Opportunities and Considerations for Addressing Misperceptions About Relative Risks of Tobacco Products among Adult Smokers

Aug.16.2023
Opportunities and Considerations for Addressing Misperceptions About Relative Risks of Tobacco Products among Adult Smokers
FDA’s Center for Tobacco Products Director, Brian King, commented on addressing misperceptions about the risks of tobacco products among adult smokers.

On August 15th, Brian King, Director of the Center for Tobacco Products (CTP) at the Food and Drug Administration (FDA), published an article in the prestigious scientific journal "WILEY" titled "Commentary on Wackowski et al.: Opportunities and Considerations for Addressing Misperceptions About the Relative Risks of Tobacco Products among Adult Smokers." This article discusses the chances and factors to be considered in tackling the misperceptions amongst adult smokers regarding the comparative risks of tobacco products.


In the article, Brian King mentions that Wackowski and colleagues conducted a survey on American adult cigarette smokers and found that only about 20% of them believe that e-cigarettes contain fewer harmful chemicals than traditional cigarettes. Among these individuals, half of them perceive e-cigarettes as less harmful. The awareness of reduced chemical content is positively associated with the use and interest in e-cigarettes.


Brian King suggests that incorrect perceptions about the relative risks of tobacco products, particularly e-cigarettes, among adult cigarette users can be corrected through education.


Meanwhile, Brian King mentioned in the article three factors that need to be considered when developing and implementing strategies for educating adult smokers about the relative risks of tobacco products.


The following is a translation of the original text: "The government announced today that it will be implementing a new policy to address the rising crime rates in the city. The policy includes increased funding for law enforcement agencies, the establishment of neighborhood watch programs, and stricter penalties for offenders. The government hopes that these measures will improve public safety and reduce crime rates. However, some critics argue that a more holistic approach is needed, including addressing the root causes of crime such as poverty and lack of social support. Only time will tell if the new policy will be successful in combating crime in the city.


Regulation of tobacco and nicotine products varies across different countries worldwide. In the United States, the Food and Drug Administration (FDA) is empowered to oversee the manufacturing, marketing, and distribution of tobacco products, including cigarettes and e-cigarettes, in order to safeguard public health.


There are no tobacco products that can be considered safe [1]. However, within the continuum of risk associated with tobacco products, smoking products such as cigarettes pose the greatest risks [1]. Substantial progress has been made in reducing tobacco consumption through evidence-based comprehensive population-level strategies. Despite these advancements, the global death toll from tobacco smoking still exceeds 8 million people annually.


Given that the majority of adult cigarette smokers initiate tobacco use during adolescence, prevention strategies, including price increases, smoke-free policies, and mass media campaigns, are crucial in reducing tobacco-related diseases and deaths. Furthermore, providing accessible, evidence-based cessation strategies for populations, healthcare systems, and individuals among tobacco product users remains essential. With the continually evolving landscape of tobacco products, shifting towards lower-risk alternatives, such as e-cigarettes, is thought to reduce the risks associated with smoking. The 2018 report from the National Academies of Sciences, Engineering, and Medicine in the United States concluded that there is "conclusive evidence that completely substituting e-cigarettes for combustible tobacco cigarettes reduces users' exposure to numerous toxicants and carcinogens found in combustible tobacco cigarettes.


Recently, a representative survey conducted by Wackowski et al. focused on American adult cigarette smokers. The study found that only about 20% of participants believed that e-cigarettes contained fewer harmful chemicals compared to traditional cigarettes. Among this group, half of the individuals perceived e-cigarettes as less harmful. The findings indicated a positive correlation between awareness of reduced chemical content and the use and interest in e-cigarettes.


The research conducted by Wackowski et al. suggests that there is an opportunity to educate adult smokers about the relative risks of tobacco products, particularly e-cigarettes. However, these educational efforts must be evidence-based. When developing content, delivery methods, and target audience, a data-driven approach should be employed. It is particularly important to assess the benefits for the target population (i.e. adult smokers) as well as the potential risks for unintended populations, such as adolescents.


When formulating and implementing strategies related to the relative risks of tobacco products for adult smokers, several factors need to be taken into consideration.


First and foremost, it is unsafe for adolescents to use tobacco products in any form, including e-cigarettes. Therefore, it is crucial to implement robust strategies to prevent youth from engaging in tobacco use. However, efforts to deter young individuals from starting should not impede endeavors to promote smoking cessation and educate adult smokers about the relative risks associated with tobacco products.


