June 22, 2016
Adults in the United States have little awareness of the chemical components of cigarette smoke, though many of them report having looked for information about the composition of tobacco products. In a study published in the journal BMC Public Health, researchers from the University of North Carolina at Chapel Hill suggest that the Food and Drug Administration (FDA) expand its messaging activities so that information about these chemicals reaches all segments of the U.S. population, especially those most vulnerable to tobacco product use and its associated health risks.
“The majority of the U.S. public wants easy access to information about the chemicals in cigarettes and other tobacco products,” said Marcella H. Boynton, PhD, research assistant professor of health behavior at the UNC Gillings School of Global Public Health, member of UNC’s Lineberger Comprehensive Cancer Center, and first author of the paper. “Surprisingly, our results reveal that the groups one might presume to be the least psychologically motivated to look for this information – young adults and smokers – were actually more likely to say that they had previously searched for it.”
In a nationally representative telephone survey of 5,014 adults aged 18 years and over, more than a quarter of participants (27.5 percent) reported having looked for information on the different components of tobacco products and tobacco smoke, many of which are known to be poisonous or cause cancer. Of those adults, 37.2 percent were young adults (18-25 years of age) and 34.3 percent were smokers. Out of non-smokers and older adults, 26 percent reported having looked for information on tobacco chemicals.
With the exception of nicotine, however, most respondents were largely unaware of which chemicals are present in cigarette smoke. More than half of respondents (54.8 percent) indicated that they would like this information to be available on cigarette packs, while 28.7 percent would prefer to access the information online.
These results indicate that publication of tobacco chemical information is of interest to the public. According to the researchers, sharing this information could improve public health in the U.S., where tobacco use is the leading cause of preventable death and disease.
“By making tobacco chemical information available to the public and tobacco industry practices more transparent, those seeking this information may be less likely to start smoking and more likely to quit because they will be better informed about the toxic chemicals present in tobacco products,” Boynton explained.
To ensure that the study sample adequately represented smokers, young adults and minority groups, the research team oversampled high smoking/low income areas and cell phone numbers, as well as groups known to have experienced mistreatment by government organizations in the past. Some of these groups, which include people living in poverty, people with lower education and sexual minorities, are most affected by tobacco use and its associated health risks.
Another element of the study examined education campaigns conducted by the FDA, which are intended to increase the public’s awareness of the potential health harms of tobacco products. In 2009, the FDA was given the authority to regulate the tobacco industry with the passage of the Family Smoking Prevention and Tobacco Control Act. In May 2016, it expanded this authority to include additional tobacco products, such as e-cigarettes, hookahs and cigars.
Given the FDA’s role in communicating the harms of tobacco use, the investigators sought to understand how tobacco product users and non-users perceive the credibility of the FDA. Survey participants were asked if they had ever heard of the FDA and if they believed that the FDA could effectively regulate tobacco products.
The vast majority of U.S. adults surveyed (94.6 percent) reported having heard of the FDA, but awareness was lower amongst young adults, those with lower education and those living in poverty. A smaller majority of both smokers (66.6 percent) and non-smokers (65 percent) believed that the FDA could effectively regulate tobacco products.
The study was limited by its focus on the chemicals in tobacco for which the FDA has already signaled it will require manufacturers to provide information. Given the large number of chemicals in tobacco, future research into a wider range of chemicals is needed to better inform efforts to regulate tobacco use and communicate its risks. Such research could benefit the majority of U.S. smokers (more than 80 percent) who reported an intention to quit in this study. Additional research also is needed to monitor public response to FDA communications and changing patterns of tobacco use.
Other study co-authors from the Gillings School include Noel T. Brewer, PhD, professor, and Kurt M. Ribisl, PhD, professor, with the Department of Health Behavior; Robert P. Agans, PhD, clinical associate professor, with the Department of Biostatistics; and J. Michael Bowling, PhD, research associate professor of health behavior and adjunct research associate professor of biostatistics. Bowling, Brewer and Ribisl also are members of UNC’s Lineberger Comprehensive Cancer Center. The Carolina Survey Research Laboratory (of which Agans is co-director) collected all telephone data used in the study.