Perceptions of nicotine harm among adults who use little cigars and cigarillos: A cross-sectional analysis of wave 7 of the Population Assessment of Tobacco and Health (PATH) Study 2022–2023

INTRODUCTION: Little is known about nicotine perceptions among people who use little cigars and cigarillos (LCCs). Nicotine perceptions may influence how people respond to changes in the tobacco marketplace, including changes that would result from regulatory actions such as a proposed nicotine product standard. This study examines differences in nicotine harm misperceptions between adults who use LCCs, those that use cigarettes, and those that use both products. METHODS: We conducted a cross-sectional analysis of a nationally representative sample of US adults (aged ≥18 years) that use LCCs and/or cigarettes (n=5507) from the Population Assessment of Tobacco and Health (PATH) Study Wave 7 (2022-2023). We estimated the percentage of people who used LCCs that overestimated (perceived nicotine as 'very' or 'extremely' harmful) or were incorrect (either overestimate the harm or perceive nicotine as 'not at all' harmful) about nicotine harms and compared this to those who exclusively used cigarettes and those who dual used both products. RESULTS: Approximately 63.0% of respondents who use LCCs overestimated nicotine harms and 65.7% reported nicotine misperceptions. We found no significant difference in nicotine harm perceptions between people who exclusively used LCCs (overestimation, adjusted odds ratio AOR=1.05; 95% CI: 0.82-1.34; incorrect AOR=1.19; 95% CI: 0.93-1.53), exclusively use cigarettes (base category), and used both products (overestimation AOR=1.05; 95% CI:0.80-1.39; incorrect AOR=1.16; 95% CI: 0.88-1.53). People who used other tobacco products in addition to LCCs and/or cigarettes were significantly less likely (overestimation AOR=0.70; 95% CI: 0.61-0.81; incorrect AOR=0.73; 95% CI: 0.63-0.84) to overestimate the harms of nicotine compared to those who did not use other tobacco products. CONCLUSIONS: People who use LCCs are equally likely to overestimate or be incorrect about nicotine harms as those who exclusively or dual use cigarettes, but using additional products is associated with correct responses about nicotine harms.