Furthermore, the preferred method for adult smokers to quit smoking should be scientifically proven safe and effective products, including FDA-approved medications and devices. Behavioral counseling and medications are both effective, and combining them increases the likelihood of quitting smoking. Currently, no e-cigarette has been approved by the FDA for smoking cessation, which requires evidence of both safety and efficacy. Increasingly, studies indicate that certain e-cigarettes may facilitate smoking cessation among adults; however, due to the toxins present in e-cigarette aerosol, further high-quality studies are still needed to examine short-term and long-term clinical outcomes, including pulmonary effects.


Thirdly, the FDA has authorized 23 tobacco-flavored e-cigarette products and devices for adult smokers who choose to use e-cigarettes. However, in order to fully reap the health benefits from these products, it is crucial for adult smokers to transition completely from traditional cigarettes to e-cigarettes. Biomarker assessments indicate that dual users who simultaneously use both e-cigarettes and traditional cigarettes typically exhibit high levels of toxic substance exposure similar to those seen in exclusive smokers. A significant number of American adults engage in dual use when using e-cigarettes; in 2021, 29.4% are current smokers, 40.3% were former smokers, and 30.3% have never smoked. Simultaneously using traditional cigarettes and e-cigarettes can either serve as a pathway to complete transition or maintain addiction. To maximize the likelihood of the former, adult smokers must fully switch to e-cigarettes and avoid prolonged dual use. Since no tobacco product is safe, the ultimate goal should be to quit using all tobacco products, including e-cigarettes.


In summary, there are opportunities to educate adult smokers about the relative risks of tobacco products, including e-cigarettes, using evidence-based methods. However, these efforts should go hand in hand with efforts to prevent youth from using tobacco products, encouraging the use of FDA-approved cessation therapies, and emphasizing the importance for adult smokers to completely switch from combustible cigarettes to e-cigarettes. These efforts can be implemented by both government and non-government stakeholders. For example, the FDA has recently initiated formative research on eliminating misconceptions about nicotine and communicating potential risks for adult smokers. This is in addition to the FDA's ongoing efforts to prevent youth tobacco use through its "Real Cost" public education campaign. Furthermore, there are also opportunities to continue innovating new tobacco cessation therapies to further reduce tobacco-related diseases and deaths.


References:


Analysis on Wackowski et al.'s study: Examining Ways to Correct Misconceptions About Tobacco Product Risks Among Adult Smokers



Disclaimer

This article is provided solely for professional research, industry discussion, and informational purposes. Any references to brands, companies, products, technologies, or policies are made for factual reporting and analytical purposes only, and do not constitute endorsement, recommendation, promotion, or advertising by 2Firsts.

Nicotine-containing products, including but not limited to cigarettes, e-cigarettes, heated tobacco products, and nicotine pouches, carry significant health risks. Readers are responsible for complying with all applicable laws and regulations in their respective jurisdictions, including age restrictions and access limitations.

The information contained in this article should not be regarded as investment, legal, medical, regulatory, or commercial advice. While 2Firsts strives to ensure the accuracy and reliability of its content, it does not assume liability for any direct or indirect loss arising from errors, omissions, inaccuracies, or reliance on the information contained herein.

This article is not intended for individuals below the legal age for accessing tobacco or nicotine-related information in their jurisdiction.

 

Copyright Notice

This article is either original content produced by 2Firsts or content reproduced, translated, summarized, or adapted from third-party sources with attribution where applicable. The intellectual property rights of the original content remain with 2Firsts or the respective original rights holders.

No individual or organization may copy, reproduce, distribute, republish, modify, translate, or otherwise use this content without prior authorization. Any unauthorized use may result in legal action.

For copyright-related inquiries, corrections, or removal requests, please contact: info@2firsts.com.

 

AI-Assisted Translation and Editing Notice

Portions of this article may have been translated, edited, or reviewed with the assistance of artificial intelligence tools to improve efficiency and readability. Due to the limitations of AI-assisted translation and editing, discrepancies, omissions, or inaccuracies may exist when compared with the original source.

Where applicable, readers are advised to refer to the original source for the most complete and accurate information. If you identify any errors or believe that any content infringes upon your rights, please contact us at info@2firsts.com, and we will review and address the matter promptly.

