With tobacco, what you don't know can kill you sooner

BUFFALO, N.Y. – Most people know smoking is risky. But that’s not news smokers can use.

What they can benefit from is knowing the varying levels of risk associated with different tobacco products, according to public health researchers at the University at Buffalo, who found that a large number of people aren’t aware of the differences.

“Even for e-cigarettes, half of the public incorrectly believed them to be just as dangerous as cigarettes and an overwhelming majority of respondents incorrectly believed smokeless tobacco to be just as dangerous as traditional cigarettes,” Marc Kiviniemi, associate professor in the Department of Community Health and Health Behavior in UB’s School of Public Health and Health Professions, and co-author Lynn Kozlowski, a professor of community health and health behavior at UB, write in the paper, published in the July issue of the journal Harm Reduction.

Kiviniemi and Kozlowski also report that 75 percent of U.S. adults misperceive smokeless tobacco products as being as harmful as cigarettes, calling it “both a considerable lack of knowledge and a serious public health problem.” Smokeless varieties of tobacco include chewing tobacco, snus and snuff.

Of course, that doesn’t mean these products are safe—just safer when compared to cigarettes. “Nobody is saying there’s no risk associated with smokeless tobacco use or e-cigarettes,” says Kozlowski.

“But the best evidence we have is that they are not as risky as traditional cigarettes. When people are making decisions, that difference in risk is important. There seems to be this perception that all tobacco is equally bad and that doesn’t fit the expert understanding of reality,” adds Kiviniemi.

Think of it this way: For people who continue to smoke, there are better alternatives to cigarettes that, while still hazardous, aren’t as lethal. For nonsmokers considering taking up tobacco, there are better options than reaching for a pack of cigarettes. “A mistaken belief can change your behavior in ways that will shorten your life,” says Kozlowski, a nationally recognized expert on tobacco and e-cigarettes. “The public has the right to know about the differential risks of these products.”

It’s also important to note, Kozlowski says, that cigarettes and smokeless tobacco are protected by the U.S. Food and Drug Administration, meaning they can’t be banned. The FDA’s warning labels on smokeless tobacco products don’t help consumers understand that they are in fact safer when compared to cigarettes.

“There’s an analogy here. If you think about the difference between crossing the street in the middle of the block at rush hour versus crossing at a crosswalk with the stop signs, you could say these are both not safe because in some sense there’s a chance that you can get hit by a car. But there’s very real differences in the amount of risk," Kiviniemi says.

"So saying this is not a safe alternative is essentially saying there is some risk associated with smokeless tobacco use, which is true in a very limited sense," he adds. "I think the more important message is, cigarette smoking is much more risky than smokeless tobacco. Smokeless still has some risk but not as much, and the current warning labels don’t capture that very important nuance.”

Kiviniemi and Kozlowski’s paper also found that a “concerning number” of adults think that some cigarettes, such as light and mild varieties, are safer than so-called full flavor. While the FDA banned such descriptors, the color coding on the packages remains.

“Taste differences exist between these products and there’s good reason to believe that if you’re smoking something that feels milder, or is easier on your chest, it’s easier to think you’re better off using that one over another,” Kozlowski says.

The researchers analyzed data from the Health Information National Trends Survey (HINTS) 4 Cycle 2, a population-representative survey of U.S. adults conducted between October 2012 and January 2013.

Among the paper’s findings:

• 35 percent of U.S. adults did not know that various cigarettes are equal in risk.
• Current smokers were twice as likely as former smokers to believe that some cigarettes are safer than others.
• 13 percent of U.S. adults believe that some types of cigarettes are less harmful than others. Perceptions varied among smokers, former smokers and people who’ve never smoked. For example, current smokers were more likely than former smokers to perceive some cigarettes as being less risky.
• 90 percent of U.S. adults aren’t aware that smokeless tobacco products are less hazardous than cigarettes.
• 51 percent think e-cigarettes are less harmful than regular cigarettes.

“It’s easy to say ‘This is safe, this isn’t safe,’ but reality is more nuanced,” says Kiviniemi. “If you really are considering switching from traditional cigarettes to another product, or if you’re a nonsmoker and you’re thinking about starting it because you think they’re safe, then you really owe it to yourself to dig a little deeper and get the more nuanced knowledge.”