Nurses' knowledge about the risk of light cigarettes and other tobacco "harm reduction" strategies

Light and ultra-light cigarettes are associated with little or no risk reduction versus regular cigarettes, but the majority of smokers believe they are safer. We evaluated whether nurses believe that certain products (light and ultra-light cigarettes, reduced-tar cigarettes, nicotine replacement), cigarette design features (filters, no additives), and smoking behaviors (smoking reduction) reduce health risks among their patients. Nurses (N = 178; 93% female, 10% smokers) completed questionnaires before mandatory training in smoking cessation counseling. Among respondents, 25% believed that light and ultra-light cigarettes are equal in tar to regular cigarettes, 55% believed that two light cigarettes are equal in tar to one regular cigarette, and 51% believed that three or more ultra-light cigarettes are equal to one regular cigarette. Further, 40% believed that light and ultra-light cigarettes are less dangerous; younger nurses (<41 years old) were more likely to believe this than older nurses (p<.05). A total of 14% of nurses would recommend light and ultra-light cigarettes to help patients reduce health risks, 15% said that cigars are less harmful than cigarettes, 41% said that additive-free cigarettes are less dangerous, and 81% said that cutting down to 5 cigarettes/day improves health. Nurses had misperceptions about nicotine replacement: 60% believed that nicotine causes cancer, 72% believed that nicotine patches could cause heart attacks, and 40% and 15% believed that a prescription is needed for the nicotine patch or gum, respectively. Among nurses, smokers were more likely than nonsmokers to believe that smoking risks are exaggerated (p<.05). Nurse misinformation could lead to inaccurate recommendations and failure to capitalize on the teachable moment provided by the medical encounter.