{
  "abstract": "Background USA is considering reducing nicotine in cigarettes to non-addictive levels, coupled with promoting alternative nicotine delivery products (eg, e-cigarettes). However, effective communication is needed to reduce misperceptions about very low nicotine cigarettes (VLNCs) being less harmful than regular cigarettes.Methods In 2022–2023, we conducted a four-group randomised clinical trial with a national probability sample from an online panel (971 adults who smoked cigarettes exclusively, 472 adults who dual used cigarettes and e-cigarettes and 458 adults aged 18–29 who had never smoked). Participants were randomised (parallel assignment) to one message condition: (1) VLNCs as harmful but easier to quit than regular cigarettes (n=468), (2) those who are not ready to quit should consider switching to e-cigarettes as less harmful alternatives (n=484), (3) combined (VLNC and e-cigarette messages; n=476) or (4) control condition (ie, water ads), n=473. The primary outcome was perceived absolute harm of VLNCs.Results Perceived harm of VLNCs was higher in the VLNC condition compared with the e-cigarette and control conditions, and higher in the combined condition compared with the e-cigarette condition (adjusted p<0.05). Among adults who dual used, intention to switch to e-cigarettes was higher in the VLNC condition than the e-cigarette, combined or control conditions (adjusted p<0.05).Conclusions VLNC messages reduced the misperception that VLNCs are less harmful than cigarettes, but adding messages about e-cigarettes did not enhance desired outcomes. These VLNC messages can be considered during the rollout of a reduced nicotine policy.Trial registration NCT05506046",
  "authors": [
    {
      "affiliations": [
        "School of Public Health, Georgia State University, Atlanta, Georgia, USA"
      ],
      "name": "Di Pei"
    },
    {
      "affiliations": [
        "Communication Department, University of Massachusetts, Boston, Massachusetts, USA"
      ],
      "name": "Reed M Reynolds"
    },
    {
      "affiliations": [
        "Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA"
      ],
      "name": "Charity A Ntansah"
    },
    {
      "affiliations": [
        "Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA"
      ],
      "name": "Emily E Hackworth"
    },
    {
      "affiliations": [
        "School of Public Health, Georgia State University, Atlanta, Georgia, USA"
      ],
      "name": "Katherine C Henderson"
    },
    {
      "affiliations": [
        "Department of Communication, University of Arizona, Tucson, Arizona, USA"
      ],
      "name": "Bo Yang"
    },
    {
      "affiliations": [
        "Department of Communication, Georgia State University, Atlanta, Georgia, USA"
      ],
      "name": "Hue Trong Duong"
    },
    {
      "affiliations": [
        "TRSConsulting56 LLC, Lilburn, Georgia, USA"
      ],
      "name": "David L Ashley"
    },
    {
      "affiliations": [
        "Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA"
      ],
      "name": "James F Thrasher"
    },
    {
      "affiliations": [
        "School of Public Health, Georgia State University, Atlanta, Georgia, USA"
      ],
      "name": "Lucy Popova"
    }
  ],
  "title": "Independent and combined effects of very low nicotine cigarette messages and e-cigarette messages: a randomised clinical trial",
  "uid": "1902eb4c-0cb7-51e6-873e-2f9490c91792"
}