August 2006

Grant Results

National Program

Substance Abuse Policy Research Program

SUMMARY

Between November 1999 and October 2003, K. Michael Cummings, Ph.D., M.P.H., and colleagues at Health Research Incorporated, Roswell Park Cancer Institute Division (Buffalo, N.Y.) surveyed adult smokers to document consumer understanding and misperceptions about:

  • The health hazards of smoking.
  • The components of cigarette smoke.
  • The safety of nicotine medications such as patches and gum.

The project was part of the Robert Wood Johnson Foundation's (RWJF) national Substance Abuse Policy Research Program (SAPRP) (for more information see Grant Results).

Key Findings

  • Almost two-thirds (65 percent) of smokers surveyed incorrectly said that low tar and nicotine cigarettes are safer than full-flavored cigarettes or did not know whether these features made cigarettes safer.
  • About one-half of smokers surveyed incorrectly believed that nicotine causes cancer and that reducing nicotine makes smoking less dangerous.
  • Only 33 percent of smokers correctly said that nicotine patches were less likely than nicotine to cause heart attacks.
  • Smokers of top brand Marlboro Lights were unaware that a smoker of a light or ultra light cigarette receives the same amount of tar and nicotine as a smoker of regular cigarettes. Some 46 percent believed they needed to smoke two or more light cigarettes to get the amount of tar included in one regular cigarette and 40 percent did not know how many light cigarettes were the equivalent of one regular cigarette.

Funding
RWJF supported this project with a $349,378 grant to Health Research Incorporated in Buffalo, N.Y.

 See Grant Detail & Contact Information
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The Problem

In response to growing awareness of health risks from smoking, tobacco manufacturers introduced low tar, light and filtered cigarettes that deliver lower levels of tar and nicotine when tested using simulated smoking machines.

In reality these cigarettes allow smokers to adjust their smoking to get the same tar and nicotine they would get in regular cigarettes, according to principal investigator K. Michael Cummings, Ph.D., M.P.H., at Roswell Park Cancer Institute.

While surveys show that most people recognize major health risks from smoking, individuals do not necessarily believe that they are personally at higher risk of becoming seriously ill as a result of smoking. Many smokers fail to appreciate that switching to a low tar and/or filtered cigarette does not make smoking less hazardous.

Despite the cigarette industry's use of advertising to induce smokers to select their brand, tobacco-cessation programs have generally not provided smokers with specific product-related information to counteract the illusions created by the colors, images and words conveyed in cigarette brand advertising.

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The Project

RWJF made a grant to Health Research Incorporated, a not-for-profit corporation affiliated with the New York State Department of Health, for research to be performed at its Roswell Park Cancer Institute Division.

The original goals of this project were to:

  • Develop a consensus statement among public health experts on best options for testing the safety and toxicity of cigarettes and other nicotine delivery products.
  • Document consumer understanding and misperceptions about the relative health risks associated with different nicotine delivery products.

Cummings and colleagues at Roswell Park Cancer Institute prepared a working paper that summarized existing research on nicotine delivery device toxicity testing and shared it with a panel of experts.

As a result of the panel's feedback, Cummings and colleagues concluded that it was impossible to develop a consensus statement with recommended standards because tobacco scientists do not agree on what products to test and which methods to use and they interpret results differently.

To examine consumer understanding of relative health risks, researchers designed a survey of adult smokers—called the BAND Survey—to assess their "beliefs about alternative nicotine delivery devices" (BAND).

Under a subcontract from Roswell Park Cancer Institute, the Center for Opinion Research at Millersville University (Millersville, Pa.) conducted the telephone survey of 1,046 smokers. The survey covered the following subjects:

  • Consumer characteristics and behaviors:
    • Demographic characteristics (age, gender, etc.).
    • Patterns and frequency of smoking.
    • Awareness and use of nicotine medications.
    • Beliefs about the health risks of smoking.
  • Whether respondents felt fully informed about:
    • The risks of smoking.
    • The content of smoke and design features of cigarettes.
    • The safety and efficacy of nicotine medications.
  • Consumer interest and perceived ability to stop smoking.
  • Consumer desire for information from tobacco companies about:
    • The health risks of smoking.
    • Components of tobacco smoke.
    • Ways to reduce health risks.

Project staff organized a special issue of the journal Nicotine & Tobacco Research (entitled Tobacco Risk Perceptions and Behavior: Implications for Tobacco Control—see the Bibliography for details) that included:

  • Four articles based on research resulting from this grant.
  • Three articles based on studies using data from this grant but funded by other grants. RWJF grant ID# 045734 to Health Research Inc. funded the study that led to two articles (along with the National Cancer Institute and funders from Canada, the United Kingdom and Australia). The American Legacy Foundation and the National Cancer Institute funded the study leading to the third article.

Four articles solicited by the editor for inclusion in the special issue of the journal. These articles reported on separate tobacco research projects that did not use data generated under this grant. RWJF funded one research project under its Substance Abuse Policy Research Program (ID# 037850). Funding for two research projects came from the evaluation of the Massachusetts Tobacco Control Program and from the National Cancer Institute. The fourth project was a doctoral research.

