Correcting Public Misperceptions About Very Low Nicotine Content Cigarettes

Study Overview
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Brief Summary
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Tobacco use is the leading preventable cause of cancer and cancer deaths in the US. While most (69%) smokers want to quit, only 6% succeed in doing so each year. For many smokers, the addictiveness of nicotine makes quitting very difficult. To reduce cigarette smoking and resulting harms, FDA has announced a comprehensive approach to tobacco and nicotine regulation that includes moving toward a very low nicotine content (VLNC) standard for cigarettes. Greatly reduced nicotine levels would facilitate smoking cessation. However, the maximal success of the policy may require public understanding that, although these new cigarettes are less addictive, their high toxicity and carcinogenicity are unchanged. Yet, nearly half of adult smokers incorrectly think smoking VLNC cigarettes is less harmful than smoking current cigarettes (the VLNC misperception). Additionally, 24% of smokers said they would be less likely to quit if a VLNC regulation is enacted. Thus, the VLNC misperception may partially undermine a nicotine reduction policy. Although communication research suggests it is challenging to change people's incorrect understanding, new communication techniques may help reduce the VLNC misperception. In this randomized trial we will examine whether messages about the harm of VLNC cigarettes can reduce the VLNC misperception and increase intention to quit in a nicotine reduction scenario.

Detailed Description
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In this study we will assess whether messages about the harm of VLNC cigarettes reduce the misperception that they are less harmful than regular cigarettes. Recruitment: We will enroll participants from an existing nationally representative panel. Informed Consent: Potential participants are part of an existing nationally representative panel and have already consented to participate in the panel. Before enrolling, participants will also be asked to consent to participate in this study via a consent form included in the study survey. Randomization: Survey software will randomly allocate participants to one of the four arms of the study (3 intervention arms or a control arm). Each study arm will have approximately the same number of participants. Assessment: Participants will complete a 15-minute survey. The survey will begin with an introduction to the concept of VLNC cigarettes. Then participants will be shown intervention or control messages, and their beliefs will be assessed. Detailed Description of the Intervention: Participants will be shown a set of 3 messages about the harms of VLNC cigarettes (intervention arms) or about littering (control arm). Each of the 3 intervention arms use a different theme to attempt to correct the VLNC misperception.

Official Title
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Correcting Public Misperceptions About Very Low Nicotine Content Cigarettes

Conditions
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Tobacco Use, Cigarette Use

Intervention / Treatment
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* Behavioral: Emotion-based messages about the harm of VLNC
* Behavioral: Continued-harm-framed messages about the harm of VLNC
* Behavioral: Myth-refuting messages about the harm of VLNC
* Behavioral: Control messages about littering


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Current Cigarette Smoker Age 18 or older Enrolled in existing nationally representative panel where recruitment is based Exclusion Criteria: None

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Emotion-based messages about the harm of VLNC<br> | Behavioral: Emotion-based messages about the harm of VLNC<br>* Participants in this arm will receive 3 emotion-based messages about the harm of VLNC during the survey data collection.<br>|
| Experimental: Continued-harm-framed messages about the harm of VLNC<br> | Behavioral: Continued-harm-framed messages about the harm of VLNC<br>* Participants in this arm will receive 3 continued-harm-framed messages about the harm of VLNC during the survey data collection.<br>|
| Experimental: Myth-refuting messages about the harm of VLNC<br> | Behavioral: Myth-refuting messages about the harm of VLNC<br>* Participants in this arm will receive 3 myth-refuting messages messages about the harm of VLNC during the survey data collection.<br>|
| Active Comparator: Control messages about littering<br> | Behavioral: Control messages about littering<br>* Participants in this arm will receive 3 control messages about littering during the survey data collection.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Very Low Nicotine Content (VLNC) Misperception | Measured by a 3 item scale. Very low nicotine content (VLNC) Misperception measured with 3 questions, the final VLNC misperception score is a mean of the response to the 3 questions, on a scale of 1 to 5, where 1 indicates a perception that VLNC are much more harmful than other cigarettes, and 5 indicates a perception that VLNC are much less harmful than other cigarettes, and 3 is a perception that VLNC are as harmful as other cigarettes. | During one day survey | 
| Percentage of Participants With Very Low Nicotine Content (VLNC) Misperception About Harm (Dichotomized) | Very low nicotine content (VLNC) Misperception of Harm was measured with 1 question, on a scale of 1 to 5, where 1 indicates a perception that VLNC are much more harmful than other cigarettes, and 5 indicates a perception that VLNC are much less harmful than other cigarettes, and 3 is a perception that VLNC are as harmful as other cigarettes. The results were dichotomized to indicate the percentage of people who hold the misperception. Specifically, responses of much less likely (5) or less likely (4) were recoded as 1 (having the misperception), and responses of Much more likely (1), More likely (2), or As likely (3) were recoded as 0 (not having the misperception). | During one day survey | 
| Percentage of Participants With Very Low Nicotine Content (VLNC) Misperception About Cancer (Dichotomized) | Very low nicotine content (VLNC) Misperception of Risk of Cancer was measured with 1 question, on a scale of 1 to 5, where 1 indicates a perception that VLNC are much more likely to cause cancer than other cigarettes, and 5 indicates a perception that VLNC are much less likely to cause cancer than other cigarettes, and 3 is a perception that VLNC are as likely to cause cancer as other cigarettes. The results were dichotomized to indicate the percentage of people who hold the misperception. Specifically, responses of much less likely (5) or less likely (4) were recoded as 1 (having the misperception), and responses of Much more likely (1), More likely (2), or As likely (3) were recoded as 0 (not having the misperception). | During one day survey | 
| Percentage of Participants With Very Low Nicotine Content (VLNC) Misperception About Death (Dichotomized) | Very low nicotine content (VLNC) Misperception of Risk of Death was measured with 1 question, on a scale of 1 to 5, where 1 indicates a perception that VLNC are much more likely to cause death than other cigarettes, and 5 indicates a perception that VLNC are much less likely to cause death than other cigarettes, and 3 is a perception that VLNC are as likely to cause death as other cigarettes. The results were dichotomized to indicate the percentage of people who hold the misperception. Specifically, responses of much less likely (5) or less likely (4) were recoded as 1 (having the misperception), and responses of Much more likely (1), More likely (2), or As likely (3) were recoded as 0 (not having the misperception). | During one day survey | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Quit Intentions | Measured by a 3 item scale. Quit intention measured with 3 questions, the final quit intention score is a mean of the response to the 3 questions, on a scale of 1 to 5, where 1 indicates low intention to quit smoking, and 5 indicates a high intention to quit. | During one day survey |