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.
Survey wording affects nicotine-cancer belief prevalence from 10% to 81% in US adultsHow you ask the question changes what people believe about nicotine and cancer
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A randomized split-sample survey experiment examined how survey item wording affects estimates of the misperception that nicotine itself causes cancer. The study included 2,526 US adults aged 18-45 who completed the survey through Cloud Research in August 2022. Participants were randomized to receive one of 10 existing and novel survey items about nicotine's role in causing cancer, followed by an open-ended question explaining their response. Overall, 36% of participants held the correct belief that nicotine does not cause cancer, but this prevalence varied widely by study condition, ranging from 10% to 81%. When using magnitude-of-harm items from existing national surveys (HINTS, PATH), the prevalence of the correct belief was 44%. However, when more direct wording ('nicotine is a cause of cancer') was used, the prevalence of the correct belief was lower at 23%. Changing response options, including whether to include a 'don't know' option or using true/false versus Likert scale formats, did not alter the prevalence of the correct belief. Analysis of open-ended responses identified four themes: (1) EXPOSURE to other chemicals or smoke causes 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 significantly associated with the theme of the open-ended response (p<.001). The study concludes that question wording significantly influences the measured prevalence of the belief that nicotine itself causes cancer.
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