Cummings and colleagues presented study findings at the 2002 National Conference on Tobacco or Health, at annual meetings in 2002 and 2003 of the Society for Research on Nicotine and Tobacco, at the 2003 American Society of Preventive Oncology Annual Meeting and at the 2003 Australian National Tobacco Control Conference.

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Findings

Cummings and colleagues reported the following findings in three of the articles published in a 2004 special issue of Nicotine & Tobacco Research (see the Bibliography for details):

  • Smokers are misinformed about many aspects of the cigarettes they smoke, but they want more information. (Reported in the article entitled "Are Smokers Adequately Informed About the Health Risks of Smoking and Medicinal Nicotine?")
    • Some 65 percent of smokers either incorrectly thought that low tar and filter cigarettes are less dangerous than full-flavored cigarettes or did not know whether these features made cigarettes less dangerous.
    • When asked about health risks of smoking, 39 percent of respondents either answered incorrectly or said they did not know.
    • More than half (53 percent) of respondents answered incorrectly or said they did not know the content of cigarette smoke.
    • Smokers older than age 55 were less knowledgeable about smoking than younger smokers.
    • Some 77 percent said they would like cigarette companies to provide them with more information about the health risks of smoking.
    • Some 83 percent said they wanted information about the chemicals in cigarette smoke.
  • Smokers are misinformed about both the health risks of nicotine and the safety of nicotine-based smoking reduction medications. (Reported in the article entitled "Stop-Smoking Medications: Who Uses Them, Who Misuses Them, and Who is Misinformed About Them?")
    • About half of respondents incorrectly believed that nicotine causes cancer and that reducing nicotine makes smoking less dangerous.
    • Only one-third of respondents correctly said that wearing a nicotine patch was less likely than smoking cigarettes to cause a heart attack.
    • Some 41 percent of smokers said they had heard of safety concerns about these products. Concerns included fears that smoking while using the patch caused adverse reactions and chewing nicotine gum led to addiction and mouth ulcers—concerns that are unfounded.
    • Knowledge deficits were particularly pronounced among smokers who had never used nicotine medications, mainly those who were older, less educated and users of light and ultra light cigarettes.
  • Marlboro Lights was the most popular brand—smoked by 19 percent of respondents—but smokers were unaware of features of this brand. (Reported in the article entitled "What Do Marlboro Lights Smokers Know About Low-Tar Cigarettes?")
    • Some 68 percent of Marlboro Lights smokers did not know that the filters on this brand were ventilated. Ventilated filters have perforations to draw in additional air during smoking, thereby reducing smoke temperature and inducing smokers to inhale longer and more deeply.
    • Marlboro Lights smokers were unaware that a smoker of a light or ultra light cigarette receives the same amount of tar and nicotine as a smoker of regular cigarettes:
      • Some 40 percent did not know.
      • Some 46 percent believed they needed to smoke two or more light cigarettes to get the amount of tar included in one regular cigarette.
      • Only 13 percent responded correctly.

Limitations

Cummings noted the following limitation to study findings.

  • Researchers experimented with different ways of asking the questions included in the survey. The reliability of some measures is questionable and there is a need for researchers to develop better measures.

Recommendations

Cummings and colleagues made the following recommendations in articles published in the 2004 special issue of Nicotine & Tobacco Research (see the Bibliography for details):

  • Government agencies should take more aggressive steps to regulate the marketing of tobacco products and educate the public about the risks of smoking. ("Are Smokers Adequately Informed About the Health Risks of Smoking and Medicinal Nicotine?")
  • Cigarette companies should be held accountable for monitoring what smokers do and do not know about the health risks of smoking. Companies should pay for an independent group to monitor perceptions and educate consumers. ("Are Smokers Adequately Informed About the Health Risks of Smoking and Medicinal Nicotine?")
  • Manufacturers of nicotine medications might want to consider ways to alter package inserts and educational material to give smokers a more realistic understanding of risks and benefits of these products. ("Stop-Smoking Medications: Who Uses Them, Who Misuses Them, and Who is Misinformed About Them?")

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Conclusions

Cummings and colleagues offered the following conclusions in articles published in the 2004 special issue of Nicotine & Tobacco Research (see the Bibliography for details):

  • "Misperceptions about the health risks of nicotine and the safety/efficacy of nicotine medications may discourage some smokers from considering the use of these medications to help them stop smoking." ("Stop-Smoking Medications: Who Uses Them, Who Misuses Them, and Who is Misinformed About Them?")
  • "[S]mokers are misinformed about many aspects of the cigarettes they smoke and nicotine medications and … they want more information about ways to reduce their health risks." ("Are Smokers Adequately Informed About the Health Risks of Smoking and Medicinal Nicotine?")

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Afterward

In 2002, Cummings and colleagues from Canada, the United Kingdom and Australia received an RWJF grant (ID# 045734) to collect longitudinal data from smokers in those countries to investigate the impact of national policies on smoking behavior. This project has continued and expanded with funding from the federal National Cancer Institute, the federal Centers for Disease Control and Prevention, and the participating countries.

