Racial and ethnic variation in perceived relative harm of tobacco and nicotine products: an experimental study

Converging lines of research indicate that the public misinterprets the relative harms associated with different tobacco and nicotine products. These misperceptions may contribute to persistent tobacco-related health disparities. To inform regulatory actions in a growing tobacco market, it is essential to understand how harm perceptions differ across tobacco and nicotine products among racial and ethnic groups to ultimately decrease disparities.

An online sample (n=897) of US adults completed a discrete choice experiment, known as a Maximum Difference Likelihood task, which is an orthogonally balanced approach designed to assess harm perceptions of 18 tobacco products that span a risk continuum. Participants selected the most and least harmful products. We estimated probability-scaled relative harm perception scores using a multinomial logit hierarchical Bayesian analysis. We then conducted linear regressions to look at differences by race and ethnicity using estimated marginal means and contrasts for each product while controlling for smoking status, age and sex.

The analyses revealed that participants' harm perceptions do not align with the established scientific literature for combustibles, smokeless tobacco and non-combustible tobacco products. We observed low harm perceptions for products with high population rates of use, such as cigarillos and little cigars for non-Hispanic (NH) Black or African American, and Latino individuals. We observed high harm perceptions for products with low population use, such as plug tobacco for NH Asian individuals, e-cigarettes for NH Black or African American and Latino individuals and nicotine replacement therapy for NH Black or African Americans.

Given the known tobacco-related health disparities among people of color, our results underscore the need to correct the tobacco product harm misperceptions among certain races and ethnicities, such as NH Black or African Americans, Latinos, NH Asians and NH Indigenous or mixed-race individuals.