Rutgers-Led National Survey Uncovers Doctors' Misconceptions About Nicotine Risks

Researchers say physicians need to understand accurate nicotine risks better to assist patients addicted to the most harmful tobacco products

Most physicians mistakenly believe that nicotine leads to cancer, and heart and respiratory diseases, according to a Rutgers-led national survey, even though it is the toxic substances in cigarette smoke and not the nicotine that causes the primary health risk. 

The study, published in the Journal of General Internal Medicine, surveying more than 1,000 doctors from six specialties between September 2018 and February 2019 about their knowledge of tobacco use, found that 80 percent of those surveyed believe it is the nicotine that directly causes cancer.

"Physicians must understand the actual risk of nicotine use as they are critical in the prescription and recommendation of FDA-approved nicotine replacement therapy products to help patients who use other dangerous forms of tobacco,” said Michael B. Steinberg, medical director of the Rutgers Center for Tobacco Studies and a professor and chief of the Division of General Internal Medicine at the Rutgers Robert Wood Johnson Medical School. "Doctors should be able to accurately communicate these risks, which may include low-nicotine cigarettes, which are not safer than traditional cigarettes."

The Rutgers-led survey asked physicians in specialties ranging from family medicine, internal medicine, obstetrics and gynecology, cardiology, pulmonary and critical care and hematology and oncology about their understanding of tobacco treatment practices, harm reduction beliefs and tobacco and e-cigarette use.

Although nicotine's primary risk is addiction or dependence on tobacco products, researchers found that 83 percent of doctors strongly believed that nicotine directly contributed to heart disease. In comparison, 81 percent thought it contributed to chronic obstructive pulmonary disease (COPD). Pulmonologists, who focus on the respiratory system, were less likely than other specialties to misperceive nicotine as a direct contributor to COPD. Family doctors were more likely than oncologists to misunderstand nicotine as a cancer-causing substance.

Less than one-third of the doctors surveyed correctly agreed that nicotine directly contributed to birth defects, while 30 percent did not answer the question, indicating they did not know the answer. Younger and female doctors were more likely than males to perceive correct nicotine risks causing birth defects, while OB/GYNs surprisingly misidentified them more than other specialties.

In the United States, an estimated 34 million people smoke cigarettes, according to the Centers for Disease Control. Nicotine replacement therapies include over-the-counter products like patches, gum and lozenges as well as prescription medications.

"Correcting misperceptions in medicine should be a priority given the FDA's proposed nicotine-centered framework that includes reducing nicotine content in cigarettes to non-addictive levels while encouraging safer forms of nicotine like NRT, to help with smoking cessation or non-combustible tobacco, like smokeless tobacco for harm reduction," said Cristine Delnevo, director of the Rutgers Center for Tobacco Studies and professor at the Rutgers School of Public Health.

Researchers recommend brief communication interventions that can effectively correct such nicotine misperceptions among doctors and the general public.