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Abstract
Introduction The USA and New Zealand have sought to establish a product standard to set a maximum nicotine level for cigarettes to reduce their addictiveness. This study examined support for very low nicotine cigarettes (VLNCs) in Australia, Canada, England and the USA between 2016 and 2020.
Methods Repeated cross-sectional data were analysed from participants who currently smoke, formerly smoked or vaped and/or currently vape in the 2016 (n=11 150) and/or 2020 (n=5432) International Tobacco Control (ITC) Four Country Smoking and Vaping Survey. Respondents were asked if they would support a law that reduces the amount of nicotine in cigarettes to make them less addictive. Adjusted and weighted logistic regression analyses estimated the prevalence and predictors of support, such as country, age, sex, education, income, race and smoking/vaping status for VLNCs (support vs oppose/do not know).
Results A majority of respondents supported a VLNC law, with support highest in Canada (69%; 2016 and 2020 combined), followed by England (61%), Australia (60%) and the USA (58%). Overall, support decreased from 62% in 2016 to 59% in 2020 (p=0.004), which did not differ by country. Levels of support differed by smoking/vaping status, where those who exclusively smoked daily showed the lowest level of support (59%) and those who exclusively vaped non-daily had the highest level of support (72%).
Conclusion More than half of respondents in all four countries—including those who smoked daily—supported a hypothetical VLNC standard to render cigarettes less addictive. It is important to examine if support is sustained after policies are implemented.
- nicotine
- addiction
- harm reduction
- surveillance and monitoring
Data availability statement
In each country participating in the International Tobacco Control Policy Evaluation (ITC) Project, the data are jointly owned by the lead researcher(s) in that country and the ITC Project at the University of Waterloo. Data from the ITC Project are available to approved researchers 2 years after the date of issuance of cleaned datasets by the ITC Data Management Centre. Researchers interested in using ITC data are required to apply for approval by submitting an International Tobacco Control Data Repository (ITCDR) request application and subsequently to sign an ITCDR Data Usage Agreement. The criteria for data usage approval and the contents of the Data Usage Agreement are described online (http://www.itcproject.org). The authors of this paper obtained the data following this application process. They did not have any special access privileges. Others would be able to access these data in the same manner as the authors.
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Data availability statement
In each country participating in the International Tobacco Control Policy Evaluation (ITC) Project, the data are jointly owned by the lead researcher(s) in that country and the ITC Project at the University of Waterloo. Data from the ITC Project are available to approved researchers 2 years after the date of issuance of cleaned datasets by the ITC Data Management Centre. Researchers interested in using ITC data are required to apply for approval by submitting an International Tobacco Control Data Repository (ITCDR) request application and subsequently to sign an ITCDR Data Usage Agreement. The criteria for data usage approval and the contents of the Data Usage Agreement are described online (http://www.itcproject.org). The authors of this paper obtained the data following this application process. They did not have any special access privileges. Others would be able to access these data in the same manner as the authors.
Footnotes
Twitter @FairmanRT, @kingsNRG, @CoralGartner, @kyliemorphett
Contributors Conceptualisation: RTF, YJC, LP, JT; methodology: RTF, YJC, LP, JT; formal analysis: RTF, YJC; writing—original draft: RTF, YJC, LP, JT; writing—reviewing and editing: all authors; supervision: LP, JT.
Funding The ITC Four Country Smoking and Vaping Survey in the USA, Canada and England was supported by grant P01 CA200512 from the US National Cancer Institute, a Foundation Grant (FDN-148477) from the Canadian Institutes of Health Research, and Australian National Health and Medical Research Council Grant (GNT#1106451). This research was partially supported by the National Cancer Institute of the National Institutes of Health and Food and Drug Administration Center for Tobacco Products (R01 CA239308). Additional support to GTF was provided by a Senior Investigator Award from the Ontario Institute for Cancer Research. CEG was supported by NHMRC Grant (GNT#1198301).
Disclaimer The funders had no role in the design of the study; in the collection, analyses or interpretation of data; in the writing of the manuscript or in the decision to publish the results.
Competing interests KM has in the past and continues to serve as a paid expert witness in litigation filed against cigarette manufacturers. GTF and JT have served as expert witnesses or consultants for governments defending their country’s policies or regulations in litigation. GTF and SG served as paid expert consultants to the Ministry of Health of Singapore in reviewing the evidence on plain/standardised packaging. All other authors declare no conflict of interest.
Provenance and peer review Not commissioned; externally peer reviewed.
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