Effect of nicotine, low nicotine, and e-cigarette beliefs on cigarette and e-cigarette use in the US population and cancer survivors

Aim This study examines how nicotine, low nicotine, and e-cigarette beliefs relate to cigarette and e-cigarette use in the general US population and more specifically cancer survivors. Methods Using the 2019 Health Information National Trends Survey, we assessed the prevalence of nicotine, low nicotine, and e-cigarette beliefs among smokers of cigarettes and e-cigarettes. Multivariable logistic regression was used to examine the association between beliefs and smoking status. Results In the overall population, participants who agreed that nicotine caused cancer were 70% less likely to be ever smokers of cigarettes compared to never smokers. Concern about nicotine addiction was associated with higher odds of ever smoking, and those who affirmed that low nicotine cigarettes were equally or more addictive than conventional cigarettes were more likely to be ever smokers relative to never smokers. These findings were similar among ever users of e-cigarettes relative to never users. Furthermore, participants who either believed that e-cigarettes were just as or more harmful than, or were unsure of the magnitude of harm compared to regular cigarettes were less likely to ever use them relative to those who believed that e-cigarettes were less harmful. Results were similar after stratifying by cancer survivorship status. Conclusion Nicotine, low nicotine, and e-cigarette beliefs are associated with cigarette and e-cigarette use in the general population and among cancer survivors. Educational and nicotine messaging interventions are needed to ensure the dissemination of correct information about tobacco products and demystify incorrect beliefs among smokers and non-smokers.