Nearly 40% of smokers and former smokers believe it is the nicotine in cigarettes that causes cancer, a UK study has found. Some smokers also overestimated the relative harm associated with e-cigarettes and nicotine replacement therapy (NRT) compared with cigarette smoking.

Members of an online panel managed by Ipsos MORI were invited to participate in a longitudinal survey. More than 6,000 individuals were eligible to participate and were either smokers or smokers who had quit in the preceding year.

Quotas were put on age, gender and geographical location to ensure a representative population, and the final study population after follow-up was 1,720 individuals.

The mean age of participants was 49 years, 56% were male. Half (51%) were daily smokers at the time of the study and a third (33%) were former smokers.

Overall, four out of ten respondents (39.2%) believed that it was the nicotine in cigarettes that caused cancer.

There was also widespread confusion over the relative harm of e-cigarettes and NRT compared with cigarette smoking.

Relative harm associated with e-cigarette vs cigarette smoking:

• 57% of the study population perceived e-cigarettes as less harmful

• 3% more harmful

• 22% equally harmful

• 18% did not know

Relative harm of NRT vs cigarette smoking:

• 63% of the population responded that NRT was less harmful

• 2% more harmful

• 15% equally harmful

• 20% did not know

Addictiveness of e-cigarettes relative to smoking cigarettes:

• 5% stated e-cigarettes were more addictive

• 49% equally addictive

• 25% less addictive

• 21% did not know

Change in harm associated with using e-cigarettes instead of cigarettes:

• 32% said this would reduce harm a great deal

• 33% reduce harm a little

• 13% said there would be no change

• 3% thought harm would increase a little

• 2% said harm would increase a lot

• 18% did not know

E-cigarettes and NRT can provide a source of nicotine while avoiding many of the harms of cigarette smoking. However, this study has shown that misconceptions about nicotine in the development of cancer are widespread in the community of smokers and those who have recently quit. Misconceptions about the relative harm of e-cigarettes and NRT compared with smoking cigarettes are also common.

The study authors conclude: ‘Misperceptions of the relative harms of e-cigarettes and NRT compared with smoking tobacco cigarettes need to be targeted in public awareness campaigns and policy. In particular, public health campaigns should differentiate the role of smoke constituents other than nicotine in causing the main health harms (cancer, heart attack, stroke) from the role of nicotine in continuing the addiction yet not having the same main health harms.’

These findings highlight the importance of explaining to patients who are trying to quit how nicotine replacement products work and the relative harms associated with e-cigarettes and NRT compared with smoking cigarettes.

Dr Jez Thompson