摘要：Objectives. We assessed public support for a potential Food and Drug Administration (FDA)–mandated reduction in cigarette nicotine content. Methods. We used nationally representative data from a June 2010 cross-sectional survey of US adults (n = 2649) to obtain weighted point estimates and correlates of support for mandated nicotine reduction. We also assessed the potential role of political ideology in support of FDA regulation of nicotine. Results. Nearly 50% of the public supported mandated cigarette nicotine reduction, with another 28% having no strong opinion concerning this potential FDA regulation. Support for nicotine reduction was highest among Hispanics, African Americans, and those with less than a high school education. Among smokers, the odds of supporting FDA nicotine regulation were 2.77 times higher among smokers who intended to quit in the next 6 months than among those with no plans to quit. Conclusions. Mandating nicotine reduction in cigarettes to nonaddictive levels may reduce youth initiation and facilitate adult cessation. The reasons behind nicotine regulation need to be communicated to the public to preempt tobacco industry efforts to impede such a regulation. Cigarettes deliver pulmonary nicotine rapidly and efficiently and are the most addictive and deadly type of tobacco product. 1,2 Nicotine dependence of varying degrees underlies the 19.8% of Americans who continue to smoke, 3,4 90% of whom began smoking before age 18 years. 4 Major US tobacco companies intentionally manipulated their products’ nicotine levels to encourage initiation and discourage cessation; 5 this motivated the US Food and Drug Administration’s (FDA’s) initial attempt to regulate cigarettes as drug delivery devices in the 1990s. 6 In 2009, the Family Smoking Prevention and Tobacco Control Act granted the FDA authority to regulate tobacco products. 7 Section 907 of the act allowed the FDA to promulgate tobacco product standards, including reducing nicotine to nonaddictive levels but not zero. 7 First suggested by Benowitz and Henningfield, 8 a nationwide nicotine content reduction strategy could reduce tobacco’s toll on society by rendering cigarettes easier to quit and reducing youth uptake and progression to nicotine dependence. 8,9 Any proposed mandated reduction in cigarette nicotine content will require both pre- and post-implementation education and surveillance efforts to ensure that the public is effectively informed about the policy change. Previous research assessing public sentiment surrounding tobacco control policies has predominantly focused on support for smoke-free indoor air laws, tobacco tax increases, and restrictions on tobacco advertising. In general, women, African Americans, older individuals, and college-educated adults are most supportive of tobacco control policies. 10–12 Smokers are less supportive of tobacco control policies than nonsmokers, 11,13–15 with support inversely related to how heavily they smoke. 10 Few studies have examined public support for FDA-mandated nicotine reduction. In a random-digit dial survey of 672 smokers, Fix et al. found that 67% of smokers would support an FDA regulation that made cigarettes less addictive if “nicotine was made easily available in non-cigarette form.” 16 (p945) Further data on support by demographic or other characteristics were not presented. A random-digit dial survey of 1021 individuals by Connolly et al. found that 65% of Americans (73% of nonsmokers and 58% of smokers) supported a mandated reduction in cigarette nicotine content “if it would cause fewer kids to become addicted or hooked on smoking.” 17 (p2) As in previous research on public support of tobacco control policies, Connolly et al. found that a greater proportion of African Americans than Whites supported nicotine reduction. They found no differences by gender or age, and data on support by education were not presented. Because of differences in survey item phrasing, the use of random-digit dial sample frames, and the potential role of nonresponse bias, comparisons between these studies are challenging. In some cases, small sample sizes, especially of smokers, may have precluded the authors from reporting on key subpopulations of interest, such as racial/ethnic minorities or individuals of low socioeconomic status. In the current study, we assessed public attitudes concerning a proposed mandated reduction in cigarette nicotine content in a large, nationally representative sample, with special attention paid to smoking status, intention to quit, race/ethnicity, and education. Improving on the methods used in previous studies, we collected our sample by means of address-based sampling, the gold standard of survey research. 18 Our oversampling of African Americans (n = 298), Hispanics (n = 288), and current smokers (n = 1308) allowed for more in-depth subgroup analyses than previously published studies. Additionally, we assessed the potential role of political ideology in support of FDA regulation of nicotine, a variable that has been overlooked in previous research and may affect the observed association between demographic characteristics and support for nicotine regulation. Measuring public support and opposition to reducing cigarette nicotine content and identifying characteristics of groups with an especially high likelihood of opposition will allow FDA to gauge public sentiment and tailor messaging if the agency chooses to move forward with this far-reaching regulation.
