Research & Commentary: State Policies Help Promote Misperception That Nicotine Causes Cancer

Published March 19, 2018

According to a recent survey, a “majority of adults erroneously link nicotine to cancer.” The findings reveal a majority of Americans incorrectly believe that nicotine causes cancer and other health risks. These widely-held, false notions regarding the adverse health effects of nicotine may undermine its presence in tobacco harm reduction (THR) products, such as smokeless tobacco, heat-not-burn products, and electronic cigarettes. Since their introduction, THR products have helped millions quit smoking more-detrimental combustible cigarettes.

Researchers at PinneyAssociates, a pharmaceutical research firm, analyzed data from the 2017 health information national trends survey and found 53 percent of respondents “said they believe nicotine causes most of the cancer related to smoking.” Lead author of the study, Karen Gerlach, urged public health officials to properly educate “the public, especially smokers, that nicotine is not what is causing smoking-related disease.”

Public misperceptions concerning nicotine overlooks overwhelming research on one of the most intensively studied drugs in history. Nicotine, while addictive, is not considered a “highly hazardous drug.” Nicotine neither causes cancer nor plays any significant role in pulmonary or cardiovascular diseases. Nicotine is a mild stimulant, similar to coffee. Both substances are derived from plants and both are addictive and cause unpleasant side effects through abstention.

The negative effects of tobacco use “are caused primarily by exposure to combustion products of tobacco.” It is the combustion process that creates the cancer-causing chemicals linked to cigarette use. More so, evidence suggests “total nicotine and tobacco abstinence is unattainable and unnecessary for many smokers.”

To avoid the health risks of combustible cigarettes, smokers are increasingly turning to THR products because they deliver nicotine with significantly less health hazards compared to combustible cigarettes.

A 2009 BioMed Central study analyzed “the relative risk of cancer and smokeless tobacco users, compared with non-users of tobacco,” finding “very little evidence” of smokeless tobacco producing a greater cancer risk.

Dr. Brad Rodu, a senior fellow at The Heartland Institute, has studied smokeless tobacco for over 20 years. According to his research, smokeless tobacco, such as snus, is “at least 98 percent safer than smoking, even though most Americans are misinformed about the differences in risk.”

Research on e-cigarettes and vaping devices continues to provide evidence that these products are effective tobacco harm reduction tools. In 2016, the Tobacco Advisory Group of the Royal College of Physicians concluded that health risks associated with e-cigarette use were “unlikely to exceed 5% of the harm from smoking.” Public Health England, in 2015, declared that e-cigarette use “is around 95% safer than smoking.”

In January 2018, the National Academies of Sciences, Engineering and Medicine found that e-cigarette use resulted in “reduced short-term adverse health outcomes in several organs.” Further, the American Cancer Society noted in 2018 that the “currently available evidence, using current generation e-cigarettes is less harmful than smoking.”

While THR products have proven to be effective agents for smoking cessation, policy makers still treat smokeless tobacco and e-cigarettes in the same manner as combustible cigarettes. Unfortunately, this adds to THR fearmongering and aids in the public’s ongoing misperception of nicotine use.

Thirteen states and over 700 municipalities classify electronic cigarettes and vaping devices as prohibited products in smoke free laws. All states have “at least some tax on non-cigarette tobacco products.” Such policies help demonize the role of nicotine, even though these products have proven to be effective alternatives to smoking combustible cigarettes.

Law makers should encourage policies that promote, or at a minimum, not discourage the usage of THR products. As the recent PinneyAssociates study indicates, many Americans are ignorant of the health risks associated with nicotine use. Such opinions could hinder the public health rewards e-cigarettes and smokeless tobacco products provide for millions of cigarette smokers.


The following documents provide further information on tobacco harm reduction.

Vaping, E-Cigarettes, and Public Policy Toward Alternatives to Smoking
For decades, lawmakers and regulators have used taxes, bans, and burdensome regulations as part of their attempt to reduce the negative health effects of smoking. Recently, some have sought to extend those policies to electronic cigarettes. This booklet from The Heartland Institute urges policymakers to re-think that tax-and-regulate strategy. Policymakers should be mindful of the extensive research that supports tobacco harm reduction and understand bans, excessive regulations, and high taxes on e-cigarettes often encourage smokers to continue using more-harmful traditional cigarette products.

