If there’s one thing that U public health faculty member Dana Mowls Carroll, Ph.D., M.P.H., wants people to remember, it’s that while nicotine in cigarettes causes people to smoke, it’s the tar they die from.
Carroll is part of a University of Minnesota team that is leading groundbreaking research, which shows that if nicotine in cigarettes is reduced by 95 percent, it could dramatically reduce their addictiveness. But if a new nicotine standard is to be truly effective, it is essential for people to know that even though they are less addictive, low-nicotine cigarettes can be just as dangerous as normal cigarettes due to the tar in them.
With Masonic support, Carroll is hoping to help shape what could one day be an important mass media campaign about the harmfulness of low-nicotine cigarettes.
“There are a lot of misconceptions about nicotine,” Carroll says. “People think it’s what causes cancer from smoking. Because of that, we’ve seen studies where smokers say they would be less likely to quit smoking if using low-nicotine cigarettes because they think they’re less harmful.
“To bring the most benefit to the public, there will need to be educational campaigns that go along with any new low-nicotine standard to inform people about what these products are—which is less addictive—and what they are not, which is less harmful.”
This year, Carroll’s team took the first steps toward this goal by launching a pilot study to develop and examine which messages would be the most effective in educating people who smoke and people who do not smoke about low-nicotine cigarettes.
In the first part of their study, they tested six different messages, starting with a baseline message that cigarette manufacturers may be required to remove 95 percent of nicotine from cigarettes, and adding additional wording to each subsequent message about the harm that low-nicotine cigarettes can cause. After testing the messages in an online survey of people across the U.S. who smoke, they found that one message in particular influenced respondents to report the most accurate understanding of the dangers of low-nicotine cigarettes.
“The message stated in very succinct terms that even though low-nicotine cigarettes are less addictive, they can still be just as deadly as normal-nicotine cigarettes,” explains Carroll.
Clinical research in a COVID-19 world
Carroll’s team is now preparing to launch the next phase of their study, which will be a clinical trial examining how their target message about low-nicotine cigarettes impacts the perceptions and behavioral intentions of people who smoke.
The trial, which launches in spring 2021, will enroll some 80 participants from around the Twin Cities who regularly smoke cigarettes.
In a pre-pandemic world, this research would have included numerous participant visits to the University with onsite observations and experimental tasks, says Carroll. But with the onslaught of COVID-19, the team has made adjustments to keep participants safe.
“Because of COVID, we are doing everything virtually over Zoom, with the exception of one in-person interaction, which is done curbside to reduce exposure,” says Carroll.
While the process might differ from what has been done in the past, that isn’t necessarily a bad thing, Carroll continues. “My experience in planning this clinical trial has made me more aware that we can better suit the needs of our participants through a virtual study. A lot of participants have transportation needs, for example, which in the past may have led to cancelled appointments. This might be a great way to engage more communities, especially those who might not be as readily able to reach our downtown Minneapolis location.”
Carroll hopes to have results from the clinical trial by early 2022. From there, she’s confident that her team will have the data they will need to launch a fully powered, multi-site study integrating low-nicotine messaging and examining its impact on tobacco use among people who smoke. She is also interested in related research that explores messaging for former smokers who might be enticed to try low-nicotine cigarettes because they’re less addictive.
And while there are still numerous hurdles to making a new low-nicotine standard a reality, Carroll is optimistic about its chances for adoption, and the difference it could make in many lives.
“If the FDA, who can set standards in tobacco products, decides to move forward with this, it could be a profound public health achievement,” Carroll says. “In the U.S. there are 30 million smokers, and worldwide there are billions.”
“This pilot study will hopefully help inform the direction in which the FDA could go in educating the public. It’s very fulfilling to be supported in this work, and I hope the Masons take great pride in the role that they are playing in fighting the tobacco epidemic.”