Altria Client Services LLC Center for Research and Technology, 601 E. Jackson Street, 23219, Richmond, VA, USA.
Harm Reduct J. 2024 Aug 9;21(1):145. doi: 10.1186/s12954-024-01059-x.
Scientific evidence clearly demonstrates that inhaling the smoke from the combustion of cigarettes is responsible for most of the harm caused by smoking, and not the nicotine. However, a majority of U.S. adults who smoke inaccurately believe that nicotine causes cancer which may be a significant barrier, preventing switching to potentially reduced risk, non-combustible products like electronic nicotine delivery systems (ENDS) and smokeless tobacco (ST). We assessed the population health impact associated with nicotine perceptions.
Using a previously validated agent-based model to the U.S. population, we analyzed nationally representative data from the Population Assessment of Tobacco and Health (PATH) study to estimate base case rates of sustained (maintained over four waves) cessation and switching to non-combustible product use, by sex. Nicotine perception scenarios were determined from PATH data. The overall switch rate from smoking in Wave 4 to non-combustible product use in Wave 5 (3.94%) was stratified based on responses to the nicotine perception question "Do you believe nicotine is the chemical that causes most of the cancer caused by smoking cigarettes?", (four-item scale from "Definitely not" to "Definitely yes"). The relative percent change between the overall and stratified rates, corresponding to each item, was used to adjust the base case rates of switching, to determine the impact, if all adults who smoke exhibited switching behaviors based on responses to the nicotine perceptions question. The public health impact of nicotine perceptions was estimated as the difference in all-cause mortality between the base case and the four nicotine perception scenarios.
Switch rates associated with those who responded, "Definitely not" (8.39%) resulted in a net benefit of preventing nearly 800,000 premature deaths over an 85-year period. Conversely switch rates reflective of those who responded, "Definitely yes" (2.59%) resulted in a net harm of nearly 300,000 additional premature deaths over the same period.
Accurate knowledge regarding the role of nicotine is associated with higher switch rates and prevention of premature deaths. Our findings suggest that promoting public education to correct perceptions of harm from nicotine has the potential to benefit public health.
科学证据清楚地表明，吸烟过程中吸入的烟雾是导致吸烟危害的主要原因，而不是尼古丁。然而，大多数吸烟的美国成年人错误地认为尼古丁会致癌，这可能是一个重大障碍，阻碍了他们转向潜在风险较低的非燃烧产品，如电子尼古丁传送系统（ENDS）和无烟烟草（ST）。我们评估了与尼古丁认知相关的人群健康影响。
我们使用以前验证过的基于美国人群的代理模型，分析了来自人口烟草与健康评估（PATH）研究的全国代表性数据，以估计按性别划分的持续（维持四个波次）戒烟和转向非燃烧产品使用的基本比率。尼古丁认知情景是根据 PATH 数据确定的。从第 4 波次吸烟到第 5 波次非燃烧产品使用的总体转换率（3.94%）是基于对尼古丁认知问题“你是否认为尼古丁是导致吸烟引起的大部分癌症的化学物质？”的回答进行分层的（从“肯定不是”到“肯定是”的四项目标量表）。与每个项目相对应的总体和分层比率之间的相对百分比变化被用于调整转换的基本比率，以确定如果所有吸烟的成年人都根据对尼古丁认知问题的回答表现出转换行为，会对结果产生什么影响。尼古丁认知的公共卫生影响是通过基本案例和四个尼古丁认知情景之间的全因死亡率差异来估计的。
对“肯定不是”的回答者（8.39%）的转换率导致在 85 年内预防近 80 万例过早死亡的净收益。相反，对“肯定是”的回答者（2.59%）的转换率导致在同一时期内近 30 万例额外过早死亡的净危害。
关于尼古丁作用的准确认识与更高的转换率和预防过早死亡有关。我们的研究结果表明，促进公众教育以纠正对尼古丁危害的认知，有可能使公众健康受益。
