If you ask people if nicotine causes cancer, the answer you get depends heavily on how you ask. A study of over 2,500 US adults found that the percentage of people who correctly said nicotine does not cause cancer ranged wildly, from 10% to 81%, based on the wording of the survey question. Using more direct wording like "nicotine is a cause of cancer" led to far fewer people giving the correct answer. The study also looked at why people answered the way they did. Their open-ended responses fell into four main groups: some correctly said other chemicals in smoke cause cancer, some incorrectly said nicotine directly causes it, many said nicotine only causes cancer by keeping people addicted to tobacco, and others gave different reasons. The way the question was asked influenced which reason people gave. This shows that measuring public misunderstanding about nicotine is tricky. Getting it right is crucial for public health, as these surveys help identify who holds these misperceptions and how to prioritize education efforts to correct them.
How you ask the question changes what people believe about nicotine and cancer.
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Survey wording dramatically changes how many people believe nicotine causes cancer. What this means for you:
Survey wording dramatically changes how many people believe nicotine causes cancer. View Original Abstract ↓
INTRODUCTION: Misperceptions of nicotine's role in health harms among US adults have increased. This study examined how survey item wording affects estimates of the misperception that nicotine itself causes cancer.
METHODS: Two thousand five hundred twenty-six US adults aged 18-45 completed a randomized split-sample experiment through Cloud Research in August 2022. After receiving one of 10 existing and novel survey items about the role of nicotine in causing cancer, participants completed an open-ended question explaining their response. Analyses examined prevalence of beliefs by study condition and open-ended responses.
RESULTS: Overall, 36% of participants believed that nicotine does not cause cancer (coded as "correct"), but this varied by condition (10%-81%). Prevalence of this belief was similar when using magnitude-of-harm items from existing national surveys (HINTS, PATH; 44%) but lower with more direct wording (ie, "nicotine is a cause of cancer"; 23%). Changing response options (including/excluding don't know; true/false versus Likert scale) did not alter prevalence of a correct belief. Open-ended responses were distributed across four themes: (1) EXPOSURE to other chemicals or smoke cause cancer, not nicotine (n = 598, 23.7%), (2) Nicotine on its own DIRECTLY causes cancer (n = 705, 28.0%), (3) Nicotine only causes cancer by keeping people ADDICTED to tobacco (n = 796, 31.6%), and (4) Other (n = 419, 16.6%); study condition was associated with theme (p < .001).
CONCLUSIONS: Question wording influences the prevalence of agreement that nicotine itself causes cancer. Including "don't know," "probably yes," and "probably not" options may identify a broader group of people who could benefit from nicotine education.
IMPLICATIONS: Ensuring accuracy in estimating misperceptions about nicotine has implications for tobacco control in two important ways: first, these measures may identify the people or groups whose misperceptions may put them at greater risk for tobacco-related disease and death, and second, the prevalence of nicotine misperceptions and people affected may determine the prioritization and tailoring of interventions aimed at correcting misperceptions.