“If There’s No Nicotine, Why Waste My Money?”: Reactions to a Proposed Reduced Nicotine Policy Among Priority and General Adult Populations
Folashayo P. Adeniji, Jordan D. Foster, Winnie Ni, Vanessa Mallory, Adebusola Ogunnaike, Di Pei, Nurul Kodriati, Samantha Petillo, Katherine C. Henderson, Aubrey Juris, Prudence Nkansah, Christin D’Ovidio, Nicholas A. Giordano, Claire A. Spears, David L. Ashley, Terry F. Pechacek, James F. Thrasher, Lucy PopovaBackground
The U.S. Food and Drug Administration proposed reducing nicotine in cigarettes and other combusted tobacco products to minimally addictive levels, a policy with the potential to save millions of lives. Limited research has examined how priority populations, including individuals with low socioeconomic status (SES) or serious psychological distress (SPD), may respond.
Methods
We conducted 12 in-person focus groups in Atlanta, GA, with adults aged 21+ who smoke (n=70), stratified into SPD (n=18), low SES (n=27), and neither subgroup (n=25). Participants were informed that the nicotine content of cigarettes would be reduced by 95% and viewed messages on Very Low Nicotine Cigarettes (VLNCs), presented as posters, storyboards, and cigarette pack inserts. Participants discussed their anticipated reactions to the policy.
Results
Participants generally expressed support for the nicotine reduction policy, with many saying they personally would quit smoking if it were implemented. Across all subgroups, a common perception was that continuing to smoke would be a waste of money. However, when considering the broader impact, skepticism about the policy’s ability to reduce smoking was common. Many participants anticipated compensatory behaviors, such as smoking more cigarettes, seeking higher nicotine products through illicit markets, or switching to alternatives, like cigars or nicotine pouches. Overall, reactions reflected a mix of support, doubt, and uncertainty. While some participants expressed interest in trying VLNCs, others preferred a gradual reduction in nicotine content over time. These reactions were similar across all participant subgroups.
Conclusion
Findings show general support for the nicotine reduction policy and its potential to motivate quitting, including among those with low SES and with SPD. However, skepticism and possible behavioral adaptations may reduce the policy’s impact. Supportive measures, including a well-designed communication strategy, may help address these concerns and strengthen the policy’s effectiveness.