NAS 2026 | Former FDA Tobacco Chief Mitch Zeller Calls for Shift From “End Game” to “End State”
NAS 2026 | Former FDA Tobacco Chief Mitch Zeller Calls for Shift From “End Game” to “End State”
At the 2026 New Approaches Summit in New York, former FDA Center for Tobacco Products Director Mitch Zeller called for the tobacco harm reduction debate to shift from the traditional “end game” toward defining a desired “end state.” He also highlighted unresolved concerns around dual use, argued that biomarkers of exposure may be more meaningful than cigarettes-per-day in assessing risk reduction, and said nicotine misperceptions remain a major barrier to public health progress.
Sep.25
2Firsts On-Site | PMI Brings IQOS, ZYN, VEEV and Marlboro Together at Its “Boulevard” at InterTabac 2026
2Firsts On-Site | PMI Brings IQOS, ZYN, VEEV and Marlboro Together at Its “Boulevard” at InterTabac 2026
At InterTabac 2026 in Dortmund, PMI is presenting multiple brands and products along “The PMI Boulevard,” including IQOS, ZYN, VEEV and Marlboro. On-site images captured by 2Firsts show dedicated spaces including the IQOS Boutique, ZYN Café, PMI Gallery and Marlboro Office
Market
Sep.16 by 2Firsts Perspectives
Philip Morris Malaysia Again Meets Religious Authority Over Cigarette Alternatives as Perlis Mufti Responds on Halal Criteria
Philip Morris Malaysia Again Meets Religious Authority Over Cigarette Alternatives as Perlis Mufti Responds on Halal Criteria
Philip Morris Malaysia Managing Director Naeem Shahab Khan met Perlis Mufti Mohd Asri Zainul Abidin on September 17 and presented the company's shift from conventional cigarettes toward alternative products. The mufti said a product could be considered halal if it is clean, its side effects are not harmful or can be controlled, and it does not involve excessive waste. His remarks did not mention IQOS or any other specific PMI product and did not amount to a new product-specific religious ruling. It was at least the second publicly reported engagement between Philip Morris Malaysia and a Malaysian religious institution over cigarette alternatives within six months.
Regulations
Sep.18 by 2Firsts Perspectives
Charlie’s Bets on Age-Gating and 678 PMTA Assets as U.S. Vape Enforcement Landscape Shifts
Charlie’s Bets on Age-Gating and 678 PMTA Assets as U.S. Vape Enforcement Landscape Shifts
Charlie’s Holdings said in its latest shareholder letter that it is moving to commercialize PACHA products and monetize its PMTA assets as the FDA changes enforcement priorities for unauthorized ENDS products. Thirty PACHA SKUs were previously tentatively identified for a proposed public list of products that the FDA generally does not intend to prioritize for enforcement. Charlie’s is also preparing test-market sales of age-gated flavored disposables and says it currently holds 678 PMTA-related product assets while seeking additional strategic transactions and partnerships.
Sep.11
FDA Authorizes 24 VELO Nicotine Pouches, Increasing U.S. Authorized Total by 56%
FDA Authorizes 24 VELO Nicotine Pouches, Increasing U.S. Authorized Total by 56%
The U.S. FDA authorized 24 VELO nicotine pouch products from a British American Tobacco subsidiary, raising the total number of authorized products from 43 to 67, a 55.8% increase. The newly authorized 4 mg products include lime and passion fruit flavors and feature certified child-resistant packaging. VELO's first FDA marketing authorization adds BAT to a list previously limited to PMI and Altria products, while bringing the agency's nicotine pouch review pilot total to 47 authorized products.
Oct.30
STIIIZY Redesign Fails to Escape PAX Labs Patent Import Ban as Section 337 Case Also Involves China ALD
STIIIZY Redesign Fails to Escape PAX Labs Patent Import Ban as Section 337 Case Also Involves China ALD
U.S. Customs and Border Protection ruled that STIIIZY had not shown that the redesigned cannabis-vape products covered by its latest request fall outside an ITC limited exclusion order tied to PAX Labs patents. CBP accepted some of STIIIZY’s claim-construction and non-infringement arguments, but the company did not address two additional claims in the same patent. Earlier STIIIZY redesigned cartridges and certain associated components imported with them had received separate CBP clearance.
Sep.16