F Thrasher2,
  4. Katherine C Henderson3,
  5. David L Ashley3,
  6. Lucy Popova3
  1. 1 Department of Communication, Georgia State University, Atlanta, Georgia, USA
  2. 2 Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
  3. 3 School of Public Health, Georgia State University, Atlanta, Georgia, USA
  1. Correspondence to Dr Lucy Popova, School of Public Health, Georgia State University, Atlanta, GA 30302, USA; lpopova1{at}


Objective In 2017, the US Food and Drug Administration (FDA) announced a proposed regulation to lower nicotine in cigarettes to minimally addictive levels to help smokers quit. We sought to explore effective message strategies communicating about nicotine reduction in cigarettes across the different key audiences that the regulation is most likely to influence.

Methods We designed four types of messages: efficacy messages, risk messages, a message about alternative sources of nicotine and a compensation message. Sixteen virtual focus groups were conducted in Atlanta and San Francisco in April–May 2020. Data were analysed in NVivo 12.0 using a thematic analysis approach.

Findings Exclusive smokers were receptive to both efficacy messages and risk messages. Dual users were the only group that was open to resorting to alternative sources of nicotine. Former smokers were critical of these messages as promoting the new kinds of cigarettes and potentially encouraging initiation and relapse of smoking. Non-smokers felt that efficacy messages downplayed the risks of smoking and did not scare people away from smoking. Presenting information that very low nicotine cigarettes (VLNCs) still contain harmful chemicals made smokers question continued smoking in the absence of nicotine and view VLNCs as harmful.

Conclusions Messages communicating about nicotine reduction in cigarettes might help to motivate smokers to quit and can correct the misperceptions that VLNCs are less harmful. The FDA should consider specific target audiences and use different messages that complement each other in communicating about this regulation.

  • nicotine
  • harm reduction
  • media
  • prevention

Data availability statement

Data are available on reasonable request to the corresponding author.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available on reasonable request to the corresponding author.

View Full Text


  • Contributors HTD drafted the manuscript. EEL and HTD coded the transcripts. LP and JT conceptualised and supervised the study. All authors contributed to the interpretation of the results and revision of the paper.

  • Funding Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health and the Food and Drug Administration Centre for Tobacco Products (R01CA239308).

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Food and Drug Administration.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.