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Measuring Support for Requiring Reduced Nicotine Cigarettes: Issues with Questions, Answers, and Respondents

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Objective: In this study, we assessed the effect of question type and answer options on support for lowering nicotine levels in cigarettes to make them less addictive. Methods: We surveyed 540 US adults using Prime Panels. Participants randomly received: (1) one of 2 Likert-type questions and (2) a forced-choice question on a range of policy options, with responses in one of 2 orders. Generalized linear models examined policy support using a latent outcome variable. Results: Overall, 53% of smokers and 77%-81% of former/never smokers supported the policy. With Likert questions, support was higher when 'support' options were presented first; with the forced-choice question, there were no answer order effects. Few smokers (21%) supported the policy consistently, compared to 47% of former and 52% of never smokers. In the multivariate latent model, current smokers (b = -0.13, 95% CI: -0.24, -0.02) and former smokers (b = -0.48, 95% CI: -0.58, -0.38) were significantly less likely to support the low nicotine policy compared to never smokers. Conclusions: Survey design, including question type and the response order, resulted in a substantial difference in participant responses. Better and multiple questions may be needed before drawing conclusions about mandatory reduced nicotine cigarettes support, especially among smokers.
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Keywords: ADDICTION; NICOTINE; NICOTINE POLICY; PUBLIC HEALTH; SURVEY RESEARCH

Document Type: Research Article

Publication date: December 1, 2020

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  • Health Behavior and Policy Review is a rigorously peer-reviewed scholarly bi-monthly publication that seeks manuscripts on health behavior or policy topics that represent original research, including papers that examine the development, advocacy, implementation, or evaluation of policies around specific health issues. The Review especially welcomes papers that tie together health behavior and policy recommendations. Articles are available through subscription or can be ordered individually from the Health Behavior and Policy Review site.
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