Nicotine Risk Misperception Among US Physicians
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J Gen Intern Med DOI: 10.1007/s11606-020-06172-8 © Society of General Internal Medicine 2020
INTRODUCTION
Nicotine is responsible for the highly addictive nature of tobacco products, but most tobacco-caused disease is not directly caused by nicotine, but rather by other chemicals present in tobacco or tobacco smoke.1 The strongest evidence for direct causality for nicotine is for birth defects (neurodevelopment), with only limited evidence supporting causal links to cancer and cardiovascular disease, and scarce data for COPD. Despite this, many misperceive nicotine as responsible for smoking-related health risks, like cancer.2, 3 These misperceptions are not unique to the general population; in one study, 60% of nurses incorrectly perceived nicotine as carcinogenic.4 This study explores physician perceptions of nicotine risk in a national survey.
METHODS
This analysis represents a national mail survey exploring physicians’ knowledge and communication about tobacco use, collected between September 2018 and February 2019. The survey targeted six specialties: family medicine, internal medicine, OB/GYN, cardiology, pulmonary/critical care, and hematology/oncology. The sample was drawn from the AMA Physician Masterfile, and 500 physicians from each specialty were randomly selected. Overall, 1058 physicians participated and 496 physicians were ineligible (e.g., not seeing outpatients), yielding an AAPOR response rate of 51.8%. The survey domains included tobacco treatment practices, harm reduction beliefs, and tobacco/e-cigarette knowledge. Physicians also rated (on a 4-point scale) if they agreed or disagreed that “nicotine directly contributes to”: the development of birth defects; cardiovascular disease; cancer; and COPD. We estimated prevalence and adjusted prevalence ratios (APRs) for strongly agreeing that nicotine causes each outcome as a function of physician gender, age, and specialty using multivariable log-binomial regression models, controlling for race/ethnicity. Received August 3, 2020 Accepted August 17, 2020
RESULTS
Participant characteristics are summarized in Table 1. Overall, the majority of physicians “strongly agreed” that nicotine directly contributes to the development of cardiovascular disease (83.2%), COPD (80.9%), and cancer (80.5%). Comparatively fewer “strongly agreed” that nicotine directly contributes to the development of birth defects (32.9%) and 30.2% did not answer this question—a potential indicator of “do not know.” Table 1 Sample Characteristics and Beliefs About Nicotine by Specialty, N = 1020 na (%) Gender Female Male Race/ethnicity White, non-Hispanic Black, non-Hispanic Hispanic Asian/PI, non-Hispanic Other/unknown, non-Hispanic Ageb Mean ± SD Specialty Cardiology Family medicine Internal medicine OB/GYN Oncology Pulmonary Nicotine causes birth defects Strongly agree Somewhat agree Somewhat disagree Strongly disagree Missing Nicotine causes cardiovascular disease Strongly agree Somewhat agree Somewhat disagree Strongly disagree Missing Nicotine causes cancer Strongly agree S
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