Effects of a Fact Sheet on beliefs about the harmfulness of alternative nicotine delivery systems compared with cigarettes

Four convenience samples from different countries (Australia, UK, Sweden and USA) were surveyed concerning their beliefs about the relative harmfulness of smokeless tobacco and NRT. Study participants were given the Fact Sheet that explained that nicotine, as used by consumers, is not particularly harmful and explained why. They were resurveyed one week later regarding their beliefs about the relative harmfulness of smokeless tobacco and NRT and future intentions to use the products.In all four samples knowledge increased by similar amounts and beliefs regarding the lower harmfulness of smokeless tobacco increased. However, misconceptions remained common and responses to belief measures were not always consistent. Likelihood of use of ST increased in all four samples after exposure to the Fact Sheet, but interest in NRT use only increased in the US sample.A Fact Sheet such as this one can help address misconceptions about NRT and smokeless tobacco, at least in the short term. However, as is true of most educational interventions, exposure to a single educational session is not sufficient to overcome misperceptions that smokers have about the relative harmfulness of oral versus combustible forms of nicotine delivery.The majority of harm from tobacco use comes from combusted forms; that is, from the dirty delivery system, not the nicotine. Some forms of smokeless tobacco (ST) are less harmful than others [1,2], with some existing smokeless products still very harmful (albeit less harmful than smoking) such as oral tobacco products used in South Asia and Sudan [3]. This is because they contain high levels of toxicants, often produced during the manufacturing, curing and storage process. However, where concerted efforts have been made to minimize the levels of known carcinogens and toxicants (most notably with Swedish snus), the potential harms can be reduced dramatically compared to cigarettes and made similar to that of oral nicotine medications, such as gum or lozeng