What a Difference the Truth Makes: Researchers Say Government Needs to Get Smokers Facts about Smokeless Tobacco

A new study reveals that telling smokers the truth about smokeless tobacco corrects their misperceptions and increases the likelihood of their trying smokeless products to quit smoking.

Lead author Ron Borland of Australia worked with colleagues in the U.S., U.K. and Sweden; their article was published in Harm Reduction Journal (available here). 

Smokers recruited in the four countries were asked about the relative harmfulness of nicotine and smokeless tobacco versus cigarettes.  Smokers were also asked if they were likely to try these products in their next quit attempt.  Smokers were then given a three-page fact sheet truthfully explaining the different health risks of nicotine or smokeless tobacco and cigarettes.  The Australia fact sheet appears in the article’s appendix; it incorporates much of the information we provided smokers in our Owensboro, Kentucky, cessation program (here).

The results for smokeless tobacco are seen in the table.  Bold numbers in the “After” rows indicate a statistically significant increase from before presentation of the fact sheet. 

Percentage of Smokers With Correct Perceptions of Smokeless Tobacco Harmfulness and Who Are Likely to Try These Products in Next Quit Attempt
	Australia	Sweden	U.K.	U.S.
Smokeless Tobacco vs. Cigarettes
Before Fact Sheet	8%	14%	22%	7%
After Fact Sheet	36%	28%	54%	27%
Likely to Try Smokeless Tobacco
Before Fact Sheet	27%	15%	51%	29%
After Fact Sheet	47%	Not Asked	79%	46%

It is evident that few smokers held correct perceptions of smokeless tobacco before they saw the fact sheet.  Only 7% of American smokers knew that smokeless is far safer than cigarettes; even in Sweden, the home of tobacco harm reduction, only 14% of smokers knew the truth.

It is encouraging that the fact sheets produced statistically significant increases in correct perceptions among smokers in all countries (even though the percentages remained low), and that they also produced significant increases in the percentage of smokers willing to try smokeless tobacco.  (Unfortunately, smokeless tobacco products are banned in Australia and the U.K.)

This study provides “evidence that the provision of information in the form of, say, a cigarette pack onset/insert, might be an effective means to educate smokers about the relative harmfulness of alternative nicotine delivery products such as [smokeless tobacco] and [nicotine replacement therapy]. Given the low levels of knowledge that smokers had about harmfulness of different nicotine delivery products, it would seem to be in the public interest to require such information to be placed on cigarette packs and at the point of sale for tobacco products to ensure that smokers are better informed about the relative harmfulness of smoked and unsmoked nicotine delivery products.”

The authors conclude with a clear call to action:

“The current lack of knowledge would seem to be largely due to the reluctance of governments to ensure that smokers are better informed about the mechanisms by which their dependence on nicotine is harming their health. This could be remedied either by requiring or encouraging manufacturers to publicise this information, and/or by governments doing so themselves through public information campaigns.”