In 2003, Cummings received grants from the Legacy Foundation and the National Cancer Institute to use data from the BAND survey to design and test EDUCATE (EnD Use of CigArettes Through Education). EDUCATE is a communications protocol to inform smokers about the features of the cigarettes they smoke.

Also in 2003, Cummings received a grant from the National Institutes of Health to use data from the BAND survey to test new messages to address smokers' misperceptions about nicotine medications and low tar cigarettes.

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GRANT DETAILS & CONTACT INFORMATION

Project

Informing Consumers About the Relative Health Risks of Different Nicotine Delivery Products

Grantee

Health Research Incorporated (Buffalo,  NY)

  • Amount: $ 349,378
    Dates: November 1999 to October 2003
    ID#:  037540

Contact

K. Michael Cummings, Ph.D., M.P.H.
(716) 845-8456
Michael.cummings@roswellpark.org

Web Site

http://www.saprp.org/grant_publications.cfm?AppID=101

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Articles

All articles are included in a special supplement to Nicotine & Tobacco Research entitled Tobacco Risk Perceptions and Behavior: Implications for Tobacco Control. This issue of Nicotine & Tobacco Research is available online.

Articles Based on Research Resulting From This Grant
Cummings KM. "Tobacco Risk Perceptions and Behavior: Implications for Tobacco Control." Nicotine & Tobacco Research, 6(S3): S285–S288, 2004.

Cummings KM, Hyland A, Bansal MA and Giovino GA. "What Do Marlboro Lights Smokers Know About Low-Tar Cigarettes?" Nicotine & Tobacco Research, 6(S3): S323–S332, 2004. Abstract available online.

Cummings KM, Hyland A, Giovino GA, Hastrup J, Bauer J and Bansal, MA. "Are Smokers Adequately Informed About the Health Risks of Smoking and Medicinal Nicotine?" Nicotine & Tobacco Research, 6(S3): S333–S340, 2004. Abstract available online.

Bansal MA, Cummings KM, Hyland A and Giovino GA. "Stop-Smoking Medications: Who Uses Them, Who Misuses Them, and Who is Misinformed About Them?" Nicotine & Tobacco Research, 6(S3): S303–S310, 2004. Abstract available online.

Articles Based on Studies Using Data From This Grant
Bansal, MA, Cummings KM, Hyland A, Bauer JE, Hastrup JL and Steger, C. "Do Smokers Want to Know More About the Cigarettes they Smoke? Results from the EDUCATE Study." Nicotine & Tobacco Research, 6(S3): S289–S302, 2004. Abstract available online.

Borland, R, Yong HH, King B, Cummings KM, Fong GT, Elton TE, Hammond D and McNeill A. "Use of and Beliefs About Light Cigarettes in Four Countries: Findings from the International Tobacco Control Policy Evaluation Survey." Nicotine & Tobacco Research, 6(S3): S311–S321, 2004. Abstract available online.

Fong GT, Hammond D, Laux FL, Zanna MP, Cummings KM, Borland R and Ross H. "The Near-Universal Experience of Regret Among Smokers in Four Countries: Findings from the International Tobacco Control Policy Evaluation Survey." Nicotine & Tobacco Research, 6(S3): S341–S351, 2004. Abstract available online.

Articles Solicited by the Editor for Inclusion in the Special Issue of the Journal
Hamilton WL, diStefano NG, Ouellette TK, Rhodes WM, Kling R and Connolly GN. "Smokers' Responses to Advertisements for Regular and Light Cigarettes and Potential Reduced-Exposure Tobacco Products." Nicotine & Tobacco Research, 6(S3): S353–S362, 2004. Abstract available online.

Hyland A, Li Q, Bauer JE, Giovino GA, Steger C and Cummings KM. "Predictors of Cessation in a Cohort of Current and Former Smokers Followed Over 13 Years." Nicotine & Tobacco Research, 6(S3): S363–S369, 2004. Abstract available online.

Murphy-Hoefer R, Alder S and Higbee C. "Perceptions About Cigarette Smoking and Risks Among College Students." Nicotine & Tobacco Research, 6(S3): S371–S374, 2004. Abstract available online.

Weinstein ND, Slovic P and Gibson G. "Accuracy and Optimism in Smokers' Beliefs About Quitting." Nicotine & Tobacco Research, 6(S3): S375–S380, 2004. Abstract available online.

Survey Instruments

"The BAND Survey," Roswell Park Cancer Institute, fielded May–September 2001.

Presentations and Testimony

Andrew Hyland, Michael Cummings, Joseph Bauer, Maansi Bansal and Gary Giovino, "Smoker Knowledge, Attitudes, Beliefs, and Use of Stop Smoking Medications," poster at the National Conference on Tobacco or Health, November 20, 2002, San Francisco. Abstract available online.

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Report prepared by: Mary Nakashian
Reviewed by: Mary B. Geisz
Reviewed by: Molly McKaughan
Program Officer: Victor A. Capoccia
Program Officer: Michelle A. Larkin

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