Research & Commentary: Cities and Sates Consider Increasing Tobacco Age Limit to 21, Regulating ENDS as Tobacco Products–commentary-cities-and-states-consider-increasing-tobacco-age-limit-to-21-regulating-ends-like-tobacco-products
In this Research & Commentary, Heartland Institute State Government Relations Manager Lindsey Stroud examines the states and municipalities that are considering increasing their smoking age from 18 to 21. Stroud says such laws fail to substantially curb consumption, and she argues the inclusion of tobacco harm reduction tools, such as e-cigarettes and vaping devices, would negatively impact the health gains these products have been repeatedly shown to provide.

Research & Commentary: Study Finds E-Cigarettes Would Prevent 6.6 Million Premature Deaths–commentary-study-finds-e-cigarettes-would-prevent-66-million-premature-deaths
In this Research & Commentary, Heartland Institute State Government Relations Manager Lindsey Stroud examines an October 2017 Tobacco Control study that found electronic nicotine delivery systems (ENDS) might help extend life for millions of people. The authors of the study found there was an estimated 6.6 million fewer deaths and more than 86 million fewer-life-years lost over a ten year period because of ENDS products. Stroud concludes the use of ENDS could also help improve the budgets of numerous state programs, including Medicaid.

Research & Commentary: Public Health Officials Urge Use of Electronic Nicotine Delivery Systems
In this Research & Commentary, Heartland Institute State Government Relations Manager Lindsey Stroud notes the importance of NHS Health Scotland’s joint statement encouraging the use of electronic nicotine delivery systems (ENDS) as an alternative to tobacco products. NHS Health Scotland, Public Health England, and other groups have found ENDS are 95 percent less harmful than tobacco cigarettes.

Research & Commentary: Qualitative Study on E-cigarettes Shows More Evidence of Tobacco Harm Reduction
In this Research & Commentary, Heartland Institute State Government Relations Manger Lindsey Stroud examines a study, published in The International Journal of Environmental Research and Public Health in June 2016, that provides additional evidence showing e-cigarettes and vaporized nicotine products (VNPs) are an effective tobacco harm-reduction tool.

E-Cigarette Primer for State and Local Lawmakers
Joel Nitzkin provides evidence e-cigarettes work as a tobacco harm reduction modality and reviews the arguments against them. He closes with recommendations for actions state and local lawmakers should and should not consider regarding tobacco harm reduction and e-cigarettes. 

Research & Commentary: New CDC Report Finds Vaping Helps Smokers Quit
A new report released by the Centers for Disease Control and Prevention (CDC) found only 0.4 percent of the people who had never smoked tobacco in a CDC study group are current vapers, which the report defines as using a vaping device either every day or some days. The CDC report, the first of its kind, estimates e-cigarette use among U.S. adults using a nationally representative household survey. The report’s findings claim only 3.4 of adults who have never smoked have tried an e-cigarette; 12.6 percent of Americans have tried an e-cigarette; and fewer than 4 percent of the U.S. population are regular e-cigarette users.

E-Cigarettes Poised to Save Medicaid Billions
In a new report from State Budget Solutions, J. Scott Moody finds e-cigarette use could create significant savings for state governments, especially in their Medicaid programs: “As shown in this study, the potential savings to Medicaid significantly exceeds [sic] the state revenue raised from the cigarette excise tax and tobacco settlement payments by 87%. As such, the rational policy decision is to adopt a non-interventionist stance toward the evolution and adoption of the e-cig until hard evidence proves otherwise.”


Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute. For further information on this and other topics, visit the Budget & Tax News website, The Heartland Institute’s website, our Consumer Freedom Lounge, and PolicyBot, Heartland’s free online research database.

Whether sending an expert to your state to testify or brief your caucus, hosting an event in your state, or simply sending you further information on the topic, Heartland can assist you. If you have any questions or comments, contact Heartland Institute Director of Government Relations John Nothdurft at [email protected] or 312/377-4000.